Coronial

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VIC2026-03-17

Finding into death of Anthony Joseph Moore

71y · Male·Complications of rib fractures, liver laceration and pneumothorax sustained in a…

Anthony Joseph Moore, 71, died from complications of rib fractures, liver laceration and pneumothorax sustained in a fall at Bundoora Park on 15 August 2025. While being assisted by a disability support worker near a ben…

emergency medicinepalliative care
NSWhospital2026-03-17

Inquest into the death of Gia Lam

32y · Female·Sepsis due to pyelonephritis of the right kidney due to acute and chronic cystit…

A 32-year-old Vietnamese-speaking woman died from sepsis due to pyelonephritis following premature discharge from hospital onto a midwifery support program. Multiple missed diagnostic opportunities occurred: difficulty p…

obstetricsmidwiferydiagnosticcommunication
VIChome2026-03-16

Finding into death of John O'Grady

63y · Male·Effects of fire

A 63-year-old man with bipolar disorder, Crohn's disease, ADHD and HIV died in a residential fire at his apartment. He was found with evidence of unsafe smoking in bed, including numerous cigarette butts throughout his u…

general practicepsychiatrysystemrisperidone
VIC2026-03-16

Finding into death of Kwok Wah Yau

62y · Male·MULTIPLE INJURIES SUSTAINED IN A MOTOR VEHICLE INCIDENT (CAR VS. CAR, REAR PASSE…

A 62-year-old man died in a motor vehicle collision when the rental car he was a rear passenger in failed to give way at an intersection. The Mazda was travelling at 33 km/h when struck by a Toyota travelling at 79-86 km…

forensic medicine
VICaged care2026-03-16

Finding into death of Michelle Anne Leiper

59y · Female·Aspiration pneumonia and urosepsis complicating Alzheimer's dementia in setting …

Michelle Anne Leiper, aged 59 with Down syndrome and Alzheimer's dementia, died from aspiration pneumonia and urosepsis. She had significant dysphagia and was largely bedbound in her final years. After a February 2025 ho…

geriatric medicinepalliative care
VICcommunity2026-03-16

Finding into death of JBV JBV

Unknown

JBV died following complications of alcohol use disorder and related medical conditions. The case highlights the importance of comprehensive assessment and appropriate management of patients with substance use disorders …

SAhospital2026-03-13

Coroner's Finding: Schlaefer, Norbert

69y · Male·disseminated urothelial carcinoma of the bladder (palliated), bilateral lung ade…

A 69-year-old man died in prison custody from disseminated urothelial carcinoma of the bladder, bilateral lung adenocarcinoma, and severe emphysema. He had a significant smoking history and prior asbestos exposure. His l…

oncologyrespiratory medicine
SA2026-03-13

Coroner's Finding: Holding, Matthew Benjamin

44y · Male·unascertained

Matthew Benjamin Holding, aged 44, died suddenly in prison on 2 January 2023. He had schizophrenia managed with antipsychotics and severe obesity (BMI 41.6). In December 2022, he showed signs of significant deterioration…

psychiatrycorrectional healtholanzapine
VIChospital2026-03-13

Finding into death of Wayne Ronald Watson

61y · Male·Intracranial haemorrhage and myocardial infarct

A 61-year-old man with extensive cardiac disease collapsed at a supermarket, striking his head and losing consciousness for less than 10 seconds. Paramedics identified STEMI and administered heparin on advice from Austin…

cardiologyemergency medicinediagnosticcommunicationheparin
WA2026-03-13

Inquest into the Suspected Death of PARBHAT

24y · Male·unknown cause (fall from cliff at The Gap, Torndirrup National Park, resulting i…

A 24-year-old Indian student visa holder living in Perth experienced multiple cascading life stressors culminating in his death at The Gap in Torndirrup National Park. An assault and robbery affected his employment stabi…

VIChospital2026-03-12

Finding into death of Nicole Jennifer Kateiva

39y · Female·Respiratory failure in the setting of aspiration pneumonia in a woman with arthr…

Nicole Kateiva, a 39-year-old woman with arthrogryposis multiplex congenita, intellectual impairment, and epilepsy, died from respiratory failure due to aspiration pneumonia. She presented to hospital with two days of co…

general medicineintensive careceftriaxone
VIC2026-03-12

Finding into death of Fan Yang

29y · Male·Drowning in the setting of flash flooding

Fan Yang, 29, drowned during unprecedented flash flooding at Buchan Caves Reserve on 26 December 2023 while exiting with his partner after a cave tour. Over 60mm rain fell in 30 minutes, causing rapid water rise. The cou…

NSW2026-03-12

Inquest into the death of Evander Tuala

23y · Male·Blunt force head injury

A 23-year-old man died from blunt force head injury after being struck during a violent altercation outside a Sydney hotel. He fell backwards, striking the back of his head on concrete and suffered multiple intracranial …

emergency medicineneurosurgery
VIC2026-03-11

Finding into death of Gerald Francis Ridsdale

90y · Male·Ischaemic and valvular heart disease

Gerald Ridsdale, a 90-year-old man incarcerated at Port Phillip Prison, died from ischaemic and valvular heart disease following a period of palliative care. He had multiple chronic conditions including congestive cardia…

palliative carecorrectional health
ACThome2026-03-10

Inquest into the death of [Redacted] Williams

Female·sodium nitrite poisoning

A 70-year-old school teacher and community advocate with motor neuron disease (MND) died by sodium nitrite ingestion on 27 April 2023. She had explicitly expressed wishes to end her life and explored available options. P…

palliative carepsychiatrysodium nitrite
NSWhospital2026-03-10

Inquest into the death of Mustafa Kayirici

31y · Male·metastatic alveolar soft part sarcoma

31-year-old man serving a custodial sentence died of metastatic alveolar soft part sarcoma on 25 January 2022. Diagnosed April 2020, the ultra-rare cancer (1 in 10 million incidence) had already metastasised at discovery…

oncologypalliative caredelaypazopanib
NSWhome2026-03-10

Inquest into the death of Judith Ingham

89y · Female·Burn wounds and the consequences thereof

Judy Ingham, aged 89, suffered severe burns from excessively hot water while bathing in her apartment on 26 August 2022, dying 26 days later from burn wound complications. A licensed plumber failed to install a required …

proceduralsystem
WAhospital2026-03-09

Inquest into the Death of Russell Graham PENNY

56y · Male·complications of viral hepatitis related advanced-chronic liver disease (medical…

Russell Graham Penny, a 56-year-old Aboriginal man, died from complications of advanced chronic liver disease with hepatocellular carcinoma while imprisoned at Casuarina Prison. He had a long history of hepatitis C and c…

gastroenterologyhepatologycommunicationsystem
QLDhospital2026-03-06

Non-inquest findings into the death of Ms B

35y · Female·Hypoxic-ischaemic encephalopathy due to cardiorespiratory arrest due to vertebro…

A 35-year-old woman presented to a rural hospital with a three-day history of collapses, slurred speech, vomiting, and abnormal eye movements. A non-contrast CT head scan was normal, and she was discharged with a diagnos…

emergency medicinegeneral practicediagnosticcommunication
NSW2026-03-06

Inquest into the death of Gregory Merriman

58y · Male·acute myocardial infarction caused by ischaemic heart disease

Gregory Merriman, a 58-year-old Aboriginal man, died from acute myocardial infarction caused by advanced ischaemic heart disease while in custody at Metropolitan Reception and Remand Centre on 27 December 2022. He experi…

cardiologygeneral practicediagnosticcommunicationperindopril
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