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VIChome2016-10-07

Finding into death of Milica (Mary) Minchev

48y · Female·Combined drug toxicity involving oxycodone, benzodiazepines (diazepam, nordiazep…

A 48-year-old woman with epilepsy, depression, anxiety and documented drug dependence died from combined toxicity of oxycodone, benzodiazepines, amitr…

general practicepsychiatrydiagnosticmedicationoxycodone
VIChome2026-02-17

Finding into death of Laurence Mark O'brien

22y · Male·Mixed drug toxicity (tapentadol, clonazepam, citalopram, amphetamine, olanzapine…

Laurence O'Brien, a 22-year-old with acquired brain injury from a childhood motor vehicle accident, died from mixed drug toxicity involving eight substances including prescribed opioids, benzodiazepines, and unprescribed…

general practicepsychiatrymedicationsystemtapentadol
WAmental health2005-09-23

Inquest into the Death of Robert David Abbott

67y · Male·Ligature Compression of the Neck (Hanging)

…d by hanging in the secure ward of Joondalup Health Campus on 19 December 2003. He had a long history of depression exacerbated by chronic pain from a 2000 motor vehicle accident, and required multiple psychiatric admiss…

psychiatrygeneral medicineproceduralsystemvenlafaxine
VICaged care2017-10-31

Finding into death of Baher Kondos

33y · Male·Sudden Unexplained Death in Epilepsy (SUDEP)

Baher Kondos, a 33-year-old man with epilepsy, intellectual disability, and schizophrenia, died suddenly at his supported accommodation facility. He was found unresponsive in bed and despite CPR, could not be resuscitate…

neurologypsychiatryclozapine
VIChome2024-10-01

Finding into death of Karen Lisa Heysham

56y · Female·End stage Alzheimer's disease with Down syndrome

Karen Lisa Heysham, aged 56, died from end-stage Alzheimer's disease and Down syndrome while residing in supported disability accommodation. She was admitted to hospital in March 2024 after functional decline, then disch…

geriatric medicinepalliative care
VIChospital2024-10-07

Finding into death of Danielle Julie Kaye Thomson

41y · Female·Neck compression and hanging

Danielle Thomson, a 41-year-old woman with complex medical and mental health conditions including cervical dystonia, bipolar disorder, borderline personality disorder, chronic pain, and alcohol use disorder, died by suic…

psychiatryaddiction medicinecommunicationsystembuprenorphine
TAShome2022-11-28

Coroner's Finding: Godwin, Chantal Maree

38y · Female·Sudden Unexpected Death in Epilepsy (SUDEP)

Chantal Maree Godwin, a 38-year-old woman with left temporal lobe epilepsy since childhood, died of Sudden Unexpected Death in Epilepsy (SUDEP) in February 2020. She had experienced increasing seizure frequency in the mo…

neurologygeneral practiceanti-epileptic medications
SAhome2017-04-19

Coroner's Finding: BOOGAR Kumana

42y · Male·sudden unexpected death in epilepsy (SUDEP)

A 42-year-old Aboriginal man with longstanding epilepsy, double-leg amputation, and alcohol abuse history died at home from sudden unexpected death in epilepsy (SUDEP). He was under Guardianship and Administration Act or…

neurologyforensic medicinecarbamazepine
VIChomePodcast2023-12-11

Finding into death of Shane Michael Tuck

38y · Male·hanging

…fessional boxing bout. During his football career, he developed obsessive behaviours, cognitive changes, depression, anxiety and forgetfulness. Later he experienced psychotic symptoms with auditory hallucinations and sui…

neurologypsychiatrycocaine
VICaged care2023-03-28

Finding into death of Christopher William Hanson

59y · Male·Complications of multiple sclerosis

Christopher William Hanson, 59, died from complications of multiple sclerosis at MS Residential Services in Williamstown after 20 years in care. He was admitted to hospital in January 2022 with sepsis, stabilized, and wa…

palliative caregeneral medicine
VIC2023-09-08

Finding into death of Dorothy June McIntosh

55y · Female·Refractory seizures secondary to Lennox-Gastaut Syndrome (palliated)

Dorothy McIntosh, a 55-year-old woman with Lennox-Gastaut Syndrome and intellectual disability, died from refractory seizures in palliative care. She had experienced significant functional decline over 12 months, includi…

neurologypalliative caremidazolam
SAhospital2020-12-18

Coroner's Finding: ANKER Paul Eugene

53y · Male·metastatic carcinoma of the rectum (operated)

Paul Eugene Anker, a 53-year-old prisoner, died from metastatic rectal carcinoma at the Queen Elizabeth Hospital. He had been appropriately diagnosed with bowel cancer in 2016 whilst in custody and underwent surgery, che…

oncologycolorectal surgerydexamethasone
VIChome2021-08-20

Finding into death of Samantha Louise Leech

28y · Female·Complications of a seizure in the setting of prescription drug abuse (pregabalin…

…ignificant at 20-25mg/L) combined with methadone, oxycodone, and amitriptyline—a combination causing CNS depression. The case highlights systemic failures: pregabalin was not monitored by SafeScript (Victoria's real-time…

general practicecardiologydiagnosticsystempregabalin
VICaged care2010-04-19

Finding into death of Jamie Alan White

44y · Male·pneumonia and possible large left cerebrovascular accident (stroke) in a man wit…

Jamie Alan White, a 44-year-old man with neurofibromatosis, paraplegia, sleep apnoea, and chronic respiratory issues, was found unresponsive in his residential care unit bed on 15 June 2008 and could not be revived. The …

general practicerespiratory medicineoxycodone
SAhospital2020-06-11

Coroner's Finding: GRUNDY Hugh Keightly

65y · Male·general inanition on a background of advanced fronto-temporal dementia

Hugh Keightly Grundy, aged 65, died from general inanition secondary to advanced frontotemporal dementia. He had a progressive decline from 2002, with formal diagnosis in 2013, complicated by seizures, stroke, and behavi…

psychiatrygeriatric medicine
VIChospital2025-07-28

Finding into death of Juvetta Pedruco Columbine

47y · Female·Aspiration pneumonia in the setting of type 1 diabetes mellitus, previous cerebr…

A 47-year-old NDIS participant with a history of stroke, diabetes, and complex comorbidities died from aspiration pneumonia at Austin Hospital. She had been living in specialist disability accommodation with support serv…

infectious diseasesrespiratory medicine
VIC2025-11-12

Finding into death of Brian Livingstone Clark

65y · Male·Unascertained (Natural Causes) - most likely myocardial infarction or pulmonary …

Brian Livingstone Clark, aged 65, died of natural causes while residing in specialist disability accommodation. He had early-onset Alzheimer's disease diagnosed in May 2023 and required full-time care. On 18 June 2025, s…

geriatric medicineneurology
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
VIChospital2013-09-23

Finding into death of Anthony Ian Gaylard

56y · Male·Hypoxic ischaemic encephalopathy following cardiac arrest

Anthony Gaylard, a 56-year-old man with severe intellectual disability living in residential care, suffered a cardiac arrest on 14 September 2012 (note: document states 2007 in one place, 2012 elsewhere; finding date is …

cardiologyneurology
VIC2025-07-07

Finding into death of Raymond John Blackney

83y · Male·end-stage Parkinson's disease (palliated)

Raymond John Blackney, an 83-year-old man with end-stage Parkinson's disease, died in custody at Port Phillip Prison from natural causes. He had complex medical needs including dementia, intellectual disability, and mult…

palliative caregeriatric medicinemorphine

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