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Inquest into the Death of Baby AM

<1y · Male·severe hypoxic ischaemic encephalopathy secondary to uterine rupture

Baby AM died from severe hypoxic ischaemic encephalopathy secondary to uterine rupture during a planned home vaginal birth after caesarean (VBAC). The mother, Ms M, was 40 weeks and 5 days pregnant, attended by a private…

obstetricsmidwiferydiagnosticcommunication
WAcommunity

Inquest into the Deaths of Amy-Lee ARMSTRONG and Kyrone Terrance EADES and Ashley Scott DE AGRELA

Unknown·Multiple injuries (Armstrong and Eades); complications of head injury (De Agrela…

Three young people died in a high-speed motor vehicle crash on 2-4 December 2015 in Western Australia. The driver, Matthew Conduit, was under the influence of alcohol and methylamphetamine, and was speeding at over twice…

alcohol
WAcommunity

Inquest into the Suspected Death of Whisky BIBROU

64y · Male·Unknown - likely drowning but possibly natural medical event; cause could not be…

This coronal finding concerns a long-term missing person case from 1976. Whisky Bibrou, approximately 64 years old, disappeared on 21 October 1976 while intoxicated and crossing Streeter Creek in Broome to reach town. He…

WA

Inquest into the Death of Dragan JACOVIC

63y · Male·ischaemic heart disease

Dragan Jacovic, a 63-year-old life prisoner with extensive comorbidities including severe ischaemic heart disease, type 2 diabetes, chronic kidney disease, and chronic paranoid schizophrenia, was admitted to hospital on …

cardiologypsychiatryolanzapine
WAcustody

Inquest into the Death of Desmond Richard KICKETT

34y · Male·multiple organ failure following cardiorespiratory arrest in a man with focal co…

A 34-year-old man died from cardiorespiratory arrest with multiple organ failure after methylamphetamine use combined with underlying focal coronary arteriosclerosis. He became unresponsive in police custody while being …

emergency medicinecardiologymethamphetamine
WA

Inquest into the Suspected Death of Hajime NAGAI

23y · Male·Drowning

Hajime Nagai, a 23-year-old Japanese tourist, drowned at Salmon Beach, Esperance, Western Australia on 11 March 1995 after slipping from rocks into the sea. Despite multiple attempts to climb back onto rocks, he was repe…

WAhospital

Inquest into the Death of Robin David MACARTNEY

62y · Male·bronchopneumonia in a man receiving terminal palliative care for metastatic carc…

Robin David Macartney, a 62-year-old prisoner serving a life sentence for murder, died from bronchopneumonia secondary to metastatic colon cancer. He was diagnosed with sigmoid colon cancer in December 2006 but refused s…

oncologygeneral surgery
WA

Inquest into the Death of Anthony John BILICK

34y · Male·Severe chest injury with fractures to ribs and sternum, internal bleeding, lacer…

A 34-year-old male motorcyclist died from severe chest injuries after crashing into a Toyota Tarago at high speed. He was riding a stolen, high-performance Ducati motorcycle with a false number plate, intoxicated with me…

emergency medicinetrauma surgeryamphetamine
WAcommunity

Inquest into the Death of Paul DICKSON

34y · Male·multiple injuries

Paul Dickson, a 34-year-old man with severe paranoid schizophrenia managed on a Community Treatment Order, died by suicide on 11 November 2013 after stepping in front of a truck. He had been discharged from Graylands Hos…

psychiatryemergency medicineolanzapine
WAcommunity

Inquest into the Death of Kim Martin FRANKER

36y · Male·Combined effects of trihexyphenidyl (benzhexol) toxicity, amphetamine-type stimu…

A 36-year-old man with schizoaffective disorder, substance abuse issues, and undiagnosed cardiomyopathy died from combined toxicity of benzhexol (prescribed by his GP for tardive dyskinesia), amphetamine-type stimulants,…

psychiatrygeneral practicecommunicationsystembenzhexol
WAmental health

Inquest into the Death of David GRIEVE

45y · Male·Coronary Atherosclerosis

David Grieve, a 45-year-old man with chronic schizophrenia and multiple cardiac risk factors (hypertension, diabetes, obesity, smoking), died of coronary atherosclerosis while an involuntary psychiatric patient at Grayla…

psychiatrycardiologysystemcommunicationhaloperidol
WA

Inquest into the Death of Jarrod Arthur HAMPTON

22y · Male·drowning secondary to incapacitation from air embolism

A 22-year-old skilled and experienced pearl shell drift diver with over 600 logged dives died from drowning secondary to air embolism and cerebral arterial gas embolism while diving for Paspaley Pearling Company off Broo…

diving medicineoccupational and environmental healthsystemdelay
WAcommunity

Inquest into the Death of Radwan KANAWATI

41y · Male·atropine toxicity

A 41-year-old man with schizoaffective disorder, intellectual disability and sexual offending history died from atropine toxicity after ingesting 6-8ml of atropine liquid prescribed for hyper-salivation. He had been disc…

psychiatrycommunicationsystematropine
WAcommunity

Inquest into the Death of Gary John LYDDIETH

54y · Male·Unknown - death established on balance of probabilities but manner and cause und…

A 54-year-old man with major depressive disorder, chronic suicidality, and alcohol abuse was discharged from psychiatric hospital on 23 April 2014 while remaining at "very high chronic suicide risk." He had multiple prio…

psychiatrygeneral medicinesystemcommunication
WAcommunity

Inquest into the Death of Dean Anthony POLLARD

41y · Male·unknown

Dean Anthony Pollard was a 41-year-old man with a long history of schizophrenia and amphetamine-induced psychotic disorder who disappeared in May-June 2010 and is presumed dead. He had multiple psychiatric admissions bet…

psychiatryemergency medicinesystemcommunicationmethamphetamine
WAhospital

Inquest into the Death of Robert Paul RODDA

62y · Male·Multi-organ failure following surgical repair of ruptured abdominal aortic aneur…

Robert Paul Rodda, a 62-year-old long-term prisoner with extensive medical comorbidities including ischaemic heart disease, COPD, and a known abdominal aortic aneurysm (AAA), presented with chest pain in September 2015. …

vascular surgerycardiology
WAmental health

Inquest into the Death of Vincent Tavita Tolai SCHWENKE

24y · Male·complications of ligature compression of the neck (hanging)

Vincent Schwenke, a 24-year-old male of Maori descent, developed acute psychotic symptoms after ceasing cannabis use and was admitted to a secure mental health unit as an involuntary patient. Despite initial improvement …

psychiatryneurologyescitalopram
WAcommunity

Inquest into the Death of Petronella ALBERT

22y · Female·Unable to determine - open finding

Petronella Albert, a 22-year-old Aboriginal woman from Broome, disappeared in late April or early May 1999 and is presumed deceased. The coronial inquest, conducted in 2017, established her death beyond reasonable doubt …

systemdelay
WA

Inquest into the Death of Matthias Ashley BACHE

25y · Male·Drowning

A 25-year-old experienced swimmer and rock jumper died by drowning after jumping into ocean water at Wyadup Rocks, Western Australia. Despite strong swell conditions and his friend's warning against jumping, the deceased…

WAcommunity

Inquest into the Death of Sean Duncan BARRETT

Unknown·Multiple injuries resulting from motor vehicle collisions following police pursu…

This inquest examined six deaths following police pursuits/intercepts in Western Australia between October 2012 and December 2014. Four of five drivers fleeing police were severely methylamphetamine-intoxicated, signific…

methamphetamine

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