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VIChospital2022-10-05

Finding into death of Stanley Stewart

91y · Male·Cholangiocarcinoma

Stanley Stewart, a 91-year-old man with advanced cholangiocarcinoma, died from natural causes at Northern Hospital. He resided in a disability group home and received palliative care from his GP and the Melbourne City Mi…

palliative careoncologybuprenorphine
VIChospital2022-10-05

Finding into death of Douglas Earnest Stott

72y · Male·Diffuse large B cell lymphoma

Douglas Stott, a 72-year-old prisoner with diffuse large B cell lymphoma, died of natural causes in hospital on 7 January 2021. He had been receiving telehealth oncology consultations while incarcerated but refused in-pe…

oncologyhaematologysystemdelayibrutinib
TASaged care2022-10-04

Coroner's Finding: Mundy, Gilbert Raymond

69y · Male·Chronic obstructive pulmonary disease, congestive cardiac failure and injuries s…

A 69-year-old man with severe COPD, congestive cardiac failure, epilepsy and high falls risk died following a fall from his motorised scooter at a post office. He had left his nursing home alone without direct staff cont…

geriatric medicineemergency medicinesystem
VIChome2022-10-04

Finding into death of Baby R

3y · Unknown·Unascertained - natural causes; evidence of aspiration pneumonia, hypoxic-ischae…

Baby R, born at 38 weeks gestation to a mother with previous pregnancy losses, was small-for-gestational-age (SGA, 10th centile). The mother was appropriately excluded from the hospital-supported home birth program due t…

obstetricsmidwiferysystemcommunication
VIChospital2022-10-03

Finding into death of Travis Jack Blows

15y · Male·pneumonia in the setting of cerebral palsy and epilepsy

Travis Blows, a 15-year-old with cerebral palsy and difficult-to-control epilepsy, died from pneumonia after a prolonged PICU admission. He presented to ED multiple times in the months before death with seizures and feve…

neurologyintensive careclobazam
TAShospital2022-09-27

Coroner's Finding: Borton Jessica Rose-Aida

43y · Female·hypoxic brain injury due to pulmonary thromboembolism (right calf deep vein thro…

A 43-year-old woman died of pulmonary embolism following Achilles tendon rupture. She fell in a car park on 4 October 2021, sustaining a right ankle injury initially treated conservatively with immobilisation. An Achille…

orthopaedic surgeryemergency medicinediagnosticsystem
VIChome2022-09-27

Finding into death of Colleen Mary Chapman

59y · Female·Myocardial infarction secondary to ischaemic heart disease

Colleen Mary Chapman, a 59-year-old woman with intellectual disability living in a community residential unit, died of myocardial infarction secondary to ischaemic heart disease, with WHO Class IV obesity as a contributi…

cardiologyemergency medicinesystemcommunicationcarbamazepine
VIChospital2022-09-27

Finding into death of Neville Ernest Mills

66y · Male·Ruptured abdominal aortic aneurysm

A 66-year-old man presented to the Emergency Department with left-sided abdominal pain on 14 July 2021. After waiting over 6 hours in a crowded ED with restricted access to treatment spaces, he left without medical asses…

emergency medicinegeneral surgerysystemdelayibuprofen
NSWhospital2022-09-26

Inquest into the death of Faithe Baxter

22y · Female·cardiac arrest of uncertain cause noting the existence of drug toxicity; the dru…

Faithe Baxter, aged 22, died from cardiac arrest due to methamphetamine toxicity after using multiple drugs including methamphetamine, benzodiazepines, opioids and nitrous oxide. She became unconscious in a car overnight…

emergency medicineintensive caredelaymethamphetamine
QLDhospital2022-09-23

Adams, Adrian John

76y · Male·Small bowel obstruction and acute renal failure, due to or as a consequence of m…

Adrian Adams, aged 76, died in Princess Alexandra Hospital from small bowel obstruction and acute renal failure secondary to metastatic colorectal cancer. He was serving an eight-year sentence for sexual offences at the …

palliative careemergency medicinemedicationsystemdutasteride
TAShospital2022-09-21

