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WAhospital2011-11-22

Inquest into the Death of Ashdown

27y · Male·cardiac arrhythmia during restraint; mechanism involved hypoxia and asphyxiation…

Warwick Andrew Ashdown, a 27-year-old male with severe treatment-resistant paranoid schizophrenia, died at Graylands Hospital on 12 October 2007 from cardiac arrhythmia during physical restraint. After assaulting another…

psychiatryintensive careproceduralsystemhaloperidol
WAcommunity2011-02-28

Inquest into the Death of Collins

0y · Male·cardiac arrhythmia associated with surgically corrected congenital heart disease

Edward Thomas Collins was a 3-month-old neonate with surgically corrected congenital heart disease (Total Anomalous Pulmonary Venous Drainage) who died on 14 January 2007 from cardiac arrhythmia. On 13 January 2007, he p…

emergency medicinegeneral practicediagnosticcommunication
WAcommunity2010-12-21

Inquest into the Death of Njana

24y · Male·left intracerebral haemorrhage and consequential brain bleeding resulting from h…

Hendrick Njana, a 24-year-old Aboriginal male, was assaulted on 27 December 2008 by Shaun Steven Midd at a service station in Broome, suffering a strike to the head causing unconsciousness, kicks to the head with steel-c…

emergency medicineintensive carecommunicationdelayalcohol
WAcommunity2010-04-15

Inquest into the Death of Lynch

20y · Female·food-induced anaphylaxis, likely to peanut allergen

Kylie Lynch, a 20-year-old woman with chronic asthma and a known peanut allergy, died from anaphylaxis on 2 September 2007 in Coral Bay, Western Australia. She consumed desserts at Fin's Café after dining at a nearby hot…

emergency medicinegeneral practicedelaydiagnosticadrenaline
WAhospital2010-03-03

Inquest into the Death of McLevie

38y · Female·Streptococcus Group A Septicaemia (Post Partum-Puerperal Sepsis)

Susannah McLevie, a 38-year-old woman, died on 6 April 2006 from untreated Group A Streptococcal septicaemia (puerperal sepsis) following childbirth at Osborne Park Hospital. She developed fever (38°C) at 3am on 5 April,…

obstetricsmidwiferydiagnosticcommunicationparacetamol/codeine
WAhospital2010-02-04

Inquest into the Death of Hudson

20y · Male·Ligature compression of the neck (hanging)

Allan Kevin Hudson, a 20-year-old male with a history of depression, suicidality, substance abuse and previous sexual trauma, died by hanging on 13 August 2006 at Sir Charles Gairdner Hospital's psychiatric ward D20. He …

psychiatryemergency medicinediagnosticcommunicationcarbamazepine
WAhospital2009-09-30

Inquest into the Death of Watmore

17y · Male·fatal asphyxia resulting from severe upper airway obstruction secondary to acute…

Kieran Watmore, a fit 17-year-old male, died from fatal asphyxia at Albany Regional Hospital on 28 August 2008 while being treated for acute tonsillitis. He presented to ED on 27 August with severe throat pain and was pr…

emergency medicinegeneral practicediagnosticcommunicationmorphine
WAhospital2009-09-11

Inquest into the Death of Gordon

1y · Female·pneumonia (staphylococcal pneumonia with bilateral bacterial pneumonia)

Jezelle Lisa Gordon, a 1-year-old child, died of staphylococcal pneumonia on 26 February 2006 in Port Hedland, Western Australia. She presented to Halls Creek Hospital on 25 February with fever, elevated respiratory rate…

general practiceemergency medicinediagnosticdelayparacetamol
WAhospital2009-08-25

Inquest into the Death of Partington

88y · Female·pneumonia and morphine toxicity in an elderly lady with a recent left leg and le…

Pauline Margaret Partington, an 88-year-old woman, suffered an unwitnessed fall at a residential aged care facility on 4 May 2008 and sustained a fractured left neck of femur, displaced fracture of the left humerus, and …

geriatric medicinegeneral medicinecommunicationsystemmorphine
WAcommunity2009-04-24

Inquest into the Death of Halford

17y · Female·Multi System Failure following acute onset (Acute Diabetic Ketoacidosis) Diabete…

Lee Rebecca Halford, a 17-year-old girl, died of acute diabetic ketoacidosis (DKA) following undiagnosed Type 1 diabetes. She initially presented to a GP with vomiting on 27 February 2007, diagnosed with gastroenteritis.…

general practiceemergency medicinediagnosticcommunicationmetoclopramide
WAhospital2009-02-01

