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VICaged care2011-05-20

Finding into death of Lena Divola

59y · Female·Subdural haemorrhage from blunt force trauma to head sustained in a backwards fa…

Lena Divola, a 59-year-old woman with intellectual disability, schizophrenia, and depression living in supported accommodation, sustained a head injury on 24 December 2007 when she fell backwards from a walker being push…

general practicepsychiatryproceduralcommunicationwarfarin
VIChome2011-05-20

Finding into death of Alan Bishop

66y · Male·Injuries sustained in fall from height

A 66-year-old man with Parkinson's disease died from injuries sustained in a fall from his third-floor balcony. He had recently commenced Duodopa treatment via percutaneous endoscopic jejunostomy for motor fluctuations, …

neurologygeneral practiceduodopa
VIChome2011-05-13

Finding into death of Paul Kenneth Stephens

42y · Male·Ischaemic heart disease - coronary atherosclerosis and thrombosis

Paul Stephens, a 42-year-old man with intellectual disability, died from ischaemic heart disease with coronary atherosclerosis and thrombosis. He presented with symptoms consistent with acute coronary syndrome (arm pain,…

general practiceforensic medicinediagnosticbuprenorphine
WAhospital2011-05-12

Inquest into the Death of Walden

68y · Female·Multi-organ failure associated with septic shock following duodenal perforation …

Athenia Hana Walden, 68, died from multi-organ failure and septic shock following duodenal perforation during laparoscopic surgery at Swan District Hospital on 8 May 2008. Surgery was performed to remove her gallbladder,…

general surgerygeneral practicediagnosticcommunicationpethidine
VIChospital2011-05-04

Finding into death of Ms P

30y · Female·Multi organ failure from hydrochloric acid ingestion

Ms P, a 30-year-old woman with recent-onset depression and anxiety, died from multi-organ failure following intentional hydrochloric acid ingestion on 22 September 2008. She had presented to mental health services on 18 …

psychiatrygeneral practicecommunicationsystemtemazepam
WAhome2011-04-21

Inquest into the Death of Whitehouse

3y · Male·unascertainable; malnourishment was a significant contributing factor

Bradley Frederick Whitehouse, aged 3 months, died on 10 February 2008 from causes ruled unascertainable. He was severely malnourished and emaciated at death, having deteriorated dramatically over the final month of life.…

paediatricsgeneral practicecommunicationdelaymethamphetamine
VIChome2011-04-15

Finding into death of Elanur Koc

2y · Female·pneumonia in a toddler with enlarged tonsils and presence of codeine in blood

Elanur Koc, a 2-year-old with a history of recurrent throat infections and enlarged tonsils, died from pneumonia. Significant codeine was detected in her blood, urine, liver, and stomach contents, with codeine also prese…

paediatricsgeneral practicemedicationcodeine
SAhome2011-04-07

Coroner's Finding: LEE Troy Thomas and MATTHEWS Scott Leslie

Troy Thomas Lee: acute neck compression due to hanging; Scott Leslie Matthews: m…

Two men died by suicide while on home detention bail awaiting trial. Troy Thomas Lee (38, hanging) and Scott Leslie Matthews (23, mixed drug toxicity from tramadol and alprazolam overdose) both died on their parents' pre…

general practicepsychiatrycommunicationdelaytramadol
VICcommunity2011-04-04

Finding into death of VH

25y · Female·injuries sustained in fall from height

A 25-year-old woman with depression died by jumping from the West Gate Bridge. In the two months before her death, she attended four general practitioners across two medical practices with depression and anxiety, was com…

general practicepsychologyescitalopram
VICcommunity2011-03-17

Finding into death of Stuart Judd

39y · Male·Ischaemic heart disease with complete occlusion of the left anterior descending …

Stuart Judd, a 39-year-old Parks Victoria Ranger, died of acute myocardial infarction due to left anterior descending coronary artery occlusion with ruptured plaque. Eight days before death, he presented to GP Dr V. with…

general practicecardiologydiagnosticdelayomeprazole
WAcommunity2011-02-28

Inquest into the Death of Collins

0y · Male·cardiac arrhythmia associated with surgically corrected congenital heart disease

