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WAcommunity2008-07-18

Inquest into the Death of Oombulgurri

Boyd Lyle Scotty Farrer: Ligature compression of the neck (hanging); Esmay Alber…

Five Aboriginal people died in Oombulgurri, a remote East Kimberley community, between March 2005 and April 2006: four by suicide and one in a motor vehicle accident. Boyd Farrer (16), Alicia Rex (15), Paul Mitchell (21)…

systemdelayalcohol
WA2008-07-07

Inquest into the Death of Kirsty Anne Slater

24y · Female·Ligature compression injury to the neck (hanging)

Kirsty Anne Slater, a 24-year-old woman with extensive mental illness and substance abuse history, was found hanging from a tree in a park on 19 April 2006, nine days after absconding from Fremantle Hospital's Alma Stree…

psychiatryintensive carecommunicationsystemmorphine
WAcommunity2008-02-25

Inquest into the Death of Kimberley Coronial Report

Multiple causes across 22 deaths: ligature compression of the neck (17 hangings)…

This coronial inquiry examined 22 deaths of Aboriginal people in the Kimberley region of Western Australia between 2000 and 2007. Seventeen were self-harm deaths, with four additional accidental deaths and one homicide. …

public healthpsychiatrysystemdelayalcohol
WAhospital2008-02

Inquest into the Death of Evans

45y · Female·Extensive retroperitoneal haemorrhage following bone marrow biopsy procedure wit…

Susan Denise Evans, a 45-year-old woman with complex medical history including neurofibromatosis type 1, essential thrombocytosis, prior cancers, and recent cerebral infarcts on warfarin, underwent bone marrow biopsy at …

haematologygeneral medicinewarfarin
WAhome2007-12-03

Inquest into the Death of Tedeschi

14y · Female·Ligature compression of the neck (suicide)

Gabrielle Mia Tedeschi, a 14-year-old girl with longstanding oppositional and self-harm behaviours and subsequent depression, died by suicide on 14 October 2004 following a ligature compression injury sustained on 11 Oct…

psychiatrypsychologycommunicationdelayfluoxetine
WAhome2007-09-14

Inquest into the Death of Jones Coronial

9y · Male·Head injury (epidural haematoma with cerebral coning following craniotomy)

Dwayne Michael Jones, aged 9, had Trisomy 10, a rare congenital chromosomal disorder causing severe developmental delay and neurological abnormalities. On 11 April 2000, he fell from a computer desk and struck his head. …

general practiceemergency medicinediagnosticdelayparacetamol
WAhome2007-07-27

Inquest into the Death of Chubby

64y · Female·Acute bronchopneumonia in a woman with liver failure

Patsy Chubby, 64, died from acute bronchopneumonia complicated by terminal liver failure and multiple chronic conditions (cardiac cirrhosis, heart failure, COPD, diabetes, pulmonary hypertension). Discharged from hospita…

general medicinecardiologycommunicationdiagnostic
WAhome2007-06-08

Inquest into the Death of Moss

40y · Female·Sudden unexpected death in epilepsy (SUDEP); epileptic seizure

Sharon Beverley Moss, a 40-year-old woman with a long history of epilepsy, died on 17 February 2005 following a period of sleep deprivation ordered to facilitate a sleep-deprived EEG. She was found unresponsive in her ho…

neurologygeneral practicecommunicationdiagnosticsodium valproate
WAhospital2007-06-08

Inquest into the Death of Rasmussen

31y · Female·cerebral anoxia following attempted intubation pre-surgery in a woman with torti…

Rachael Anne Rasmussen, a 31-year-old mother of three with severe neck deformities (torticollis, dysmorphia, short rigid neck), died on 17 June 2003 from cerebral anoxia following attempted intubation at Joondalup Health…

anaesthesiageneral surgerydiagnosticproceduralatracurium
WAcommunity2007-05-11

Inquest into the Death of Robson

16y · Female·Adrenal insufficiency (Addison's Disease)

Emma Louise Robson, a 16-year-old female, died on 29 September 2004 from adrenal insufficiency (Addison's Disease), a treatable autoimmune condition. She presented with progressive fatigue, weight loss (from 48–50 kg to …

general practiceemergency medicinediagnosticsupervision_issue
WAcommunity2007-05-02

