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WAmental health2004-09

Inquest into the Death of Peter Daniel Mahoney

55y · Male·Immersion (Drowning) arising by way of suicide

Peter Daniel Mahoney, a 55-year-old man with treatment-resistant bipolar affective disorder, died by drowning on 13 June 2003 after absconding from Joondalup Health Campus where he was detained as an involuntary patient …

psychiatrypsychiatrycommunicationsystemtemazepam
WAhome2004-06-04

Inquest into the Death of Paul John Long

37y · Male·Acute Aspiration Pneumonitis following on Quetiapine Ingestion

Paul John Long, a 37-year-old man with chronic schizoaffective disorder and alcohol dependence, died on 4 November 2002 from acute aspiration pneumonitis following quetiapine overdose. After presenting to Avro Clinic in …

psychiatrygeneral practicecommunicationsystemquetiapine
WA2004-03-02

Inquest into the Death of Natasha Leanne Quartermaine

25y · Female·Ligature Compression of the Neck (Hanging)

Natasha Quartermaine, a 25-year-old female prisoner at Bandyup Women's Prison in Western Australia, died by suicide via ligature compression of the neck on 27 August 2001. She had a long history of mental illness, person…

psychiatrygeneral practicecommunicationsystemzuclopenthixol
WA2004-02-10

Inquest into the Death of Dylan Robert Green

26y · Male·Ligature Compression of the Neck (Hanging)

Dylan Robert Green, a 26-year-old remand prisoner at Hakea Prison, died by hanging on 11 July 2002. He had a history of serious mental illness, including psychotic episodes with delusional beliefs, and a previous suicide…

psychiatrycorrectional healthsystemcommunicationolanzapine
WAhospital2003-07

Inquest into the Death of Mark Andrew Burnside

45y · Male·Natural causes - cardiac arrest, most likely secondary to severe tardive dyskine…

Mark Andrew Burnside, a 45-year-old man with intellectual disability and chronic mental illness, died of natural causes on 7 November 2001 at Royal Perth Hospital. He had been prescribed thioridazine (Mellaril) for appro…

general practicepsychiatrythioridazine
WA2003-04-29

Inquest into the Death of Mark Anselo Ugle

36y · Male·Acute on Chronic Myocardial Infarction

Mark Anselo Ugle, a 36-year-old Aboriginal man with a significant history of cardiac problems, seizures, and non-compliance with medication, died in East Perth Lockup on 9 December 2000 from acute on chronic myocardial i…

cardiologyemergency medicinecommunicationsystemmethamphetamine
WA2003-03-07

Inquest into the Death of slater

28y · Male·Ligature compression of the neck (hanging)

Evan Charles Slater, 28, died by ligature compression of the neck (hanging) in Cell D7, Unit 10 of Hakea Prison on 12 March 2001. He was on remand facing assault and restraining order breach charges stemming from domesti…

psychiatrycorrectional healthcommunicationsystemanti-depressant medication
WAcommunity2002-07-19

Inquest into the Death of Elizabeth Ann Studd

33y · Female·Immersion (drowning) by suicide

Elizabeth Ann Studd, a 33-year-old woman with longstanding borderline personality disorder, died by drowning in the Swan River on 28 August 1999. She had a severely traumatic childhood characterised by emotional neglect,…

psychiatrygeneral practicealprazolam
WAhome2002-07-05

Inquest into the Death of Bradley William Rapley

22y · Male·Hypoxic Ischaemic Encephalopathy due to suffocation

Bradley William Rapley, aged 22, died from hypoxic ischaemic encephalopathy on 2 September 1999 at Fremantle Hospital after a suicide attempt by suffocation in a Casuarina Prison cell on 25 August 1999. Rapley was a pris…

psychiatrygeneral practicesystemcommunicationdosulepin
WA2002-05-03

Inquest into the Death of Gerhardus Theron

39y · Male·Ligature Compression of the Neck (Hanging)

Gerhardus Theron, 39, died by suicide in a remand centre on 25 June 2000 by ligature compression of the neck. He had murdered his wife on 28 April 2000 while their four children were present, and was remanded in custody.…

psychiatrycorrectional healthsystemanti-depressants
WA2002-04-12

Inquest into the Death of Scott Davidson

26y · Male·Ligature compression of the neck (Hanging)