Edward Thomas Collins was a 3-month-old neonate with surgically corrected congenital heart disease (Total Anomalous Pulmonary Venous Drainage) who died on 14 January 2007 from cardiac arrhythmia. On 13 January 2007, he p…

emergency medicinegeneral practicediagnosticcommunication
VICcommunity2011-02-21

Finding into death of Constantinos Retsas

60y · Male·Acute myocardial infarction with thrombosis of the left anterior descending coro…

Constantinos Retsas, a 60-year-old man with intellectual disability and autism in residential care, died from acute myocardial infarction due to thrombosis of the left anterior descending coronary artery. He had attended…

general practice
VIChome2011-02-17

Finding into death of Michael William Gledhill

37y · Male·Mixed drug toxicity (heroin, methadone and diazepam) in a man with coronary arte…

Michael Gledhill, 37, died from mixed drug toxicity involving heroin, methadone, and diazepam, complicated by pre-existing coronary artery disease. He was enrolled in a methadone maintenance program but continued illicit…

general practicepharmacologymedicationcommunicationheroin
QLDcommunity2010-12-16

Bell, Jennifer Elizabeth

34y · Female·Multiple injuries from pedestrian motor vehicle collision; suicide by stepping i…

Jennifer Bell, a 34-year-old woman with severe postnatal depression, obsessive-compulsive disorder, and borderline personality disorder, died by suicide on 2 October 2007 after stepping into the path of a truck. She had …

psychiatrygeneral practicecommunicationsystemstillnox
NSWhome2010-12-13

Coroner's Finding: Paul Justyn Brauer

64y · Male·Large pulmonary embolus (origin undetermined)

Paul Brauer, 64, died of pulmonary embolus at Leeton District Hospital following a complex admission involving psychiatric depression, atrial fibrillation, urinary retention, and multiple comorbidities. The coroner ident…

psychiatrygeneral medicinediagnosticmedicationlactulose
VICcommunity2010-12-09

Finding into death of DONNA LAVINIA FAURE

39y · Female·neurological disorder of unknown cause and right axillary abscess

Donna Lavinia Faure, aged 39, lived in a Department of Human Services group home with a lifelong neurological disability requiring full-time care. In June 2009, she developed an axillary abscess with bacterial infection …

general practiceemergency medicine
NThome2010-10-29

Inquest into the death of Kristelle Ruby Mulladad aka Oliver

16y · Female·obstructed breathing and heart arrhythmia secondary to severe obstructive sleep …

A 16-year-old Aboriginal girl with severe obstructive sleep apnoea died unexpectedly in her home one week before scheduled surgery. She had been symptomatic since age 13, but surgery was delayed for four years due to mul…

ENT surgerygeneral practicediagnosticcommunication
QLDhospital2010-10-18

Little Gungallida Girl

4y · Female·aspiration of vomitus and its treatment due to rheumatic carditis against a back…

A 4-year-old Aboriginal girl from Doomadgee died on 23 July 2009 from aspiration of vomitus complicating rheumatic carditis with concurrent viral respiratory tract infection. She presented with fever and cough on 19, 21,…

emergency medicinepaediatricsparacetamol
NSWcommunity2010-10-15

Coroner's Finding: Charmaine Margaret Dragun

29y · Female·Effects of multiple injuries sustained when she projected herself from the top o…

Charmaine Dragun, a 29-year-old newsreader, died by suicide at The Gap on 2 November 2007. She was diagnosed with depression and treated with escalating doses of antidepressants (Efexor, then Lexapro) by multiple health …

general practicepsychiatrydiagnosticmedicationsertraline
SAhome2010-09-30

Coroner's Finding: Infant Co-Sleeping

Female·Multiple: undetermined consistent with overlaying (Naomi Kade); undetermined pos…

This inquest examined five infant deaths (aged 1 month to 10 months) occurring between July 2007 and November 2008, all involving co-sleeping with adults. Deaths were attributed to undetermined causes, possible overlayin…

forensic medicinepaediatricsamitriptyline
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