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NSW2015-06-16

Inquest into the death of AB

34y · Male·Hanging

A 34-year-old man died by suicide by hanging whilst on remand in a correctional facility. He had disclosed his father's suicide 12 years earlier during initial assessment, but was not identified as self-harm risk. In the…

psychiatrycorrectional healthcommunicationsystem
NSWhospital2015-06-16

Inquest into the death of Sean WAYGOOD

47y · Male·acute renal failure caused by bilateral ureteral obstruction due to metastatic c…

Sean Waygood, an Extreme High Security prisoner, died from acute renal failure caused by metastatic colorectal cancer. He presented with abdominal pain, constipation, and blood per rectum in March 2011 but received subop…

general practiceoncologydiagnostictramadol
NSWcommunity2015-06-10

Inquest into the death of Laurence Paul LANDER

23y · Male·open finding - not determined

A 23-year-old man with intellectual disability and chronic schizophrenia disappeared into bushland in 1982 and was presumed deceased. Clinical lessons include the importance of comprehensive discharge planning for vulner…

psychiatrysystemcommunicationstelazine
NSWhome2015-06-09

Inquest into the death of Gabriele HANNEMANN

54y · Female·complications related to post-polio syndrome and chronic respiratory weakness; n…

Gabriele Hannemann, a 54-year-old woman with severe post-polio quadriplegia and chronic respiratory failure, died suddenly at home during consensual sexual activity. She had severely compromised lung function (13% predic…

respiratory medicinegeneral practicedelayparoxetine
NSW2015-06-09

Inquest into the disappearance and suspected deaths of Gheorghe RADU and Iudit SIMIONESCU

Unknown·unascertained

This inquest investigated the suspected deaths of Gheorghe Radu and Iudit Simionescu, members of the Sydney Romanian community who disappeared on 11 August 2001. Evidence showed Mr Radu was heavily involved in major drug…

heroin
NSWhospital2015-05-22

Inquest into the death of AB

33y · Male·Multiple injuries sustained from falling from height (fifth-floor window ledge) …

AB, a 33-year-old male, died on 20 April 2013 after falling from the fifth-floor window ledge of Liverpool Hospital while under police negotiation. He had been transferred from prison to immigration detention on 9 April …

psychiatrygeneral medicinecommunicationsystemquetiapine
NSWhome2015-05-15

Inquest into the death of Skye SASSINE

1y · Female·head injury sustained when the motor vehicle in which she was a passenger was st…

A 19-month-old child was fatally injured when a vehicle she was a passenger in was struck at high speed by a car being pursued by police. The pursuing officers drove with significant disregard for safe driving policies, …

proceduralsystem
NSW2015-05-13

Inquest into the disappearance and suspected death of Ninus Pedro Paul SCOGNAMIGLIO (n/a,PDF File)

38y · Male·undetermined

Ninus Pedro Paul Scognamiglio, a male aged approximately 38 years, went missing around 6-8 September 1998 near Budgewoi, NSW. Despite a coronial investigation, the available evidence was insufficient to determine the man…

NSW2015-05-12

Inquest into the death of John Vincent CREAN

25y · Male·Suspicious death, likely homicide; exact cause undetermined

John Vincent Crean disappeared on 6 January 1980 aged 25, found dead on balance of probabilities. While no body was recovered, all evidence indicates suspicious death, likely homicide related to drug debts owed to George…

systemdelay
NSWhome2015-04-20

Inquest into the disappearance and suspected death of John Ewen SCHRECK (aka John Charles STEWART)

74y · Male·Ischaemic Heart Disease

John Ewen Schreck disappeared from Moree, NSW in August 1978, leaving his family without explanation. He subsequently assumed the identity 'John Charles Stewart' and relocated to Thornbury, Victoria, where he died on 21 …

NSWcommunity2015-04-14

Inquest into the death of William James ROBSON-PEARCE

16y · Male·Severe closed head injury sustained when motorcycle collided with post and rail …

A 16-year-old learner motorcycle rider died from severe head injury after colliding with a fence while being pursued by police for speeding (121 km/h in a 50 km/h zone). The coroner found police actions complied with the…

NSW2015-04-02

Inquest into the death of SR

18y · Male·combination of blunt force injuries to chest and head from falling onto train ro…

An 18-year-old with depression and recent psychological trauma jumped from a railway bridge intending suicide. He struck a destination board and fell onto a train roof instead of in front of it. During a police rescue op…

emergency medicinepsychiatry
NSW2015-04-01

Inquest into the disappearance and suspected death of Marion REES

13y · Female

Marian Carole Rees, a 13-year-old girl, disappeared on 7 April 1975 after leaving for school from her family home in Hillsdale, NSW. The coroner examined evidence of her disappearance including witness accounts, governme…

NSWhome2015-04-01

Inquest into the death of Sebastien YEOMANS

2y · Male·Hypoxic brain damage due to drowning in a swimming pool

A 2.5-year-old boy drowned in a non-compliant private swimming pool after accessing it through a collapsed boundary fence that had been down for months. The coroner found the death preventable and examined systemic failu…

systemdelay
NSW2015-03-23

Inquiry into the fire at Sydney Aquatic Centre 13 October 2013

Fire at Sydney Olympic Park P2 car park, likely origin discarded cigarette in ga…

On 13 October 2013, a fire erupted in a garden bed abutting the P2 car park at Sydney Olympic Park Aquatic Centre during an extreme weather event (high temperature, strong wind, low humidity). The fire likely originated …

system
NSWhospital2015-03-16

Inquest into the death of John Gibson

63y · Male·Right cerebral infarction caused by infusion of medication via central venous li…

A 63-year-old man with COPD, liver cirrhosis and alcohol dependence underwent emergency hemicolectomy for caecal volvulus. Post-operatively he developed respiratory depression, hypernatremia and alcohol withdrawal requir…

surgeryanaesthesiaproceduraldiagnosticdiazepam
NSWmental health2015-03-13

Inquest into the death of Robert Gordon BRITTEN

68y · Male·bronchopneumonia with underlying Chronic Obstructive Pulmonary Disease

Robert Gordon Britten, a 68-year-old forensic patient under the Mental Health (Forensic Provisions) Act 1990, died of bronchopneumonia with underlying chronic obstructive pulmonary disease at Macquarie Hospital. He had b…

psychiatrygeneral medicine
NSWaged care2015-03-09

Inquest into the deaths and fire at the Quakers Hills Nursing Home, Hambledon Road, Quakers Hill

smoke inhalation and burns from deliberately-lit fire (primary cause varies by i…

Fourteen elderly residents died in a deliberately-lit fire at Quakers Hill Nursing Home on 18 November 2011, set by drug-dependent nurse Roger Dean to destroy evidence of medication theft. Dean had worked while visibly i…

geriatric medicineoccupational and environmental healthsystemcommunicationoxycodone
NSWcommunity2015-03-06

Inquest into the death of Andrew HABIB

20y · Male·hypertrophic cardiomyopathy shortly after participating in a martial arts traini…

Andrew Habib, aged 20, died from hypertrophic cardiomyopathy (a genetic heart condition causing left ventricular hypertrophy) during martial arts training at a gym despite having been advised to avoid strenuous exercise.…

cardiologyforensic medicinesystemdelayverapamil
NSWcommunity2015-02-27

Inquest into the death of Jake Robert INNES

21y · Male·Blunt force injuries to head and neck sustained in motor vehicle crash

Jake Robert Innes, 21 years old, died from blunt force injuries to his head and neck after losing control of a vehicle during a police interception attempt. The crash occurred on a wet road at excessive speed on an off-r…

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