Coronial

135 results for absconding

NSWcommunity2023-03-03

Inquest into the death of Darren Higgins

25y · Male·Dehydration with contributory causes of severe mental health conditions and hype…

…nia and polysubstance abuse disorder, died from dehydration and hyperthermia in Moira State Forest after absconding during escorted weekend leave from an involuntary mental health facility. Key clinical lessons include: …

psychiatryemergency medicinediagnosticcommunicationolanzapine
SAhospital2013-04-05

Coroner's Finding: RICCI John Peter

57y · Male·Acute renal failure complicating end stage liver cirrhosis with resultant enceph…

A 57-year-old man with end-stage alcoholic liver cirrhosis died of acute renal failure complicated by hepatic encephalopathy and coagulopathy while detained under mental health legislation. He presented with severe liver…

psychiatrygastroenterologylactulose
VICcommunity2025-11-18

Finding into death of Darren John Atkinson

50y · Male·Mixed alcohol and drug toxicity (clozapine, paracetamol, caffeine); cardiac hype…

A 50-year-old man with treatment-resistant schizoaffective disorder died from mixed alcohol and drug toxicity (clozapine, paracetamol, caffeine) combined with cardiac hypertrophy. He ceased his antipsychotic medication o…

psychiatryemergency medicinecommunicationsystemclozapine
QLDmental health2013-01-25

SH and AW

25y · Female·Chest injuries due to fall from height

Two psychiatric inpatients (SH, 25-year-old female; AW, 24-year-old male) died by suicide by jumping from the Buranda car park across from Princess Alexandra Hospital's Mental Health Unit within a 10-month period despite…

psychiatrydiagnosticcommunicationhaloperidol
VIC2016-08-22

Finding into death of Helen

68y · Female·Multiple injuries sustained in a fall

68-year-old woman with bipolar affective disorder and history of suicide attempts died by jumping from a car park rooftop on 14 April 2015. She had been discharged from psychiatric inpatient care to aged care on 2 March …

psychiatryemergency medicinesystemmirtazapine
NTmental health2019-09-13

Inquest into the death of Daniel Alexander Bleaney

37y · Male·blunt force injuries to the head and chest from jumping off an 8.65 metre roof

Daniel Bleaney, 37, experienced acute psychosis with command hallucinations while at sea and attempted suicide by jumping overboard. He was rescued and admitted involuntarily to Cowdy Ward, an open psychiatric ward, foll…

psychiatryemergency medicinesystemdiagnosticdiazepam
NSWmental health2025-10-20

Inquest into the Death of JSZ

66y · Male·Multiple blunt force injuries

JSZ, a 66-year-old forensic patient with chronic paranoid schizophrenia, died by suicide while on unsupervised day leave from Cumberland Hospital's Bunya Unit on 20 September 2023. He jumped from a cliff at Queen Elizabe…

psychiatryproceduralcommunicationzyprexa relprevv
WAcommunity2020-12-30

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

16y · Male·multiple injuries

… Department of Communities, which made reasonable efforts to find stable placements despite his repeated absconding. No systemic failures in child protection were identified.

emergency medicinetrauma surgerycannabis
WAhospital2005-02-04

Inquest into the Death of Alexander Albert Steinbrenner

36y · Male·Multiple injuries sustained from intentional jump from cliff top

Alexander Albert Steinbrenner, a 36-year-old man with schizo-affective disorder, died from multiple injuries sustained when he jumped from an 11-metre cliff at the Roundhouse in Fremantle on 27 February 2004. He was an i…

psychiatryemergency medicineflupenthixol
VICaged care2012-12-14

Finding into death of Harold Louis

67y · Male·Ischaemic Heart Disease and Coronary Artery Atherosclerosis

Harold Louis, a 67-year-old man with Alzheimer's dementia, ischaemic heart disease, diabetes, and hypertension, was admitted to an aged care facility as 'low care' despite rapidly requiring high-level supervision. Staff …

geriatric medicinecardiologydiagnosticsystem
VICmental health2020-07-30

Finding into death of William Thomas Flanagan

57y · Male·Multiple injuries sustained by being struck by a freight train

A 57-year-old man with 28-year history of treatment-resistant schizophrenia died by suicide when he absconded from an acute psychiatric unit and stepped in front of a train. Despite comprehensive psychiatric management i…

psychiatrycardiologysystemvenlafaxine
NSW2021-05-12

Inquest into the death of Jack KOKAUA

30y · Male·Malignant ventricular arrhythmia without myocardial infarction, precipitated by …