Inquest into the Death of Fox

62y · Male·Acute Gastrointestinal Haemorrhage in association with Acute on Chronic Peptic U…

Kenneth Charles Fox, 62, presented to Fremantle Hospital ED on 12 April 2006 with a gastrointestinal bleed after fainting. He was diagnosed with a massive bleed causing hypovolaemic shock and stabilized with fluid resusc…

emergency medicinegeneral surgerydiagnosticdelayaspirin
WAhospital2008-07-28

Inquest into the Death of kidner

41y · Male·Head Injury in a Man with Acute Alcohol Intoxication; basal skull fracture with …

Ronald Gregory Kidner, 41, died from a basal skull fracture and severe head trauma on 25 October 2004, four days after falling at a recreation club while acutely intoxicated. He presented to Nickol Bay Hospital with sign…

emergency medicinegeneral medicinediagnosticcommunicationalcohol
WAcommunity2008-02-25

Inquest into the Death of Kimberley Coronial Report

Multiple causes across 22 deaths: ligature compression of the neck (17 hangings)…

This coronial inquiry examined 22 deaths of Aboriginal people in the Kimberley region of Western Australia between 2000 and 2007. Seventeen were self-harm deaths, with four additional accidental deaths and one homicide. …

public healthpsychiatrysystemdelayalcohol
WAhome2007-09-14

Inquest into the Death of Jones Coronial

9y · Male·Head injury (epidural haematoma with cerebral coning following craniotomy)

Dwayne Michael Jones, aged 9, had Trisomy 10, a rare congenital chromosomal disorder causing severe developmental delay and neurological abnormalities. On 11 April 2000, he fell from a computer desk and struck his head. …

general practiceemergency medicinediagnosticdelayparacetamol
WAhome2007-07-27

Inquest into the Death of Chubby

64y · Female·Acute bronchopneumonia in a woman with liver failure

Patsy Chubby, 64, died from acute bronchopneumonia complicated by terminal liver failure and multiple chronic conditions (cardiac cirrhosis, heart failure, COPD, diabetes, pulmonary hypertension). Discharged from hospita…

general medicinecardiologycommunicationdiagnostic
WAcommunity2007-05-11

Inquest into the Death of Robson

16y · Female·Adrenal insufficiency (Addison's Disease)

Emma Louise Robson, a 16-year-old female, died on 29 September 2004 from adrenal insufficiency (Addison's Disease), a treatable autoimmune condition. She presented with progressive fatigue, weight loss (from 48–50 kg to …

general practiceemergency medicinediagnosticsupervision_issue
WAcommunity2007-05-02

Inquest into the Death of Hasluck

69y · Male·Compound Head Injury sustained in motor vehicle crash

Norman John Hasluck, aged 69, died from a compound head injury sustained in a motor vehicle crash on 9 January 2004 at the intersection of Guildford Road and Eighth Avenue, Maylands. Hasluck's vehicle was struck by a Mit…

neurologyemergency medicinesystemcarbamazepine
WAhospital2006-12-05

Inquest into the Death of Steele

63y · Male·ruptured abdominal aortic aneurysm

Norman Eric Keith Steele, 63 years old, collapsed at work on 28 May 2004 and was transported to Merredin District Hospital at 9:10am with a presenting complaint of severe abdominal pain (9/10) radiating to his back, dizz…

emergency medicinegeneral practicediagnosticdelayhyoscine butylbromide
WAhospital2006-05-31

Inquest into the Death of nilon

67y · Female·Pneumonia (streptococcus pneumoniae) in a woman receiving treatment for carcinom…

Peggy Anne Nilon, 67, died from pneumonia (streptococcus pneumoniae) at St John of God Hospital Bunbury on 25 February 2003. Her small cell lung cancer had achieved remission following chemotherapy and radiotherapy. A cr…

oncologygeneral practicediagnosticcommunicationcisplatin
WAhospital2005-12-13

Inquest into the Death of Peter Daryl Samson

20y · Male·Pelvic Injury

Peter Daryl Samson, a 20-year-old Aboriginal male, died from a pelvic fracture sustained in a motor vehicle rollover on 22 September 2003. He was brought to Derby Regional Hospital where he was assessed briefly by nursin…

emergency medicinegeneral practicediagnosticdelayalcohol
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