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TASaged care2023

Coroner's Finding: Tweedie, Valma Ann

72y · Female·Pneumonia following cervical spine injuries sustained in an unwitnessed mechanic…

Valma Ann Tweedie, aged 72, died from pneumonia following cervical spine injuries sustained in an unwitnessed fall at a disability support facility. She had a known history of falls, mobility problems, and probable demen…

emergency medicinetrauma surgerydiagnosticcommunication
NTcommunity2023

Inquest into the death of Toddler R

3y · Male·Disseminated Staphylococcus aureus infection

A 3-year-old Aboriginal boy died from disseminated Staphylococcus aureus infection with sepsis. He presented to a remote clinic on 10 April with fever and dizziness, then returned on 13 April with irregular fever, lethar…

general practicepaediatricsdiagnosticdelayparacetamol
VIChome2023

Finding into death of Mr ZJF

27y · Male·Dextromethorphan toxicity

Mr ZJF, a 27-year-old man with a longstanding history of schizophrenia, polysubstance use disorder, and depression, died from dextromethorphan toxicity. He was subject to a Community Treatment Order at the time of death …

psychiatrygeneral practicesystemdextromethorphan
VIChospital2023

Finding into death of Bailey James Blackwell

17y · Male·head injury in a fall from a height

Bailey Blackwell, a 17-year-old Aboriginal man, died from a head injury sustained in a fall from approximately 20 metres at Big Hill near Stawell. While attempting to jump between ledges on an open cliff face, the ground…

trauma surgeryneurosurgery
WA2022-12-23

Inquest into the Death of Ms L (Name Subject to Suppression Order)

27y · Female·multiple injuries sustained from fall from 30-storey building

Ms L, a 27-year-old German national, died by suicide on 4 March 2021 after jumping from a 30-storey building in Perth. She had experienced depression since 2016, exacerbated by recent diagnoses of chlamydia and HPV16 in …

general practicegynaecologyfluoxetine
VIChospital2022-12-22

Finding into death of Paige Dent

25y · Female·Injuries sustained in a single vehicle motor vehicle incident in which Ms Dent w…

Paige Dent, 25, died in a single-vehicle motor accident after absconding from hospital on 6 October 2018. She had a 19-year history of psychiatric admissions for schizophrenia, borderline personality disorder, and substa…

psychiatryemergency medicinesystemcommunicationmethamphetamine
NSWhospital2022-12-21

Inquest into death of Andrea LESTER

49y · Female·Hypoxic brain injury related to tracheostomy complications in form of airway occ…

Andrea Lester, age 49, suffered a subarachnoid haemorrhage from a PICA aneurysm in March 2018 with delayed diagnosis. Following complex neurosurgery causing Wallenberg syndrome, she required tracheostomy for bulbar dysfu…

neurosurgeryintensive carediagnosticcommunicationtramadol
VICcommunity2022-12-20

Finding into death of Charles Frederick Norton

87y · Male·Ischaemic heart disease in the setting of immersion

Charles Frederick Norton, 87, was found deceased in an unsecured canal at a retirement village on 28 February 2020. He had ischaemic heart disease with severe atherosclerosis and aortic stenosis. In the week before death…

general practiceemergency medicinesystemdiltiazem
VIChospital2022-12-20

Finding into death of John Hardy Stow

73y · Male·Aspiration pneumonia

John Hardy Stow, 73, died of aspiration pneumonia complicated by a small bowel obstruction. He had cerebral palsy, intellectual disability, dysphagia, and was at high risk of aspiration. He presented with vomiting and wa…

palliative caregeneral medicineescitalopram
SAhome2022-12-16

Coroner's Finding: Reid, Paul

50y · Male·ischaemic heart disease

Paul Reid, a 50-year-old Aboriginal man with severe ischaemic heart disease and poor medication compliance, died of a cardiac arrhythmia during his arrest by South Australian Police. He was highly intoxicated (BAC 0.25%)…

cardiologyforensic medicinediagnosticsystemalcohol
VIChospital2022-12-16

Finding into death of Arthur Peter Andrianakis

51y · Male·Hyperthermia of unknown cause in a man with cardiac hypertrophy; chronic obstruc…