… and coronary artery disease, died from malignant ventricular arrhythmia during a police encounter after absconding from hospital. Contributing factors included positional asphyxia, exertion, taser use (deployed three ti…

emergency medicinepsychiatryproceduralcommunicationzuclopenthixol
NSW2018-05-30

Inquest into the death of Abduelaziz Omerhaj

36y · Male·undetermined (possibly ethylene glycol poisoning; possibly natural cause such as…

A 36-year-old man with acute psychotic illness absconded from Ryde Hospital Emergency Department on 3 August 2013 after refusing oral antipsychotic medication. He evaded police efforts to locate him and was found dead in…

psychiatryemergency medicinecommunicationproceduralolanzapine
VIChospital2023-04-03

Finding into death of David Bramwell Van Vledder

48y · Male·Drowning

A 48-year-old man with depression, problematic alcohol use, and recent onset paranoid ideation and auditory hallucinations presented twice to the Emergency Department on the morning of his death. Despite expressing suici…

emergency medicinepsychiatrydiagnosticcommunicationsertraline
VICmental health2015-10-30

Finding into death of Jarrod Wade Christie

23y · Male·injuries sustained when struck by train

Jarrod Christie, 23, a voluntary then involuntary psychiatric inpatient at Maroondah Hospital, absconded from the high-dependency unit on 22 December 2012 and died by suicide. Clinical lessons include: (1) GPs should ful…

psychiatrygeneral practicecommunicationsystemdesvenlafaxine
VIChospital2013-07-11

Finding into death of Stuart Alan Ronning

41y · Male·Hanging

Stuart Alan Ronning, a 41-year-old man with recurrent depressive disorder, alcohol dependency, and previous suicide attempts, presented to Royal Melbourne Hospital emergency department after being found with a noose at a…

psychiatryemergency medicinecommunicationsystemalcohol
VICmental health2012-10-12

Finding into death of Grant Elliot Phillips

29y · Male·Multiple injuries sustained in a train incident (intentional self-harm)

Grant Phillips, 29-year-old with schizophrenia and complex psychiatric history including multiple suicide attempts, was admitted involuntarily to Broadmeadows Inpatient Psychiatric Unit on 5 May 2007. Despite being asses…

psychiatrydiagnosticsystemdextroamphetamine
VICcommunity2016-12-05

Finding into death of Miroslaw Dziczkowski

40y · Male·UNDETERMINED - natural causes (most probably natural disease; starvation could n…

Miroslaw Dziczkowski, a 40-year-old man with paranoid schizophrenia managed under a Community Treatment Order, disappeared in January 2013 after withdrawing $7300 and relocating to a caravan park without notifying his me…

psychiatryforensic medicinesystemdelayzuclopenthixol decanoate
ACThospital2018-05-04

AN INQUEST INTO THE DEATH OFTAHADESSE (TAD) KAHSAI

61y · Male·exposure and dehydration, preceded by alcohol withdrawal and chronic alcoholism

A 61-year-old man with chronic alcoholism was admitted to hospital for alcohol withdrawal management. He became confused and paranoid on the ward, received appropriate medication, but left hospital unobserved approximate…

emergency medicinegeneral medicinesystemcommunicationoxazepam
NSW2016-09-12

Inquest into the death of M

15y · Female·hypoxic brain damage due to multiple drug toxicity

…le a known drug user was present. She had complex trauma from childhood abuse, a history of drug use and absconding, and was awaiting trial to give evidence about sexual assault. Gordon House youth workers provided resid…

emergency medicinetoxicologydelaysystemheroin

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