Scott Davidson, a 26-year-old recently sentenced prisoner with paranoid schizophrenia, died by suicide in Casuarina Prison on 5 June 2000. Following sentencing to 9 years imprisonment, he was transferred to Casuarina Pri…

psychiatrycorrectional healthdiagnosticcommunicationolanzapine
WA2002-01-11

Inquest into the Death of Leslie William Wesley

32y · Male·Ligature Compression of Neck (Hanging)

Leslie William Wesley, a 32-year-old Indigenous man, died by hanging on 7 May 2000 in Cell A10 of Unit 5, Casuarina Prison Complex, Western Australia. He was on remand awaiting trial for sexual assault charges. Wesley ha…

psychiatrycorrectional health
WAcommunity2001-12-19

Inquest into the Death of Martin Raymond Coffey

24y · Male·Aspiration of vomit associated with combined drug effect

Martin Raymond Coffey, 24, died from aspiration of vomit associated with combined drug effect while on home detention after serving a prison sentence for traffic offences. He had a history of depression (following the de…

psychiatrygeneral practicesystemcommunicationamitriptyline
WA2001-11-19

Inquest into the Death of Adam Timothy Garner

18y · Male·Ligature Compression of Neck (Hanging)

Adam Timothy Garner, aged 18½, died by hanging in his prison cell at Canning Vale Prison Complex on 6 January 2000, approximately 24 hours after admission. He was on remand for a serious violent offence and was experienc…

correctional healthpsychiatrysystemcommunicationprescription medication for alcohol and drug withdrawal
WAmental health2001-02-02

Inquest into the Death of Giovanni Mario Franco

30y · Male·Acute Cardiac Dysrhythmia of Uncertain Aetiology

Giovanni Mario Franco, a 30-year-old man with schizophrenia, died on 10 March 1998 at Graylands Hospital from acute cardiac dysrhythmia of uncertain aetiology. During his final admission in February 1998, he developed se…

psychiatryintensive caremedicationflupenthixol decanoate
WAmental health2000-08-18

Inquest into the Death of Wendy Anne Eadie

29y · Female·asphyxiation due to ligature compression of the neck (hanging)

Wendy Anne Eadie, 29, died by suicide in Graylands Hospital's Frankland Centre on 1 November 1998 while detained following charges of unlawful wounding against her parents. She had a longstanding history of depression, c…

psychiatryforensic medicinecommunicationsystemparoxetine
WA2000-04-28

Inquest into the Death of Dean Kieran Lauder

22y · Male·Ligature Compression of the Neck (Hanging)

Dean Kieran Lauder, aged 22, died on 31 May 1998 at Canning Vale Prison by ligature strangulation (hanging) while in a punishment cell. He was serving a 7-day sentence for cannabis possession offences. He had a history o…

psychiatrygeneral practicecannabis
WA2000-04-07

Inquest into the Death of Kenneth John Groth

47y · Male·Ligature compression of the neck (hanging)

Kenneth John Groth, aged 47, died by hanging in Casuarina Prison on 9 April 1998. He was a sentenced prisoner convicted of sexual offences, serving a 10-year sentence. His appeal was adjourned and legal aid was refused, …

psychiatrycorrectional healthdiagnosticfluoxetine
WAmental health2000-03-21

Inquest into the Death of Lorna Silvester

27y · Female·Ligature compression of neck (hanging)

Lorna Silvester, a 27-year-old woman with depression and suicidal ideation, died by hanging on 18 January 1999 while on approved leave from Graylands Hospital. She had been admitted involuntarily on 13 January after pres…

psychiatrycommunicationsystemhaloperidol
WA2000-02-11

Inquest into the Death of Sean Kevin Hayes

24y · Male·plastic bag asphyxiation

Sean Kevin Hayes, a 24-year-old male remand prisoner, died from plastic bag asphyxiation in his cell at Canning Vale Remand Centre in Western Australia on 20-21 August 1997. He had a history of psychiatric illness, previ…

psychiatrycorrectional healthsystemcommunicationstelazine

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