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WAmental health2019-05-22

Inquest into the Death of Christopher John DEBNAM

40y · Male·Cardiomyopathy with early pneumonia in a man with reported sleep apnoea and high…

Christopher John Debnam, 40, died from cardiomyopathy with early pneumonia and obstructive sleep apnoea. He was readmitted to Graylands Hospital's mental health ward on 20 November 2014 with acute psychiatric decompensat…

psychiatryrespiratory medicinediagnosticcommunicationhaloperidol
WA2019-04-04

Inquest into the Death of Ronald Alan GIBLETT

79y · Male·Valvular ischaemic heart disease in association with coronary arteriosclerosis

A 79-year-old prisoner with a long history of ischaemic heart disease and coronary arteriosclerosis suffered fatal cardiac arrest in his cell at Karnet Prison Farm. He had been appropriately managed with regular cardiova…

cardiologygeneral practice
WAhospital2019-04-04

Inquest into the Death of Maris KUGIS

68y · Male·Bronchopneumonia in a man with chronic obstructive pulmonary disease

Maris Kugis, a 68-year-old man with chronic schizophrenia, personality disorders, and multiple serious physical conditions including COPD, ankylosing spondylitis, and undiagnosed pancreatic adenocarcinoma, died from bron…

psychiatryrespiratory medicinehaloperidol
WAcommunity2018-12-12

Inquest into the Death of Joseph Frederick WOODS

34y · Male·cardiorespiratory arrest during struggle and restraint in a man with methylamphe…

A 34-year-old man with methylamphetamine intoxication (blood level 1.2 mg/L) and focal coronary artery atherosclerosis died from cardiorespiratory arrest during a struggle and restraint by a homeowner and subsequent poli…

toxicologycardiologymethamphetamine
WAhospital2018-10-12

Inquest into the Death of Augustinus Clemens Antonius HEESTERS

70y · Male·Acute myocardial infarction in association with coronary artery atherosclerosis

A 70-year-old sentenced prisoner with severe ischaemic heart disease and prior myocardial infarctions died from acute myocardial infarction with coronary artery atherosclerosis. He presented with severe chest pain on 5 O…

cardiologyemergency medicinesystemaspirin
WAhospital2018-03-15

Inquest into the Death of Roderick Leslie CARTER

63y · Male·Atherosclerotic Heart Disease

A 63-year-old farmer presented to a small rural hospital with atypical chest pain symptoms (also reporting indigestion, shivering, and numbness). Although a registered nurse appropriately triaged him as ATS 2 (high prior…

cardiologyemergency medicinecommunicationsystemaspirin
WAhospital2018-03-07

Inquest into the Death of William Scott BARTLETT

36y · Male·hypoxic brain injury and myocardial ischaemia following cardiac arrest during re…

A 36-year-old man with methylamphetamine intoxication was restrained by civilians and police following a property damage incident. He experienced cardiac arrest during restraint and died from hypoxic brain injury and myo…

emergency medicineintensive caremethamphetamine
WAhospitalPodcast2017-05-03

Inquest into the Death of Edith Catherine BEE

80y · Female·Gas embolism complicating surgical repair of an atherosclerotic aortic aneurysm …

An 80-year-old woman with multiple comorbidities (COPD, renal impairment, cardiac disease) underwent complex endoluminal repair of a thoracoabdominal aortic aneurysm at a private hospital. The procedure required use of C…

vascular surgerygeneral surgeryproceduralsystem
WAhome2017-04-26

Inquest into the Death of Leslie Troy OVENS

32y · Male·Asphyxia in a man with Friedreich's Ataxia due to positional asphyxia; unable to…

Leslie Troy Ovens, a 32-year-old man with progressive Friedreich's Ataxia, died from positional asphyxia after falling from his wheelchair. He had deteriorated significantly after hospitalisation in June 2013 and was wea…

neurologycardiologycommunicationsystem
WAhome2017-02-17

Inquest into the Death of Christine Pearl STRONER

69y · Female·unascertained

Christine Pearl Stroner, 69, died of an unascertained cause on the evening of discharge following laparoscopic cholecystectomy and hiatus hernia repair at Fremantle Hospital. She was observed at 2pm with tachycardia (HR …

general surgerycardiologydocumentationcommunicationoxycodone
WA2016-10-10

Inquest into the Death of Hayder SAYED

30y · Male·Acute cardiac failure in association with severe ischaemic heart disease seconda…

