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VIChome2025-04-01

Finding into death of Jack Elliot Atkinson

26y · Male·Drug toxicity (1,4 butanediol, gamma hydroxybutyrate, methylamphetamine, cocaine…

Jack Atkinson, 26 years old, died from mixed drug toxicity involving GHB/1,4-butanediol, methylamphetamine, cocaine, novel benzodiazepines (bromazolam, flubromazepam), nordiazepam, and ketamine. He had a history of subst…

general practiceaddiction medicine1,4-butanediol
VIChome2025-04-01

Finding into death of Andrew Cameron McDougall

57y · Male·Bilateral bronchopneumonia in a man with asthma, tetraplegia and multiple other …

Andrew McDougall, 57, a man with complex medical comorbidities including tetraplegia, COPD, asthma, ischaemic heart disease and diabetes, died from bilateral bronchopneumonia at his supported disability accommodation hom…

respiratory medicinegeneral practiceoxycodone
SAhome2025-03-31

Coroner's Finding: Tanti, Greg Anthony

43y · Male·compression of the neck in keeping with hanging

A 43-year-old man on home detention died by hanging in September 2021. He had a history of epilepsy, depression, anxiety, illicit drug use, and previous suicide attempts. In the weeks before death, he presented to hospit…

emergency medicinepsychiatrysodium valproate
SAhome2025-03-31

Coroner's Finding: Constantine, Matthew Keith

33y · Male·hypoxic-ischaemic encephalopathy due to hanging with resuscitation

Matthew Keith Constantine, aged 33, died from hypoxic-ischaemic encephalopathy following a hanging attempt while under home detention. He was released from prison in December 2021 with parole conditions including electro…

intensive careemergency medicinemethamphetamine
QLDhospital2025-03-31

Inquest into the death of Jamie Brian Campbell

43y · Male·Hypoxic ischaemic encephalopathy, due to or as consequence of, cardiac arrest of…

A 43-year-old man with methamphetamine toxicity was restrained by police and given two doses of droperidol by paramedics who failed to recognize he was critically unwell. The first dose was clinically indicated, but the …

emergency medicinetoxicologydiagnosticmedicationmethamphetamine
VIC2025-03-31

Finding into death of George Platakis

54y · Male·Klebsiella pneumoniae pneumonia in a man with Huntington's Disease, with contrib…

George Platakis, a 54-year-old man with Huntington's Disease and COPD, died from Klebsiella pneumoniae pneumonia while residing in specialist disability accommodation. He had sustained a serious fall in January 2023 caus…

neurologyrespiratory medicine
NSWmental health2025-03-31

Inquest into the Death of G.P.

41y · Male·Multiple traumatic injuries

This inquest examined the death of a 40-year-old man who died by suicide following a fall from a cliff. He had three involuntary admissions to mental health facilities in a fortnight before his death. Critical clinical l…

psychiatryemergency medicinediagnosticcommunicationlisdexamfetamine
NSW2025-03-25

Inquest into the death of Bernard Greenwell

84y · Male·haemoperitoneum due to ruptured abdominal aortic aneurysm

Bernard Greenwell, an 84-year-old male, died from rupture of an abdominal aortic aneurysm (AAA) while in custody at Cessnock Correctional Centre. He experienced sudden-onset severe left groin pain at 11:30am on 25 April …

emergency medicinevascular surgery
VIChospital2025-03-18

Finding into death of R J

41y · Male·complications of acute ethanol toxicity

Mr RJ, a 41-year-old man with a history of progressive alcohol misuse and mental health conditions (anxiety and depression), died from complications of acute ethanol toxicity following cardiac arrest due to aspiration an…

emergency medicineintensive caresystemalcohol
VIChome2025-03-18

Finding into death of R T

66y · Male·Complications of excess alcohol intake in a man with heart disease

A 66-year-old man died from complications of excess alcohol intake in the setting of underlying heart disease. He had a 40+ year history of heavy daily alcohol consumption (12+ cans of beer plus whiskey daily), chronic p…

general practiceemergency medicinealcohol
TAShospital2025-03-17

Coroner's Finding: Phillips, Helen Lynette

77y · Female·intracranial haemorrhage (subdural, intraventricular and brainstem)

