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WAcommunity2020-11-05

Inquest into the Suspected Death of Paul Clifford YORK

45y · Male·unascertained

Paul Clifford York, 45, disappeared from Petrudor Rocks National Park on 10 November 2011 and is presumed dead. He had a long history of depression, suicidal ideation, and previous suicide attempts by hanging and overdos…

psychiatrygeneral practicediagnosticsystemmirtazapine
WAprison2020-11-04

Inquest into the Death of Damien PURNELL

47y · Male·organ failure following cardiorespiratory impairment in a man with arteriosclero…

Damien Matthew Purnell, a 47-year-old prisoner with a long history of polysubstance abuse and undiagnosed coronary artery disease, collapsed in his cell after smoking synthetic cannabinoids (Kronic). Despite immediate re…

emergency medicineintensive caresystemmethadone
WAcommunity2020-11-04

Inquest into the Death of Andrew John KEY

49y · Male·incised injury to the neck

Andrew Key, a 49-year-old man with bipolar affective disorder, died by suicide on 11 August 2015 after self-inflicting a neck injury while being restrained by police. Clinical lessons emerged regarding mental health asse…

psychiatryemergency medicinecommunicationsystemquetiapine
SAhospital2020-11-03

Coroner's Finding: WHISKEY Louise Kitty

51y · Female·community acquired pneumonia

Louise Kitty Whiskey, a 51-year-old Aboriginal woman with chronic alcohol misuse, cirrhosis, and recurrent respiratory infections, died from community-acquired pneumonia at Royal Adelaide Hospital. She was admitted on 23…

intensive carepsychiatrysystemnoradrenaline
NSW2020-11-03

Inquest into the death of Lawrence Hausia

30y · Male·atherosclerotic coronary artery disease

Lawrence Hausia, a 30-year-old man with type II diabetes and hypertension, died of atherosclerotic coronary artery disease while in custody at Metropolitan Reception and Remand Centre. He had engaged in physical activiti…

emergency medicinecardiologymetformin
SAhospital2020-11-02

Coroner's Finding: NIXON Viola Daphne

92y · Female·decompensated congestive cardiac failure secondary to haemophilus influenzae low…

A 92-year-old woman with dementia, heart disease, and COPD died from decompensated congestive cardiac failure secondary to haemophilus influenzae lower respiratory tract infection. She was admitted to psychiatric care un…

psychiatryemergency medicine
SAhospital2020-11-02

Coroner's Finding: MILOCCHI Guiseppe

90y · Male·pneumonia leading to atrial fibrillation leading to myocardial infarction

A 90-year-old man with lung cancer, dementia, and frontal lobe disease died from pneumonia leading to atrial fibrillation and myocardial infarction while on an inpatient mental health treatment order. He was admitted wit…

emergency medicinepsychiatryantibiotics
SAhospital2020-11-02

Coroner's Finding: MAGGS Eric Arthur

85y · Male·ischaemic heart disease

Eric Arthur Maggs, aged 85, died of ischaemic heart disease at Royal Adelaide Hospital. He was profoundly deaf from birth and had dementia. Admitted with acute chest pain and difficulty breathing, he became distressed an…

emergency medicinecardiologycefalexin
SAhospital2020-11-02

Coroner's Finding: HAUSLER Christopher Raymond

61y · Male·Creutzfeldt-Jakob disease

Christopher Raymond Hausler, a 61-year-old man, died from Creutzfeldt-Jakob disease (CJD) at the Royal Adelaide Hospital on 13 March 2018 while subject to a Level 2 Inpatient Treatment Order. He presented with rapidly pr…

general practiceneurologydiagnostic
SAhospital2020-11-02

Coroner's Finding: DAVIES Brian

79y · Male·myocardial infarction

Brian Davies, 79, died of myocardial infarction while under an Inpatient Treatment Order for Alzheimer's dementia at Noarlunga Hospital. He presented with cognitive decline following his partner's death and developed agi…

geriatric medicinepsychiatrymedicationoxazepam
SAhospital2020-11-02

Coroner's Finding: BROWN Graham Douglas

79y · Male·combined cardiac, respiratory and renal failure as terminal events on a backgrou…

