Coronial

113 results for behavioural disturbance

SAhospital2019-04-15

Coroner's Finding: CURTIN Roger

63y · Male·metastatic non-small cell lung carcinoma with chronic obstructive lung disease

Mr Curtin, a 63-year-old with metastatic non-small cell lung carcinoma and severe COPD, was admitted to Repatriation General Hospital on 14 August 2015 with dyspnea and confusion. His condition deteriorated with delirium…

palliative carepsychiatryolanzapine
NSWcommunity2014-12-18

Inquest into the death of Kenneth MAWBY

59y · Male·Suicide by hanging while suffering from a mood disorder in the nature of deliriu…

…p Brain Stimulation (DBS) surgery for Parkinson's disease. Post-operatively, he experienced significant behavioural changes including agitation, impulsivity, and mood disturbances. Critical failures in post-operative ca…

neurologyneurosurgerycommunicationsystemmadopar
VICcommunity2015-12-18

Finding into death of Paul Bermingham

38y · Male·Toxicity to methylamphetamine

Paul Bermingham, a 38-year-old man with a history of recreational drug use, experienced acute behavioural changes consistent with methamphetamine intoxication on 15 December 2013. He displayed paranoid delusio…

toxicologyemergency medicinemethamphetamine
SAhospital2014-11-28

Coroner's Finding: ANDERSON Joel Kenneth

50y · Male·hepatic encephalopathy secondary to liver cirrhosis with background of hepatitis…

…is hospital course was complicated by non-compliance, alcohol use during brief absconding episodes, and behavioural disturbance requiring psychiatric detention and restraint. The coroner found his detention lawful and m…

gastroenterologyhepatologyspironolactone
WAcommunity2005-06-09

Inquest into the Death of Richard Stanley Tauwhare

25y · Male·gastro-intestinal haemorrhage due to erosive gastritis in association with acute…

Richard Stanley Tauwhare, a 25-year-old male, died on 10 February 2002 from gastro-intestinal haemorrhage due to erosive gastritis in association with acute-on-chronic amphetamine toxicity. He had consumed a large dose o…

methamphetamine
SAhospital2022-08-15

Coroner's Finding: Kelley, John Michael

83y · Male·General inanition and aspiration pneumonia on a background of end-stage Alzheime…

An 83-year-old man with end-stage Alzheimer's dementia died from general inanition and aspiration pneumonia while subject to a Mental Health Act order in hospital. He had experienced two episodes of aspiration pneumonia …

psychiatrygeriatric medicineantibiotics
QLDhospital2025-03-31

Inquest into the death of Jamie Brian Campbell

43y · Male·Hypoxic ischaemic encephalopathy, due to or as consequence of, cardiac arrest of…

A 43-year-old man with methamphetamine toxicity was restrained by police and given two doses of droperidol by paramedics who failed to recognize he was critically unwell. The first dose was clinically indicated, but the …

emergency medicinetoxicologydiagnosticmedicationmethamphetamine
NSWcommunity2016-07-12

Inquest into the death of Matthew Mitchell

30y · Male·head injury occasioned by impact with a moving vehicle moving at speed

…idence prevented establishing his involvement. Key clinical lesson: the importance of recognising acute behavioural disturbance and intoxication-related risks in community settings, and the value of witness cooperation …

trauma surgeryneurosurgeryalcohol
SAaged care2012-12-13

Coroner's Finding: Kruger Mary Patricia

69y · Female·bronchopneumonia complicating intracranial tumour (meningioma with obstructive h…

…ored all subsequent clinical decisions. Visual symptoms (progressive vision loss and optic atrophy) and behavioural changes (disinhibition, tremor) were later attributed to dementia rather than prompting neuroimaging. C…

general practiceneurologydiagnosticcommunicationcarbidopa
VICmental health2010-09-08

Finding into death of Brian O'Connor

73y · Male·Acute on chronic subdural haematoma due to recent head trauma in the context of …