A 30-year-old Afghan asylum seeker died from acute cardiac failure due to severe coronary atherosclerosis while in immigration detention. He had developed a large anteroseptal myocardial infarction between 4-18 August 20…

cardiologyemergency medicinemirtazapine
WA2016-09-09

Inquest into the Death of Sajidu RAHMAN

51y · Male·ischaemic heart disease with myocarditis

Sajidu Rahman, a 51-year-old Rohingya man, died suddenly from ischaemic heart disease with myocarditis at a Christmas Island detention centre shortly after arrival by boat. He had a pre-existing history of diabetes, hype…

emergency medicinecardiologycommunication
WAhospital2016-02-05

Inquest into the Death of Pauline Margaret DODD

51y · Female·Ischaemic heart disease

Pauline Margaret Dodd, 51, died of ischaemic heart disease at Sir Charles Gairdner Hospital on 4 March 2014. She was an involuntary psychiatric patient with long-standing bipolar affective disorder, complicated by childh…

psychiatrycardiologydiagnosticolanzapine
WAhospital2015-08-06

Inquest into the Death of Francis Gerald ROBERTS

62y · Male·fatal cardiac arrhythmia secondary to end-stage ischaemic cardiomyopathy

A 62-year-old prisoner with severe ischaemic heart disease, diabetes, and cardiomyopathy died from a fatal cardiac arrhythmia in hospital. He had extensive cardiac history including pacemaker insertion, coronary stents, …

cardiologycardiothoracic surgeryfurosemide
WAhospital2015-07-29

Inquest into the Death of Tien Chung NGUYEN

55y · Male·ruptured dissection of the thoracic aorta

Tien Chung Nguyen, a 55-year-old male prisoner, died from rupture of a thoracic aortic dissection during emergency surgery at Royal Perth Hospital. He presented with chest pain and dyspnoea at Wooroloo Prison on 26 Novem…

emergency medicinecardiothoracic surgerydiagnostic
WAhospital2015-07-02

Inquest into the Death of John MAJINSKI

55y · Male·Complications of fibrosing alveolitis

John Majinski, a 55-year-old prisoner with severe fibrosing alveolitis, pulmonary hypertension, diabetes, and recurrent infections, died from complications of his lung disease while incarcerated. He received intensive me…

respiratory medicinegeneral medicinemirtazapine
WA2015-06-22

Inquest into the Death of Shane John ROBINSON

29y · Male·Multiple drug toxicity

Shane John Robinson, a 29-year-old prisoner with complex medical conditions including Crohn's disease, pulmonary embolism, anaemia and schizoaffective disorder, died from multiple drug toxicity in prison. He had been pre…

gastroenterologycardiologysystemmethadone
WA2015-02-24

Inquest into the Death of Valfrids KLAVINS

65y · Male·complications of mesothelioma

Valfrids Klavins was a 65-year-old prisoner who died from mesothelioma complications on 9 January 2012 at Sir Charles Gairdner Hospital. He had been exposed to asbestos during his youth while working as a laborer. In Aug…

general practicecardiology
WAhospital2015-02-13

Inquest into the Death of Christopher Ling TAO

2y · Male·Myocarditis secondary to Kawasaki Disease

Christopher Tao, aged 2 years 9 months, presented to Princess Margaret Hospital ED with a 5-day fever, cervical lymphadenopathy, rash, conjunctivitis, and other features diagnostic of Kawasaki Disease (KD) on 7 September…

emergency medicinepaediatricsdiagnosticcommunicationparacetamol
WAPodcast2015-02-09

Inquest into the Death of Myosotis Julianna MORIARTY

68y · Female·acute gastrointestinal haemorrhage secondary to bilateral dental extraction

A 68-year-old woman on long-term warfarin therapy for a prosthetic aortic valve died from acute gastrointestinal haemorrhage following dental extraction. The dentist failed to obtain an INR test within 24 hours of the pr…

dentistrygeneral practicediagnosticcommunicationwarfarin

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