Coronial
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NThospital2025-05-27

Inquest into the death of Child MS

4y · Male·Haemophilus influenzae septicaemia with superimposed respiratory tract infection

A 4-year-old previously healthy male presented to Katherine Regional Hospital on 10 September 2023 with fever and eye pain. He was examined, found to have tachycardia (HR 156) and fever (39.2°C), and diagnosed with viral…

emergency medicinepaediatricsdiagnosticcommunicationparacetamol
NTcommunity2025-04-04

Inquest into the death of Kailab

15y · Male·multiple injuries caused by a motor vehicle accident

Kailab Moir, a 15-year-old Aboriginal boy with FASD, complex trauma, and ADHD, died in a single-vehicle rollover while a passenger in a stolen vehicle. He had been in out-of-home care since age 5 with approximately 35 di…

paediatricspsychiatrydiagnosticsystemalcohol
NThospital2025-03-25

Inquest into the death of Judith Smart

66y · Female·Hypoxic-ischaemic encephalopathy

A 66-year-old woman with COPD, obstructive sleep apnoea, and obesity underwent routine knee surgery at Royal Darwin Hospital. Post-operative care was inadequate. Despite dropping oxygen saturations to 88% when sedated an…

anaesthesiaorthopaedic surgerydiagnosticsystemmorphine
NT2025-03-06

Inquest into the death of Dhakiyarr Wirrapanda

34y · Male·Unable to be determined

Dhakiyarr Wirrapanda, a highly respected Dhudi Djapu clan elder and lawman from north-eastern Arnhem Land, was last sighted alive on 10 November 1934 at Kahlin Compound, Myilly Point, in the Northern Territory. He disapp…

NTmental health2025-02-14

Inquest into the death of Pukumani

47y · Female·acute respiratory failure in the context of known underlying chronic obstructive…

Rita Alimankinni (Pukumani), aged 47, died from acute respiratory failure while an involuntary mental health patient in the Joan Ridley Unit. Her death was preventable. She had COPD, obesity, and received multiple high-d…

psychiatryemergency medicinediagnosticcommunicationketamine
NThospital2025-01-10

Inquest into the death of Mati Tamwoy

66y · Male·infectious complications of plasmablastic myeloma

Mati Tamwoy, a 66-year-old Aboriginal man, died in ICU from infectious complications of plasmablastic myeloma after 661 days on remand. He received excellent oncological care including chemotherapy and radiotherapy. Howe…

haematologyoncologysystemcommunicationchemotherapy agents
NTcommunity2025

Inquest into the death of Road Death 43 of 2024

41y · Female·Blunt force head injury from motor vehicle collision

A 41-year-old Aboriginal woman died from blunt force head injury sustained in a motor vehicle collision. The driver (her mother) failed to stop at a remote intersection marked with warning and stop signs, colliding with …

NT2025

Inquest into the death of Road Death 41 of 2024

59y · Female·Extensive crush injury sustained when struck by a heavy vehicle (road train)

A 59-year-old woman was struck and killed by a road train while attempting to cross the Stuart Highway at night near Stuarts Well. She was highly intoxicated (BAC 0.15%) and had documented poor vision and hearing. The ro…

system
NTcommunity2025

Inquest into the death of Road Death 18 of 2024

29y · Female·Multiple blunt force injuries due to motor vehicle collision (pedestrian)

A 29-year-old woman died after being struck by a vehicle while walking on an unlit road at night after leaving a nightclub event. She had consumed alcohol (BAC 0.15%) and was wearing dark clothing on a dark, unlit stretc…

systemdelayalcohol
NThome

Inquest into the death of Sudden unexpected death of an infant

<1y · Female·Sudden unexpected death of an infant (SUDI) from viral pneumonitis (Rhinovirus a…

A 5-week-old Aboriginal infant with intrauterine growth restriction (IUGR) died of sudden unexpected infant death (SUDI) caused by viral pneumonitis from rhinovirus and enterovirus. She was found unresponsive at a remote…

obstetricspaediatrics
NThome

Inquest into the death of SUDI Death of 45-day old female

Female·Sudden unexpected death of an infant (SUDI) in an unsafe sleeping environment

