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NSWcommunity2023-03-16

Inquest into the death of Luis Fernandez

78y · Male·Not determined - no remains found, no postmortem examination possible

Luis Fernandez, 78, was reported missing on 1 January 2019 after last being seen on 28 December 2018 near Glenfield station. The coroner found he is now deceased but cannot determine the place, cause, or manner of death …

geriatric medicineforensic medicinesystemcommunication
NSWhospital2023-03-15

Inquest into the death of Matthew Smith

47y · Male·Follicular lymphoma with transformation to acute lymphoblastic leukaemia and the…

Matthew Geoffrey Smith, a 47-year-old man imprisoned for sexual offences, died in the ICU of Prince of Wales Hospital on 5 May 2022 from follicular lymphoma that had transformed to acute lymphoblastic leukaemia with comp…

oncologyhaematology
NSW2023-03-14

Inquest into the death of James Brown

70y · Male·Hemopericardium due to ruptured aortic dissection contributed to by hypertension

Mr James Brown, a 70-year-old prisoner with a long-standing history of hypertension and atrial fibrillation, died from hemopericardium due to ruptured aortic dissection. He collapsed with chest pain while at work in the …

emergency medicinevascular surgeryprazosin
NSWhospital2023-03-09

Inquest into the death of William Edmunds

79y · Male·complications of peritonitis

A 79-year-old man with multiple comorbidities presented with a perforated bowel requiring emergency Hartmann's procedure. The operating surgeon, Dr L.-Ming Schmidt, made a catastrophic surgical error by exteriorising the…

general surgeryintensive careproceduraldiagnosticmorphine
NSWhome2023-03-08

Inquest into the death of Mark JOHNSTON

Male·Unable to determine exact cause of death; manner was homicide

Mark Johnston disappeared on 1 September 1986 from Paddington, Sydney, after leaving the Bellevue Hotel. An initial 1999 inquest found he likely died that day at Dover Heights, with evidence implicating Arthur Smith. Joh…

NSW2023-03-06

Inquest into the death of JM

61y · Male·Complications of metastatic adenocarcinoma

JM, a 61-year-old man incarcerated at Long Bay Correctional Centre, died from complications of metastatic adenocarcinoma (stage 4 lung cancer with liver lesions). He was diagnosed in February 2022 after presenting to Wag…

oncologypalliative care
NSW2023-03-06

Inquest into the disappearance and suspected death of Fraser Bruce Ewan

44y · Male·Unascertained

Fraser Bruce Ewan, aged 44, disappeared from a 28-foot motor sailing boat on 29 July 1966 while travelling from Pittwater to Mosman Bay. The boat lacked lifelines or railings, and weather conditions were poor with choppy…

NSWhospital2023-03-03

Inquest into the death of Irene Charlish

68y · Female·Complications of a fall with contributing factors of respiratory failure, respir…

Irene Charlish, a 68-year-old woman with longstanding schizoaffective disorder and multiple comorbidities, fell at her residential facility on 6 June 2017, sustaining a pneumothorax and rib fracture. She was admitted to …

emergency medicinepsychiatryclozapine
NSWhospitalPodcast2023-03-03

Inquest into the death of Bradley HOPE

16y · Male·cardiac arrhythmia or hypoxia in the setting of hydrocarbon inhalation

Bradley Hope, 16, died from cardiac arrhythmia or hypoxia following inhalation of hydrocarbon propellants from an aerosol deodorant purchased at a supermarket self-checkout. After engaging in volatile substance use with …

emergency medicinetoxicologydelaybutane
NSWcommunity2023-03-03

Inquest into the death of Darren Higgins

25y · Male·Dehydration with contributory causes of severe mental health conditions and hype…

Darren Higgins, a 25-year-old Wiradjuri man with treatment-resistant schizophrenia and polysubstance abuse disorder, died from dehydration and hyperthermia in Moira State Forest after absconding during escorted weekend l…

psychiatryemergency medicinediagnosticcommunicationolanzapine
NSWaged care2023-03-01

