Coronial
ACThome2019-09-23

AN INQUEST INTO THE DEATH OFJANDY RENIA SHEA

27y · Female·neck compression (suicide by hanging)

Jandy Renia Shea, 27, died by suicide by hanging on 4 March 2018 after a history of depression, anxiety, and previous suicide attempts following childhood sexual assault at age 16. She had recently reconciled with her es…

VICaged care2022-11-23

Finding into death of Lucio Chiussi

89y · Male·septicaemia due to infected groin wound, femoropopliteal bypass in a man with mu…

…following femoropopliteal bypass surgery while residing in aged care. The wound deteriorated rapidly from bruising on 8 September to a purulent abscess by 13 September 2020. While the aged care facility's GP prescribed a…

geriatric medicinevascular surgerydiagnosticcommunicationoral antibiotics
VIChome2022-10-27

Finding into death of Elizabeth Judith Robyn Wilms

29y · Female·Assault with blunt force injuries resulting in widespread bruising and traumatic…

Elizabeth Wilms, age 29, died between 1-5 July 2016 from fatal assault while in an abusive intimate relationship with Alexander Freeburn. Freeburn was the subject of an unexecuted NSW parole warrant for 541 days. The war…

forensic medicinetoxicologysystemdelaygamma hydroxybutyrate
SAmental health2010-03-11

Coroner's Finding: SHIN Jeong

35y · Female·pulmonary thrombo-emboli

A 35-year-old woman with treatment-resistant schizophrenia detained under Mental Health Act died from pulmonary thromboembolism while an inpatient in a psychiatric ward. In the final days, she reported leg pain and possi…

psychiatryemergency medicinedelayclozapine
NSWhospital2019-02-07

Inquest into the death of Sharon Bell

53y · Female·cardiorespiratory arrest in a person with blunt force head injury, end-stage liv…

Sharon Bell was found dead in her hallway on 25 May 2013 aged 53. She had end-stage liver disease with hepatic encephalopathy, had suffered recent blunt force head injuries of unclear origin, and had high blood methadone…

emergency medicineforensic medicinediagnosticcommunicationmethadone
TASaged care2017-06-12

Coroner's Finding: Bugg, Margaret Evalina

89y · Female·pneumonia and acute renal failure following a fractured right femur due to a fal…

Margaret Evalina Bugg, aged 89, died from pneumonia and acute renal failure following a spiral fracture of her right femur sustained during a fall from a stand-up lifter on 17 December 2015. A mobility assessment in Octo…

emergency medicinegeriatric medicineproceduraldiagnostic
VIChome2012-07-05

Finding into death of Angela Jade Bannister

1y · Female·Chest injuries

Angela Bannister, aged 22 months, died from extensive chest injuries sustained overnight in her mother's care. On 18 July 2008, she had a minor head injury and alleged dog bite at a shopping centre. When examined at hosp…

emergency medicinepaediatricscommunicationibuprofen
VIChospital2013-06-05

Finding into death of Lenin McLarty

68y · Male·Dilated cardiomyopathy with previous aortic valve replacement and aortic graft

…ical lesson is that GPs managing warfarin patients must ensure receipt of INR results and remain alert to bruising and abdominal pain as bleeding signs, especially with elevated INR. ED identification of warfarin toxicit…

cardiothoracic surgeryemergency medicinecommunicationsystemwarfarin
NSWhospital2018-05-22

Inquest into the death of TM

5y · Male·complications of blunt force injury to the head

… doctor initially diagnosed a seizure without promptly considering traumatic brain injury despite visible bruising. NETS consultation eventually led to recognition of likely cerebral oedema, but Mannitol was unavailable …

paediatricsemergency medicinediagnosticdelaymannitol
VIChospital2021-04-08

Finding into death of Ian Lindsay Gould

64y · Male·Complications of Creutzfeldt-Jakob Disease following a fall

…tal health unit. On 7 August, he fell backwards, hitting his head, but was assessed as orientated with no bruising. No CT scan was performed despite being on anticoagulation (rivaroxaban). Over subsequent days he deterio…

neurologyophthalmologysystemrivaroxaban
NThome2016-09-21

Inquest into the death of Natalie McCormack

Female·Wendy Murphy: blunt head and chest trauma. Natalie McCormack: haemorrhage follow…

