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SAaged care2021-11-25

Coroner's Finding: McCormack, Donald Stewart

81y · Male·pneumonia complicating surgery for left hip fracture on a background of ischaemi…

An 81-year-old man with end-stage dementia, severe frontal lobe injury, and ischaemic heart disease died from pneumonia following hip fracture surgery. He fell while hip protectors were being cleaned after bowel incontin…

geriatric medicineorthopaedic surgery
SAhospital2021-11-23

Coroner's Finding: Barry, Margaret Joan

80y · Female·Right haemothorax due to bleeding right pleural adhesion with contributing apixa…

Margaret Joan Barry, 80, died from right haemothorax due to bleeding from a pleural adhesion while on apixaban anticoagulation therapy for atrial fibrillation. She was admitted to Royal Adelaide Hospital for psychiatric …

psychiatrycardiologyapixaban
SAhospital2021-11-16

Coroner's Finding: Kresevic, Ivanka

74y · Female·acute myocardial infarction due to coronary artery thrombosis

74-year-old woman presented to emergency department with chest pain on 6 January 2017. She was diagnosed with gastro-oesophageal reflux disease and discharged after 53 minutes. She died of acute myocardial infarction due…

emergency medicinecardiologydiagnosticcommunication
SAhospital2021-06-30

Coroner's Finding: MOKETARINJA Anthea Ryder

42y · Female·multiple organ failure due to sepsis on a background of pneumonia, spontaneous b…

Anthea Ryder Moketarinja, a 42-year-old Aboriginal woman with advanced cirrhosis, died from multiple organ failure due to sepsis, pneumonia, spontaneous bacterial peritonitis, and end-stage liver disease. She was admitte…

general medicinepsychiatryantibiotics
SAhospital2020-12-22

Coroner's Finding: MAVRIDIS Emanuel

64y · Male·Heart failure secondary to alcohol related liver disease, coronary obstructive p…

Emanuel Mavridis, aged 64, died of heart failure secondary to alcohol-related liver disease, COPD, and ischaemic/alcoholic cardiomyopathy. He presented to Royal Adelaide Hospital hypotensive with metabolic acidosis and w…

intensive caregeneral medicine
SAhospital2020-12-18

Coroner's Finding: WALSH Patrick Lawrence

86y · Male·combined effects of acute myeloid leukaemia, acute renal failure and staphylococ…

Patrick Lawrence Walsh, aged 86, died in custody at Royal Adelaide Hospital from combined acute myeloid leukaemia, acute renal failure, and staphylococcal pneumonia. He had a significant medical history including ischaem…

haematologyinfectious diseasesdiagnosticdelay
SAhospital2020-10-30

Coroner's Finding: VELT Hank Jakob

65y · Male·ischaemic and hypertensive heart disease with contributing acute cholecystitis (…

A 65-year-old man with hypertension presented with acute cholecystitis, underwent laparoscopic cholecystectomy, and initially recovered well. On post-operative day 7, he experienced chest pain radiating to his jaw. Two E…

general surgerycardiologydiagnosticcommunication
SA2020-10-12

Coroner's Finding: KEIRL Dennis Frank

63y · Male·metastatic carcinoma of the lung (small cell neuroendocrine carcinoma with poorl…

A 63-year-old male prisoner died from metastatic small cell lung cancer with adenocarcinoma features. Cancer was incidentally discovered during investigation of a deep vein thrombosis in October 2018, leading to one mont…

oncologygeneral medicinewarfarin
SAhospital2020-07-02

Coroner's Finding: WHATLEY Deborah Rose

55y · Female·ischaemic heart disease complicated by epilepsy, asthma and schizophrenia

A 55-year-old woman with schizophrenia, epilepsy, asthma and COPD presented to hospital with abdominal pain and confusion. Initial ED assessment treated presumed UTI and discharged her. She returned the next day with wor…

emergency medicinepsychiatryclozapine
SAhospital2020-06-25

Coroner's Finding: DEERING Peter Charles

66y · Male·metastatic oesophageal cancer

A 66-year-old man detained under criminal legislation died from metastatic oesophageal cancer at a hospital providing palliative care. He presented with weight loss and dysphagia in late 2016, was investigated at Royal A…

palliative caregastroenterologyclozapine
SAhospital2020-06-18

Coroner's Finding: TUCKER Colin Pryor

96y · Male·general inanition on a background of advanced dementia, chronic congestive cardi…