A 45-day-old female infant died from SUDI (Sudden Unexpected Death of an Infant) in an unsafe sleeping environment in Darwin, NT. The infant was placed to sleep between her mother and 2-year-old sibling in an adult bed a…

midwiferypaediatricscommunicationsystem
NThospital2024-12-06

Inquest into the death of Baby G

<1y · Male·Trisomy 21 with complex cardiac anomalies complicated by pulmonary hypertension,…

Baby G, born with Trisomy 21 (Down Syndrome) and complex cardiac anomalies, died at Royal Darwin Hospital on 18 March 2023 aged 6 months. The coroner found that non-invasive prenatal testing (NIPT) should have been offer…

neonatologypaediatricsdiagnosticsystem
NTcommunity2024-11-26

Inquest into the death of Richard Roe

40y · Male·unknown

Richard Ken Roe disappeared on 2 November 2016 from Lake Bennett, NT, and is presumed deceased. He was last seen near his abandoned vehicle, reportedly having car trouble. The coronial investigation examined two main hyp…

methamphetamine
NTcommunity2024-11-25

Inquest into the death of Kumarn Rabuntja, Kumanjayi Haywood, Miss Yunupingu and Ngeygo Ragurrk

Female·Domestic violence homicides: Miss Yunupiŋu—stab wound to chest; Ngeygo Ragurrk—b…

This landmark coronial finding examines four domestic violence deaths of Aboriginal women in the Northern Territory—Miss Yunupiŋu (2018), Ngeygo Ragurrk (2019), Kumarn Rubuntja (2021), and Kumanjayi Haywood (2021)—all ki…

paediatricsemergency medicinediagnosticcommunicationalcohol
NTcommunity2024-11-15

Inquest into the death of Kumanjayi Jurrah

2y · Male·accidental drowning

A 2-year-old boy drowned at a public pool in a remote Australian community during a childcare centre excursion. Critical clinical and organisational failures contributed: no formal risk assessment was documented for the …

public healthemergency medicineproceduralsystem
NT2024-11-08

Inquest into the death of Roger Nowland helicopter crash

65y · Male·Multiple blunt force injuries from helicopter crash

A 65-year-old experienced helicopter pilot crashed during mustering operations near Limbunya Station, NT, resulting in fatal blunt force injuries. The ATSB investigation could not definitively determine the cause, identi…

aviation medicinesystemprocedural
NThome2024-06-27

Inquest into the death of Grace

13y · Female·Self-inflicted single gunshot wound to the chest

Grace, 13, died from a self-inflicted gunshot wound using an unsecured .308 Winchester rifle stored in her parents' bedroom. She had disclosed suicidal thoughts to a school counsellor in September 2021, but this disclosu…

psychiatrypaediatricsdiagnosticcommunication
NT2024-06-12

Inquest into the death of Mr Dooley

37y · Male·Complications due to atherosclerotic heart disease and dyslipidaemia

Glen Dooley, a 37-year-old Aboriginal man, died of atherosclerotic heart disease and dyslipidaemia while in custody at Darwin Correctional Centre. His death was avoidable. He had abnormal ECGs in 2019 and 2022 that were …

cardiologygeneral practicediagnosticcommunicationatorvastatin
NT2024-05-30

Inquest into the death of Douglass Maggie

46y · Male·Complications arising from hyperthermia, with alcohol intoxication and underlyin…

A 46-year-old man with epilepsy, hypertension, and COPD died after prolonged exposure to heat in a locked vehicle on a hot day in Darwin. He had been drinking heavily and was left sleeping in the car while companions vis…

emergency medicineparamedicinesystemdelayalcohol
NT2024-04-30

Inquest into the death of Kumanjayi Walker

Unknown

This ruling addresses a procedural matter in the ongoing inquest into the death of Kumanjayi Walker, who died in police custody in the Northern Territory. The coroner considered whether notes prepared by police officer Z…

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