Graham Douglas Brown, a 79-year-old man with end-stage dementia, died at Noarlunga Hospital from combined cardiac, respiratory and renal failure. He was subject to a Level 2 Mental Health Act Inpatient Treatment Order at…

psychiatryemergency medicinemorphine
NSWcommunity2020-10-30

COOK Grant Findings

28y · Male·Hypoxic brain injury as a result of a respiratory arrest, after inadequate respi…

Grant Cook, aged 28, collapsed during a rugby league game after a tackle caused him to fall and hit his head. He suffered a grand mal seizure with snoring/obstructed breathing, leading to respiratory arrest, cardiac arre…

paramedicineintensive carecommunicationdiagnosticadrenaline
VICcommunity2020-10-30

Finding into death of Norman MacKenzie

85y · Male·Multiple injuries sustained when struck by a bicycle

An 85-year-old pedestrian was struck by a cyclist travelling at 40 km/h through a busy pedestrian crossing. The victim crossed during a red pedestrian light when vehicle traffic was stationary, creating a false sense of …

trauma surgeryneurosurgerysystem
NSW2020-10-27

Inquest into the death of Mikael FELSCH

29y · Male·Unascertainable - likely drowning or accidental injury during terrain navigation…

Mikael Felsch, aged 29, died on 16 December 2015 in Wollemi National Park after becoming stranded in bushland. He had a significant history of suicide attempts and mental health issues exacerbated by methylamphetamine us…

psychiatryemergency medicinemethamphetamine
NSW2020-10-23

Inquest into the death of Ye Chiu

67y · Male·Head injuries sustained from a fall from the upstairs landing in Goldsmith G Blo…

Ye Chiu, a 67-year-old Chinese-speaking prisoner on remand, died by suicide in prison on 6 February 2017 after falling head-first from a landing. He had a complex psychiatric history including anxiety, depression, hypona…

psychiatryemergency medicinesystemcommunicationparoxetine
VICaged care2020-10-22

Finding into death of Phillip Harry Parker

61y · Male·Pneumonia

A 61-year-old man with significant medical complexity including acquired brain injury, bronchiectasis, pulmonary fibrosis, and dysphagia died from pneumonia 26 days after receiving another resident's slow-release opioid …

geriatric medicineemergency medicinemedicationsystemtapentadol sr
WAcommunity2020-10-22

Inquest into the Death of Jordana KOSTOVSKI

27y · Female·Multiple injuries sustained in motor vehicle collision

A 27-year-old woman under the influence of alcohol and methylamphetamine deliberately drove her van head-on into oncoming traffic on Forrest Highway, resulting in her death. Police had attempted to intercept her for dang…

forensic medicinetoxicologyalcohol
VIChospital2020-10-21

Finding into death of MRS M

91y · Female·Complications of pelvic fractures sustained in a fall

A 91-year-old woman with osteoporosis and multiple comorbidities sustained pelvic fractures in a mechanical fall at home. She presented to the ED where initial hip x-ray showed no fracture. She deteriorated with hypotens…

emergency medicinegeriatric medicinediagnosticdoxycycline
VIChospital2020-10-21

Finding into death of Anthony Lansell Churches

70y · Male·Cyanide Toxicity

Anthony Lansell Churches, a 70-year-old man with a history of substance use and criminal offences, died from cyanide toxicity after absconding from St Vincent's Hospital's Emergency Department. He had been placed on an i…

emergency medicinepsychiatrycommunicationsystemcyanide
WAhospital2020-10-19

Inquest into the Death of Renee Desiree RUYZING

21y · Female·pulmonary embolism in association with deep vein thrombosis of the left leg

A 21-year-old woman died from pulmonary embolism associated with deep vein thrombosis following ankle fracture surgery and immobilisation. She was discharged without thromboprophylaxis despite multiple VTE risk factors (…

orthopaedic surgeryemergency medicinediagnosticmedicationenoxaparin

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