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NThospital2019-04-16

Inquest into the death of Ali Achmadun Djawas

70y · Male·multi-organ failure due to septic shock consequent on faecal peritonitis due to …

Ali Djawas, a 70-year-old Indonesian-born man with comorbidities (hypertension, diabetes, COPD), underwent elective right hemicolectomy on 13 March 2017 for a suspicious ileo-caecal lesion. Biopsies were benign, CT imagi…

colorectal surgerygeneral surgerydiagnosticcommunicationmethylnatrexone
TAShospital2019-04-16

Coroner's Finding: Ham, Roderick David Charles

59y · Male·pulmonary thromboemboli due to deep vein thrombosis following right hip replacem…

A 59-year-old man died from pulmonary thromboembolism following right hip replacement surgery. He had mild polycythaemia and elevated BMI (33.26), both risk factors for deep vein thrombosis. Pre-operatively he was classi…

orthopaedic surgeryanaesthesiadiagnosticmedicationaspirin
TAShospital2019-04-16

Coroner's Finding: Hill, Phillip John

82y · Male·sepsis due to faecal peritonitis due to suture failure of bowel anastomosis foll…

An 82-year-old man died from sepsis due to faecal peritonitis following anastomotic breakdown after right hemi-colectomy for colon cancer. Surgery was appropriate and proceeded without incident. Five days post-operativel…

colorectal surgerygeneral surgerydelayamiodarone
SAhospital2019-04-15

Coroner's Finding: ADAMS Debra Louise

52y · Female·hepatic encephalopathy due to Child C cirrhosis of the liver on a background of …

A 52-year-old woman with chronic liver disease from alcohol abuse, diabetes and hepatitis C died from hepatic encephalopathy and cirrhosis. She presented to Port Pirie Medical Centre with bleeding, pain and confusion. Bl…

general practicehepatology
NSWhospital2019-04-04

Inquest into the death of Ahmed RIZK

49y · Male·Complications of metastatic gastric adenocarcinoma

Ahmed Rizk, a 49-year-old man in custody, died from complications of metastatic gastric adenocarcinoma. He presented with abdominal pain and constipation on 10 August 2017, was investigated at Glen Inness District Hospit…

gastroenterologyoncology
VIChospital2019-03-28

Finding into death of Kerri Michelle Moore

55y · Female·Aspiration pneumonia in a woman with epilepsy and intellectual disability

Kerri Michelle Moore, a 55-year-old woman with intellectual disability, epilepsy, and progressive neurological deficit, died from aspiration pneumonia. She was admitted with status epilepticus, treated with antibiotics a…

intensive carerespiratory medicine
SAhospital2019-03-25

Coroner's Finding: NICHOLSON James

65y · Male·hypoxic ischaemic encephalopathy complicating hanging

James Nicholson, aged 65, died from hypoxic ischaemic encephalopathy following a suicide attempt by hanging while an inpatient at Noarlunga Hospital on 18 August 2015. He had undergone extensive facial cancer surgery in …

oncologypsychiatrydiagnosticcommunicationdexamethasone
NSWhospital2019-03-22

Inquest into the death of Patrick THOMAS

52y · Male·Intestinal failure/sepsis arising from venous ischemia as a result of superior m…

Patrick Thomas, a 52-year-old man, died from intestinal failure and sepsis following an accidental division of the superior mesenteric vein (SMV) during laparoscopic surgery for colon cancer at Kareena Private Hospital o…

colorectal surgeryintensive carecommunicationsystem
VIChospital2019-03-20

Finding into death of Erika Maria Gerlach

79y · Female·Complications of injuries sustained in a motor vehicle collision (passenger)

Erika Maria Gerlach, aged 79, died from complications of injuries sustained in a rear-end motor vehicle collision on 27 November 2017. She was a passenger when her husband's vehicle collided with a stationary car on the …

trauma surgeryneurosurgerysystemlevetiracetam
VIChospital2019-03-19

Finding into death of John Edwin Wilks

76y · Male·Bronchopneumonia complicating fractured ribs sustained in a fall on a bus