Inquest into the death of Daryl Suckling

85y · Male·cerebellar haemorrhage due to hypertension

An 85-year-old man died in custody from cerebellar haemorrhage due to hypertension. He was in the palliative care unit following an advanced care directive refusing resuscitation. He reported nausea and vomited around 8p…

palliative caregeneral medicinemetoclopramide
NSWprison2023-03-01

Inquest into the death of William Haines

37y · Male·Pulmonary thromboembolus due to left leg deep vein thrombosis

A 37-year-old Aboriginal man died of pulmonary thromboembolism due to deep vein thrombosis while incarcerated. He presented to hospital on his birthday with lethargy, shortness of breath, and tachycardia. Initial assessm…

emergency medicinecardiologydiagnosticsystemenoxaparin
NSWhospital2023-02-10

Inquest into the death of Anzac Sullivan

38y · Male·Combined effects of coronary atherosclerosis and cardiomegaly, with methylamphet…

Anzac Sullivan, a 38-year-old Aboriginal man, died of a cardiac arrhythmia secondary to severe underlying cardiac disease (coronary atherosclerosis, cardiomegaly, and possible QT prolongation) while fleeing from police a…

cardiologyforensic medicinedelaymethamphetamine
NSW2023-02-09

Inquest into the disappearance and suspected death of Alexander Stetz

72y · Male·Unable to be determined

Alexander Stetz, a 72-year-old man with significant dementia, hypertension, coronary artery disease, and prior stroke, disappeared on 14 July 2014 from a remote property in Sackville, NSW while under the care of his long…

geriatric medicineemergency medicine
NSW2023-02-03

Inquest into the death of Roy Roberts

33y · Male·Prolonged epileptic seizure resulting in gastric content aspiration and cardiac …

Roy Roberts, a 33-year-old Aboriginal man, died at Long Bay Correctional Complex from a prolonged epileptic seizure resulting in aspiration and cardiac arrest. He had experienced three prior seizure-like episodes in Apri…

emergency medicinegeneral practicediagnosticcommunicationmethadone
NSW2023-02-01

Inquest into the death of Jay Lee Crich

41y · Male·Cardiomegaly and Coronary Artery Disease with significant contributing condition…

Jay Crich, a 41-year-old man in custody at Clarence Correctional Centre, died of cardiomegaly and coronary artery disease with emphysema and obesity as significant contributing conditions. He was discovered unresponsive …

cardiologyrespiratory medicinebuprenorphine
NSW2022-12-23

Explosions Inquiry

No deaths resulted from the bombings; property damage and injuries only

On 23 December 1982, two coordinated bombings targeted Israeli interests in Sydney. The Israeli Consulate on William Street was bombed at 1:55pm, causing a hole in reinforced concrete and injuring a tea lady who suffered…

forensic medicine
NSWhospital2022-12-21

Inquest into death of Andrea LESTER

49y · Female·Hypoxic brain injury related to tracheostomy complications in form of airway occ…

Andrea Lester, age 49, suffered a subarachnoid haemorrhage from a PICA aneurysm in March 2018 with delayed diagnosis. Following complex neurosurgery causing Wallenberg syndrome, she required tracheostomy for bulbar dysfu…

neurosurgeryintensive carediagnosticcommunicationtramadol
NSW2022-12-16

Inquest into the death of Joshua DUKE

38y · Male·gunshot wound of the head

Joshua Duke died following a police operation where he was shot by four NSW Police officers after a vehicle pursuit. He was armed with a double-barrel shotgun and had two separate shooting encounters with police on a pri…

forensic medicineemergency medicinemethamphetamine
NSW2022-12-15

Inquest into the death of YAKAMURRO - Findings

15y · Male·Neck compression due to hanging

Yakamurro, a 15-year-old First Nations boy in Territory Families care, died by hanging in NSW in December 2018. The coroner found multiple systemic failures contributed to his death. Key failures: inadequate family consu…

systemcommunication
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