Two Aboriginal women, aged 36 and 31, died following prolonged domestic violence by their partners in Alice Springs. Both had extensive histories of police-documented assaults, domestic violence orders (DVOs), and uncoop…

forensic medicineemergency medicinesystemalcohol
VIChome2025-01-09

Finding into death of C M

25y · Female·Neck compression secondary to hanging

…ted to hospital multiple times with injuries consistent with assault (fractured vertebra, hand fractures, bruising) and disclosed physical and sexual abuse. Despite these presentations and a high-risk family violence ass…

emergency medicinepsychiatrydiagnosticsystemalprazolam
QLDcommunity

Peuckert, Bay Roxas - Non-inquest findings

48y · Female·Neck and chest injuries sustained in the incident with the cherry picker. Mechan…

Ms Peuckert, a 48-year-old farm worker with 12 years experience, died from crush injuries to her neck and chest while operating an Afron HAS-650 cherry picker on her employer's farm. She was directed to use the machine a…

systemcommunication
ACThospital2024-09-11

Inquest Into The Death Of Baby X

0y · Male·Hypoxic-ischemic encephalopathy and massive subgaleal haemorrhage, both associat…

…NICU. The haemorrhage went undetected until cardiac arrest at 15+ hours post-birth, despite visible scalp bruising from 27 minutes after birth. Delayed recognition deprived Baby X of timely blood product transfusions and…

obstetricsneonatologydiagnosticcommunication
VIChospital2014-11-26

Finding into death of Ming Shan Yuan

88y · Male·Tuberculous pneumonia in the setting of multiple rib fractures, osteoporosis and…

Ming Shan Yuan, an 88-year-old man with osteoporosis and cachexia, died from tuberculosis pneumonia precipitated by multiple rib fractures. He suffered elder abuse and neglect by his primary carer daughter over months be…

emergency medicinegeriatric medicinediagnosticdelayantibiotics
VIChome2020-11-20

Finding into death of Baby S

1y · Male·head injury

Baby S, a 12-month-old boy, died from head injuries inflicted by his mother's de facto partner, Mr B, while the mother was away obtaining heroin. The child had multiple previous injuries documented by childcare staff and…

paediatricsgeneral practicediagnosticcommunicationheroin
SAaged care2018-05-17

Coroner's Finding: BAUM Dorothy Mavis

93y · Female·blunt trauma with head injury on a background of ischaemic heart disease

…upervised and able to access vulnerable patients; Mrs Baum's devastating injuries (extensive lacerations, bruising, exposed tendons) went undiscovered for at least 2 hours; and staff then falsely claimed the injuries wer…

geriatric medicineemergency medicinediagnosticcommunicationoxycodone
VIChospital2023-05-29

Finding into death of Kaleb Baylis-Clarke

0y · Male·Head injury in the setting of chronic subdural haemorrhage

Kaleb Baylis-Clarke, a 17-week-old infant, presented to hospital on 14 January 2016 with a head lump, vomiting, raised fontanelle and reduced milk intake. Cranial ultrasound showed fluid in subdural spaces. MRI on 15 Jan…

paediatricsneurosurgerysystem
NSWhome2021-03-10

Inquest into the death of Z

2y · Male·traumatic head injury

…010-2012, including multiple mandatory reports from childcare workers in June-July describing unexplained bruising, bite marks and injuries, no caseworker ever assessed the child. Reports were repeatedly closed due to 'c…

paediatricsemergency medicinediagnosticcommunication
QLDhome2016-02-09

DM

35y · Female·Stab wound to chest penetrating the descending thoracic aorta resulting in catas…

DM, a 35-year-old woman, died from a stab wound to the chest inflicted by her husband during a domestic violence incident on 26 June 2011. The wound penetrated the descending thoracic aorta, causing catastrophic blood lo…

forensic medicineemergency medicinesystemcommunicationamphetamine

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