Brian O'Connor, a 73-year-old man with vascular dementia, was admitted to a mental health inpatient unit following aggressive behaviour. He was placed on 15-minute observations due to Level 3 falls risk. Over several wee…

psychiatryneurosurgerydiagnosticsystemfluphenazine
SAhospital2016-05-05

Coroner's Finding: FALKENBERG Malcolm David

77y · Male·septic shock due to cellulitis of the left forearm

…e the importance of early recognition of cellulitis signs, ensuring adequate IV access in patients with behavioural disturbance (including consideration of sedation or restraint), and prompt escalation when oral antibio…

geriatric medicineemergency medicinediagnosticdelayantibiotics
NSWhospital2020-02-14

Inquest into the death of Tristan Naudi

23y · Male·Acute cardiac arrhythmia in 3,4-methylenedioxymethylamphetamine (MDMA) intoxicat…

Tristan Naudi, 23, died from acute cardiac arrhythmia during MDMA intoxication while being restrained prone at hospital. Police appropriately placed him in a police vehicle after finding him violently agitated at home. A…

emergency medicinetoxicologysystemdelayMDMA
NTcommunity2026-01-23

Inquest into the death of Kumanjayi Johnson

45y · Male·Environmental exposure and dehydration

… procedures for missing person reporting; poor coordination between disability service providers (LSS), behavioural support staff, and guardianship officers; lack of Aboriginal staff and cultural competency training; in…

geriatric medicinepsychiatrycommunicationsystem
NSWhospital2024-01-30

Inquest into the death of Subash Subedi

26y · Male·Not able to be determined - skeletalised remains

Subash Subedi, a 26-year-old international student from Nepal, died in a stormwater drainage system beneath the M2 Motorway between February 2018 and April 2019. He presented to Westmead Hospital ED on 14 February 2018 w…

emergency medicinepsychiatrycommunicationsystemolanzapine
VICaged care2010-09-08

Finding into death of Joan Hendrickson

78y · Female·Aspiration pneumonia, epistaxis, and trauma to the face

Joan Hendrickson, a 78-year-old with vascular dementia, was assaulted by a co-resident at an aged care facility in April 2006, sustaining facial trauma and epistaxis. She died from aspiration pneumonia 10 days later. The…

general practicegeriatric medicinecommunicationsystem
NSWhome2021-03-11

Inquest into the death of Chan Chen

35y · Female·Stab wounds to the chest

Chan Chen, 35, was killed by her husband Andrew Luo in their home through stab wounds to the chest. Luo had displayed increasingly erratic behaviour throughout 2019, including delusions of persecution, beliefs that Chen …

general practicepsychiatrydiagnosticcommunicationrisperidone
NSWcommunity2022-02-18

Inquest into the death of SP

36y · Male·hanging

A 36-year-old man died by hanging on 10 July 2018 after leaving his home in Blacktown, NSW. His partner called Triple Zero after 30 minutes, reporting concern for his welfare and that he was acting strangely, restless, a…

emergency medicineparamedicinecommunicationsystem
QLDcommunity2026-02-13

Inquest into the passing of Steven Lee Nixon-McKellar

27y · Male·Sudden cardiac arrest in the context of physical and psychological exertion duri…

Steven Nixon-McKellar, a 27-year-old First Nations man, died following a physical altercation with Queensland Police officers attempting to arrest him on 7 October 2021. He suffered cardiac arrest during restraint, with …

emergency medicineforensic medicinemethamphetamine
VIC2026-03-30

Finding into death of Hari Prasad Dhakal

57y · Male·Neck compression and hanging

A 57-year-old man with schizophrenia and schizoaffective disorder died by hanging in prison on 4 August 2024. He had been receiving antipsychotic treatment via injection (paliperidone) but ceased antipsychotic medication…

psychiatrygeneral practicesystemcommunicationpaliperidone
NSW2025-03-06

Inquest into the death of Leah Jane Porter

50y · Female·hanging

A 50-year-old woman with severe borderline personality disorder and ADHD died by hanging in immigration detention. The coroner found her mental health monitoring and treatment were adequate, though she received only two …

psychiatrygeneral practicecommunicationsystemmethylphenidate

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