Coroner's Finding: Brown, Sandra Anne

54y · Female·hypothermia, likely related to drug toxicity

Sandra Anne Brown, a 54-year-old woman with multiple chronic conditions including COPD, diabetes, bipolar disorder and epilepsy, died from hypothermia likely related to drug toxicity. She presented to the ED with breathi…

emergency medicinerespiratory medicinecommunicationsystemfluvoxamine
VIChome2022-09-21

Finding into death of Colin Snooks

70y · Male·Multiple injuries sustained in a motor vehicle incident (pedestrian)

Colin Snooks, aged 70, died from multiple injuries sustained when struck by a motor vehicle driven by his former partner, Janice Bufton, on 30 October 2017. The death occurred in the context of a family violence relation…

emergency medicineforensic medicinesystem
VICaged care2022-09-20

Finding into death of Tom Owen Row

59y · Male·Choking asphyxia

Tom Owen Row, a 59-year-old man with intellectual disability, dementia, Fragile X Syndrome, and Chromosome 18 Deletion Syndrome, died from choking asphyxia at a residential care facility. He had a prior choking incident …

geriatric medicinepsychiatrysystemrisperidone
TAShospital2022-09-19

Coroner's Finding: Tommerup, Daniel James

51y · Male·multi-organ failure due to acute kidney injury and haemodynamic shock as a conse…

A 51-year-old man with significant alcohol intoxication sustained thermal burns affecting over 60% of body surface area when he accidentally set fire to himself while homeless. He was transported from Launceston General …

emergency medicineplastic and reconstructive surgeryalcohol
ACThospital2022-09-16

Inquest into the death of Mrs Judith Gaye Flynn

72y · Female·subdural haemorrhage sustained from a fall from a hospital bed on 18 January 201…

Mrs Judith Gaye Flynn, aged 72, died from a subdural haemorrhage sustained when she fell from a hospital bed on the General Medicine Ward at Canberra Hospital. She was a high-risk fall patient with cognitive impairment, …

general medicineemergency medicinesystemcommunication
NSWcommunity2022-09-16

Inquest into the disappearance of CD

36y · Male·Cannot be determined

CD, aged 36, disappeared on 17 June 2019 after exhibiting significant mental health deterioration, recent suicidal ideation, paranoia, alcohol abuse, and relationship breakdown. The coroner found sufficient evidence that…

psychiatryemergency medicinesystemcommunicationalcohol
NSWcommunity2022-09-16

Inquest into the death of M G

51y · Male·multiple injuries sustained by a high velocity fall from a height

A 51-year-old man with longstanding schizoaffective disorder who was inadequately medicated drove 400km from home and positioned himself precariously on the Wingecarribee River Bridge with clear suicidal intent. Fourteen…

psychiatryemergency medicine
WA2022-09-15

Inquest into the Death of Leslie SHORTTE

71y · Male·Complications of metastatic squamous cell carcinoma (terminal palliation)

Leslie Shortte, a 71-year-old life prisoner, died from metastatic squamous cell carcinoma with complications. Critical failures in his prison medical care included: failure to complete annual health assessments after 201…

oncologypalliative carediagnosticcommunicationlidocaine
VIChospital2022-09-15

Finding into death of Jennifer Anne Jones

62y · Female·Sepsis secondary to lower respiratory tract infection

Jennifer Anne Jones, a 62-year-old woman with Down's syndrome, dementia, dysphagia, and epilepsy living in a disability care facility, died from sepsis secondary to lower respiratory tract infection. She presented with h…

general practiceemergency medicinebetamethasone
WAcommunity2022-09-14

Inquest into the Death of Warren Keith MATTHEWS

27y · Male·Head injury

Warren Keith Matthews, aged 27, died from head injury following a motor vehicle collision on Bussell Highway, Western Australia. He was driving a vehicle without registration plates when police attempted to stop him. He …

emergency medicineneurosurgerymethamphetamine

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