Arthur Andrianakis, 51, died from hyperthermia of unknown cause with cardiac hypertrophy and COPD. He presented to hospital with respiratory distress following police custody for assaulting his mother. Initial diagnosis …

emergency medicineintensive caresalbutamol
NSW2022-12-16

Inquest into the death of Joshua DUKE

38y · Male·gunshot wound of the head

Joshua Duke died following a police operation where he was shot by four NSW Police officers after a vehicle pursuit. He was armed with a double-barrel shotgun and had two separate shooting encounters with police on a pri…

forensic medicineemergency medicinemethamphetamine
TAScommunity2022-12-15

Coroner's Finding: Wildman, Benjamen

37y · Male·self-inflicted stab wound to the chest

Benjamen Robert Wildman, aged 37, died from a self-inflicted stab wound to the chest while in police custody on 29 December 2020. He had a lifelong history of mental health difficulties, personality dysfunction stemming …

psychiatrypsychology
TAShospital2022-12-15

Coroner's Finding: Mather, Robert Andrew

80y · Male·asphyxia due to choking on food

Robert Mather, 80, died from asphyxia due to choking on food while hospitalised with acute psychosis, severe malnutrition, iron deficiency anaemia and urinary retention. He had schizophrenia with 40+ year history and poo…

psychiatrygeriatric medicineantipsychotic medications
VIChome2022-12-15

Finding into death of Taylor Zachary Oliver

19y · Male·Stab wounds to the neck and chest

Taylor Oliver, a 19-year-old with schizophrenia and substance use disorder, died by self-inflicted stab wounds on 1 December 2019. He had been admitted to mental health inpatient care on 18 November 2019 following overdo…

psychiatryemergency medicinecommunicationsystempaliperidone
WAprison2022-12-13

Inquest into the Death of William Frederick ANDERSON

53y · Male·intracerebral haemorrhage

William Anderson, an Aboriginal man aged 53, suffered a catastrophic intracerebral haemorrhage while imprisoned and died despite timely emergency response. Multiple delays occurred: 25 minutes before the cell was opened,…

emergency medicineneurologydelaysystemaspirin
WAcommunity2022-12-12

Inquest into the Death of Lewis Henry Mark WESTON

22y · Male·ligature compression of the neck (hanging)

Lewis Weston, aged 22, died by suicide on 3 November 2020 while subject to a Community Treatment Order (CTO) for Schizoaffective Disorder. He presented with first-episode psychosis in 2017 and repeatedly refused antipsyc…

psychiatryemergency medicineolanzapine
WAhome2022-12-08

Inquest into the Death of Child B (Name Subject to Suppression Order)

3y · Male·Hypoxic ischaemic encephalopathy complicating hypoglycaemia with shock and statu…

A 3-year-old boy with septo-optic dysplasia and panhypopituitarism died from hypoxic ischaemic encephalopathy secondary to adrenal crisis and hypoglycaemic shock. He was in state care and had an emergency management plan…

endocrinologypaediatricssystemdelayhydrocortisone
NSWhospital2022-12-08

Inquest into the death of Austin Facer

6y · Male·cardiopulmonary arrest on a background of earlier cardiac arrests and resuscitat…

Austin Facer, a 6-year-old boy, suffered multiple cardiac arrests at school on 21 October 2019, initially resuscitated successfully, but died during transfer preparation to a higher-level hospital that evening. Autopsy r…

paediatricsemergency medicinecommunicationsystemadrenaline
TAScommunity2022-12-07

Coroner's Finding: Triffett, Brendan

40y · Male·cardiac arrhythmia due to cardiovascular disease

Mr Brendan Triffett, aged 40, died suddenly from cardiac arrhythmia whilst participating in supervised hydrotherapy at Kingston Pool, Tasmania on 13 March 2018. He had significant medical history including an acquired br…

cardiologyemergency medicineamitriptyline

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