John Wilks, a 76-year-old wheelchair user, fell when his wheelchair tilted during a left-turn on a bus on 13 August 2017. He sustained fractured ribs and a small haemothorax. Although initially treated with painkillers, …

intensive carerespiratory medicinesystemdelay
WAhospital2019-03-12

Inquest into the Death of Lorna May WOODS

39y · Female·pulmonary thromboembolism due to deep vein thrombosis and sepsis due to pyelonep…

Lorna May Woods, 39, died from pulmonary thromboembolism due to deep vein thrombosis and sepsis secondary to pyelonephritis on a background of metastatic ovarian cancer. She presented to Joondalup Health Campus with uros…

emergency medicinepsychiatryheparin
VIChospital2019-03-01

Finding into death of Madeleine Therese Sobb

25y · Female·Airway obstruction complicating laryngeal dilation for the treatment of subglott…

Ms Sobb, a 25-year-old woman with spondylo-epi-metaphyseal dysplasia causing severe airway abnormalities and subglottic stenosis, died from airway obstruction following laryngeal dilation. She was admitted to ICU with as…

intensive careemergency medicinecommunicationsystemadrenaline
NSWhospital2019-03-01

Inquest into the death of Stephen Kline

51y · Male·Pulmonary thromboemboli due to deep vein thrombosis on a background of a leg bur…

Stephen Kline, a 51-year-old Aboriginal man, died from pulmonary thromboembolism due to deep vein thrombosis following a leg burn wound sustained when NSW Police deployed a taser during a confrontation on 8 March 2016. H…

plastic and reconstructive surgerypsychiatrydiagnosticsystemheparin
NSWmental health2019-02-12

Inquest into the death of Kevin O’Halloran

55y · Male·positional asphyxia, with sedation as an underlying risk factor

Kevin O'Halloran, a 55-year-old with chronic schizophrenia, presented with acute severe behavioural disturbance related to medication changes and possible substance use. He received substantial intravenous sedation (75mg…

emergency medicinepsychiatrycommunicationproceduralmidazolam
VIChospital2019-02-11

Finding into death of Stephen John Caruana

48y · Male·Hypoxic ischaemic encephalopathy complicating upper cervical spine and cord inju…

A 48-year-old construction worker died from hypoxic ischaemic encephalopathy following a traumatic cervical spine injury sustained while cutting down a gum tree from a cherry picker. Tree branches struck him, causing los…

emergency medicineintensive caremidazolam
VIChospital2019-02-07

Finding into death of JP

39y · Male·septicaemia following self-administered intravenous injection of faeces

A 39-year-old Aboriginal man with schizophrenia, personality disorder, and substance dependence died from septicaemia after self-injecting faeces into his vein while an involuntary mental health patient. He obtained a sy…

psychiatryinfectious diseasessystemdelaypaliperidone
NSWhospital2019-02-07

Inquest into the death of Shamon Shamon

67y · Male·Blunt head injury (bilateral subarachnoid haemorrhage, left sided subdural haemo…

A 67-year-old man died from blunt head injury sustained when struck by a car while crossing a residential road near his home. He was taken to Liverpool Hospital for urgent neurosurgery but died 13 days later from the tra…

neurosurgerytrauma surgery
WAcommunity2019-02-06

Inquest into the Death of Torran Jake THOMAS

15y · Male·Multiple organ failure associated with hyperthermia (heat stroke)

A 15-year-old rugby league player died from heat stroke during training on an extremely hot Perth summer evening (44.4°C). The coaching staff appropriately applied NRL heat guidelines in deciding to proceed with modified…

emergency medicineintensive carediagnosticdelay
VIChospital2019-02-05

Finding into death of Eliza Gill

18y · Female·Colchicine toxicity

An 18-year-old female died from colchicine toxicity after intentional overdose of her father's medications during a mental health crisis. She ingested approximately 10-15g of colchicine (dose 0.25mg/kg), below the guidel…

emergency medicineintensive carediagnosticsystemcolchicine
WAcommunity2019-01-29

Inquest into the Death of Glenn William STRICKLAND

43y · Male·Complications of neck injury; specifically extensive brainstem infarction second…

Glenn William Strickland, an experienced Harley Davidson rider, died from brainstem infarction following severe cervical spinal injury sustained in a motorcycle crash on Julimar Road, Western Australia. He failed to nego…

emergency medicinetrauma surgerysystemdelay
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