Inquest into the Death of Hasluck

69y · Male·Compound Head Injury sustained in motor vehicle crash

Norman John Hasluck, aged 69, died from a compound head injury sustained in a motor vehicle crash on 9 January 2004 at the intersection of Guildford Road and Eighth Avenue, Maylands. Hasluck's vehicle was struck by a Mit…

neurologyemergency medicinesystemcarbamazepine
WAhospital2007-05

Inquest into the Death of frith

80y · Female·Pulmonary Thromboembolism in a woman with Left Femur Fracture

Sheila Margaret Frith, 80, sustained a left femur fracture after falling at the top of an escalator at an immigration office on 4 July 2005. She was admitted to Sir Charles Gairdner Hospital for urgent surgical repair. H…

orthopaedic surgeryanaesthesiacommunicationsystemsolprin
WAhospital2006-12-05

Inquest into the Death of Steele

63y · Male·ruptured abdominal aortic aneurysm

Norman Eric Keith Steele, 63 years old, collapsed at work on 28 May 2004 and was transported to Merredin District Hospital at 9:10am with a presenting complaint of severe abdominal pain (9/10) radiating to his back, dizz…

emergency medicinegeneral practicediagnosticdelayhyoscine butylbromide
WA2006-08-24

Inquest into the Death of Quilliam

60y · Male·incineration resulting from aircraft crash

Peter and Norma Quilliam, a retired couple from the United Kingdom, died on 30 August 2004 when their Cessna 421C aircraft crashed shortly after takeoff from El Questro Wilderness Park airstrip in remote Western Australi…

aviation medicineforensic medicine
WAhospital2006-05-31

Inquest into the Death of nilon

67y · Female·Pneumonia (streptococcus pneumoniae) in a woman receiving treatment for carcinom…

Peggy Anne Nilon, 67, died from pneumonia (streptococcus pneumoniae) at St John of God Hospital Bunbury on 25 February 2003. Her small cell lung cancer had achieved remission following chemotherapy and radiotherapy. A cr…

oncologygeneral practicediagnosticcommunicationcisplatin
WAhome2006-04-21

Inquest into the Death of Grierson, Lewis, Hancock

39y · Male·Grierson: gunshot wound to chest and abdomen from .30 calibre rifle. Hancock and…

Three men died in related incidents in Western Australia. William Joseph Grierson, 39, was shot with a .30 calibre rifle at Ora Banda on 1 October 2000 following a confrontation between Gypsy Jokers motorcycle club membe…

systemdelay
WAcommunity2006-03-24

Inquest into the Death of Tarah Anne Basiak

12y · Female·Crush Asphyxia with Vomit Aspiration

Tarah Anne Basiak, aged 12, died on 19 June 2004 when a utility vehicle she was riding on rolled over while being driven by an inexperienced teenage driver on a private property near Baldivis, Western Australia. Tarah wa…

WA2006-03

Inquest into the Death of Leon John Donaldson

20y · Male·Ligature compression of the neck (hanging)

Leon John Donaldson, a 20-year-old sentenced prisoner with a documented history of self-harm, depression, and suicidal ideation, died by hanging in his cell at Casuarina Prison on 2 September 2004. He had been identified…

psychiatrypsychologysystemcommunicationsodium valproate
WAhospital2005-12-13

Inquest into the Death of Peter Daryl Samson

20y · Male·Pelvic Injury

Peter Daryl Samson, a 20-year-old Aboriginal male, died from a pelvic fracture sustained in a motor vehicle rollover on 22 September 2003. He was brought to Derby Regional Hospital where he was assessed briefly by nursin…

emergency medicinegeneral practicediagnosticdelayalcohol
WAhospital2005-12-09

Inquest into the Death of Laura Marguerite Sinclair

31y · Female·Post-partum Haemorrhage associated with Amniotic Fluid Embolism and Uterine Hypo…

Laura Marguerite Sinclair, 31-year-old primigravida, died from post-partum haemorrhage associated with amniotic fluid embolism (AFE) and uterine hypotonia. She underwent emergency caesarean section for foetal distress at…

obstetricsanaesthesiadiagnosticcommunicationpethidine
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