A 77-year-old woman fell from a ladder on 12 December 2022, suffering loss of consciousness and rib fractures. No brain CT scan was performed at Mersey Community Hospital despite the mechanism of injury and unconsciousne…

emergency medicinecardiologydiagnosticdelaythrombolytic agents
QLDhospital2025-03-14

Non-inquest findings - a 5 year old boy

5y · Male·Complications of burns

A 5-year-old boy died from complications of severe burns sustained during a fuel ignition incident at his father's rural property. While refuelling a small motorcycle, the father failed to shut off the engine and did not…

plastic and reconstructive surgeryintensive careprocedural
VIC2025-03-14

Finding into death of Aaron Matthew Forte

24y · Male·Sudden unexpected death in epilepsy (SUDEP)

Aaron Forte, a 24-year-old man with epilepsy, Jacob's XXY Syndrome, intellectual disability, and schizophrenia, died of sudden unexpected death in epilepsy (SUDEP) while in specialist disability accommodation. He was fou…

neurologygeneral practicelamotrigine
VIChome2025-03-14

Finding into death of Jonathan Mark Townsend

59y · Male·Unascertained

Jonathan Townsend, a 59-year-old Navy veteran with PTSD, alcohol use disorder, and multiple psychiatric comorbidities, died at home on 5 November 2021. The cause of death was unascertained despite autopsy and toxicology.…

trauma surgerypsychiatrycommunicationsystemdiazepam
VIChospital2025-03-07

Finding into death of Heather Joan Moody

77y · Female·Pneumonia with contributing factors of acquired brain injury, Parkinson's diseas…

A 77-year-old woman with acquired brain injury, Parkinson's disease, epilepsy and intellectual disability died of pneumonia while an SDA resident. She presented with breakthrough seizures and aspiration pneumonitis on 16…

neurologyrespiratory medicineprednisolone
SAmental health2025-03-06

Coroner's Finding: Fowles, Wayne Lincoln

59y · Male·hanging

A 59-year-old man with major depression and psychotic features was lawfully detained under an inpatient treatment order at Noarlunga Hospital's Morier Ward. He was appropriately managed, initially in the high-dependency …

psychiatryemergency medicinelorazepam
NSW2025-03-06

Inquest into the death of Moses Kellie

33y · Male·hanging

Moses Kellie, aged 33, died by hanging at Villawood Immigration Detention Centre in January 2019 after four years in immigration detention. He had schizophrenia, PTSD, and substance dependence, with a prior suicide attem…

psychiatrygeneral practicesystemcommunicationpaliperidone
NSW2025-03-06

Inquest into the death of Leah Jane Porter

50y · Female·hanging

A 50-year-old woman with severe borderline personality disorder and ADHD died by hanging in immigration detention. The coroner found her mental health monitoring and treatment were adequate, though she received only two …

psychiatrygeneral practicecommunicationsystemmethylphenidate
NSW2025-03-06

Inquest into the death of Muhammad Hafizuddin Bin Zaini

29y · Male·hanging

Muhammad Hafizuddin Bin Zaini, a 29-year-old detainee in immigration detention at Villawood, died by hanging on 12 December 2020. He had a history of substance-induced psychotic disorder and was prescribed antipsychotic …

psychiatrygeneral practicecommunicationolanzapine
NSWcommunity2025-03-06

Inquest into the death of Fiona Turnbull

59y · Female·multiple injuries from fall from height

Fiona Turnbull, a 59-year-old woman with chronic schizophrenia on clozapine, died from multiple injuries after falling from her third-floor balcony on 12 October 2017 during a psychotic relapse. The death occurred shortl…

psychiatryemergency medicinedelaycommunicationclozapine

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