Colin Pryor Tucker, aged 96, died of general inanition on a background of advanced dementia, chronic congestive cardiac failure and pneumonia at Repatriation General Hospital. He was admitted with urinary retention, acut…

psychiatrygeriatric medicineantipsychotic medication
SAhospital2020-06-18

Coroner's Finding: THOMPSON Wayne Robert McInnes

33y · Male·Multi-organ failure due to sepsis on a background of severe ischaemic cardiomyop…

Wayne Robert McInnes Thompson, aged 33, died from multi-organ failure due to sepsis complicated by severe ischaemic cardiomyopathy. He had a complex medical history including viral myocarditis, previous intestinal resect…

cardiologyintensive carewarfarin
SAhospital2020-06-11

Coroner's Finding: SMITH Robert Duncan Strachan

85y · Male·general inanition on a background of end stage dementia

An 85-year-old man with advanced mixed fronto-temporal and Lewy body dementia died from general inanition (wasting) following progressive decline over several years. He was hospitalised in July 2017 after becoming unmana…

psychiatrygeriatric medicine
SAhospital2020-05-08

Coroner's Finding: DUNBAR Brian Samuel

75y · Male·pulmonary thromboembolus due to left calf deep vein thrombosis with contributing…

Brian Samuel Dunbar, aged 75, died from pulmonary thromboembolus secondary to left calf deep vein thrombosis, complicated by Influenza A infection and Parkinson's disease. He was under an Inpatient Treatment Order (ITO) …

psychiatrygeneral medicine
SAhospital2020-05-08

Coroner's Finding: HALL Bryan Robert

71y · Male·general inanition on a background of end-stage mixed pattern dementia and acute …

Bryan Robert Hall, age 71, died from general inanition secondary to end-stage mixed dementia and acute renal failure while under a Level 2 Inpatient Treatment Order at Repatriation General Hospital. He had a complex medi…

geriatric medicinepsychiatry
SAmental health2020-04-30

Coroner's Finding: BENN John Harold

70y · Male·ischaemic heart disease

A 70-year-old man with ischaemic heart disease, dementia, diabetes, hypertension and aortic stenosis died suddenly of acute myocardial infarction while in compulsory mental health detention. He had fallen the previous mo…

psychiatrygeriatric medicine
SAhospital2020-01-10

Coroner's Finding: PLAYFORD Aldona Mariana

84y · Female·sepsis and cardiac failure in a woman with hypertensive ischaemic and valvular h…

Aldona Mariana Playford, an 84-year-old woman with extensive medical comorbidities including ischaemic heart disease, chronic renal failure, and severe biventricular dysfunction, died of sepsis and cardiac failure. She w…

cardiologypsychiatryfurosemide
SAhospital2019-10-29

Coroner's Finding: PEMBERTON Graham Ashton

87y · Male·aspiration pneumonia, urinary tract infection and general inanition complicating…

Graham Pemberton, 87 years old with advanced Alzheimer's dementia, died of aspiration pneumonia, urinary tract infection, and general inanition. He was admitted to hospital multiple times in 2015 with behavioural disturb…

geriatric medicinepsychiatry
SAhospital2019-08-30

Coroner's Finding: SHUEARD Braydon Adrian

60y · Male·Sepsis due to pressure ulcers due to immobility on a background of advancing fro…

A 60-year-old man with frontotemporal dementia, diabetes, and ischaemic heart disease died from sepsis secondary to pressure ulcers while subject to a Mental Health Act inpatient treatment order. He developed sacral and …

psychiatrygeneral medicinehaloperidol
SAhospital2019-06-21

Coroner's Finding: COOK Janet Ann

79y · Female·multi-organ failure as a result of ischaemic and valvular heart disease with uri…

Janet Ann Cook, aged 79, died of multi-organ failure complicated by hydromorphone toxicity on 30 September 2015. She was mistakenly administered 16mg hydromorphone intended for another patient (room 28 vs room 26) on 21 …

cardiologypalliative caremedicationcommunicationhydromorphone

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