Coronial

186 results for neck trauma

WA2025-11-28

Inquest into the Death of Cleveland Keith DODD

16y · Male·complications of ligature compression of the neck (hanging)

…ons, including immediate closure of Unit 18, extended mental health services, adequate custodial staffing, trauma-informed care models, and shorter staff shifts. The findings reveal systemic failures in staffing, trainin…

psychiatrypsychologyproceduralcommunication
NSW2015-09-21

Inquest into the death of William Crews

26y · Male·gunshot wound to the neck

…fication. Nguyen drew a firearm; Roberts returned fire while retreating, with a bullet hitting Crews in the neck causing unsurvivable vascular injuries. Systemic failures contributed: inadequate risk assessment methodolo…

forensic medicineemergency medicineproceduralcommunicationcocaine
WA2019-05-22

Inquest into the 5 Deaths in Casuarina Prison who are Mervyn Kenneth Douglas BELL and Bevan Stanley CAMERON and Brian Robert HONEYWOOD and JS (Name Subject to Suppression Order) and Aubrey Anthony Shannon WALLAM

Male·Multiple: ligature compression of neck (hanging) in four cases; incised injury t…

…d cells, reciprocal access to prisoner health records between services, mental health triage on admission, trauma-informed care implementation, enhanced staff training on mental health and personality disorders, and impr…

psychiatrypsychologysystemcommunication
VICcommunity2024-11-13

Finding into death of N A

59y · Male·compression of the neck secondary to hanging

A 59-year-old man with treatment-resistant depression, anxiety, and suicidal ideation died by hanging while on weekend leave from psychiatric care. He had been hospitalised four times in 2021 and was receiving electrocon…

psychiatrypsychologycommunicationsystemvenlafaxine
WAcommunity2008-02-25

Inquest into the Death of Kimberley Coronial Report

Multiple causes across 22 deaths: ligature compression of the neck (17 hangings)…

…to alcohol and cannabis abuse. The primary cause of death across most cases was ligature compression of the neck (hanging). The inquest revealed appalling living conditions in Aboriginal communities: extreme poverty, ove…

public healthpsychiatrysystemdelayalcohol
VICcommunity2012-03-23

Finding into death of Simon Rhys MacQueen

34y · Male·head and neck trauma (train impact)

Simon MacQueen, a 34-year-old man with chronic schizophrenia and recurrent suicidality, died by stepping in front of a train on 15 December 2008. He had been discharged from inpatient psychiatric care on 12 November 2008…

psychiatrygeneral practicecommunicationsystemrisperidone
VIChome2022-08-30

Finding into death of Boe Luke Memery

24y · Male·Neck compression in the circumstances of hanging

Boe Luke Memery, a 24-year-old Aboriginal man, died by hanging on 19 May 2019 following a relationship breakdown. He had a history of depression, self-harm, and previous suicide attempts. In the weeks before his death, h…

psychiatrygeneral practicedocumentationcommunicationvenlafaxine
WAhome2017-03-30

Inquest into the Death of Troy William MURRAY

34y · Male·ligature compression of the neck (hanging)

Troy William Murray, a 34-year-old man with a long history of substance abuse (primarily amphetamine and alcohol), psychiatric illness, and multiple previous suicide attempts, died by hanging on 11 March 2012. He had bee…

psychiatrygeneral practicecommunicationamphetamine
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…

…vised intervention programs. Key clinical lessons: depression and anxiety require active follow-up; recent trauma/stressors increase risk; medication prescriptions for depressed patients need careful monitoring; and suic…

general practicepsychiatrycommunicationdelaytramadol
SAmental health2025-04-17

Coroner's Finding: Furlan, Mark John & Miller, Richard John

50; 37y · Male; male·Mark John Furlan: hypoxic brain injury due to acute neck compression due to hang…

Two men died by hanging while detained under inpatient treatment orders at Ward 2G of Royal Adelaide Hospital. Mark Furlan (50) died in 2018 after developing psychotic depression with suicidal ideation. The coroner found…

psychiatryemergency medicinediagnosticcommunicationescitalopram
VIChome2012-09-07

Finding into death of RGF

34y · Male·Firearm injury to the head and neck

A 34-year-old male died from a gunshot wound to the head on 13 March 2008. His stepdaughter, who had been sexually abused by him since age 14 with threats of violence and control, shot him in self-defense during a sexual…

paediatricsforensic medicinecommunicationsystem
WAhospital2024-05-23

Inquest into the Death of Baby BE (Name Subject to Suppression Order)

0y · Female·brain death complicating head and neck injury

A five-month-old girl died from catastrophic brain injuries caused by violent shaking on 20 May 2019. Medical evidence established she was shaken by an adult on at least two occasions: once around 6 May 2019 (evidenced b…

paediatricsneonatologydiagnosticcommunicationmethamphetamine
VIChome2020-09-11

Finding into death of Mr A

44y · Male·compression of the neck consequent upon hanging

A 44-year-old man with a 42-year history of intimate partner violence died by hanging. He had recently separated from his wife and was enrolled in a 18-week men's behaviour change program, having completed 17 of 18 sessi…

general practicepsychiatrysystemdelayalcohol
VIChome2024-03-07

Finding into death of Claire Louise Carroll

45y · Female·Neck compression secondary to hanging

Claire Louise Carroll, 45, died by hanging while experiencing severe untreated psychotic symptoms including auditory hallucinations, paranoid delusions, and persecutory ideation. She had complex mental health diagnoses (…

psychiatrygeneral practicesystemcommunicationclonazepam
QLDcommunity2013-03-01

Arnold, Vicki; Leahy, Julie-Anne

26y · Female·intentionally inflicted gunshot wounds to the head

This complex triple-inquest into the deaths of two women in 1991 reveals systemic investigative failures and challenges the original murder-suicide finding. Julie-Anne Leahy and Vicki Arnold died from gunshot wounds on 2…

forensic medicinepsychiatrydiagnosticprocedural
VICcommunity2014-08-25

Finding into death of Travis Joseph Hartskeerl

32y · Male·Head and neck trauma (train impact)

Travis Hartskeerl, a 32-year-old man with a complex history of schizophrenia, polysubstance abuse, and multiple serious suicide attempts, died by suicide on railway tracks on 16 December 2008. He had been discharged from…

psychiatrygeneral practicecommunicationsystemzuclopenthixol decanoate
VIChome2020-04-07

Finding into death of Jesse Stephen Bird

32y · Male·neck compression in the circumstances of hanging

Jesse Bird, a 32-year-old Torres Strait Islander veteran, died by suicide in June 2017 after struggling to navigate the Department of Veterans' Affairs (DVA) compensation system. He served in Afghanistan in 2009, develop…

psychiatryparamedicinesystemcommunicationduloxetine
VIC2025-11-12

Finding into death of Wendy Ann McCabe

40y · Female·hypoxic ischaemic encephalopathy due to ligature compression of the neck

Wendy McCabe, a 40-year-old woman with a history of depression, anxiety, substance use and previous self-harm, died of asphyxiation from ligature compression after fashioning a noose from a standard blanket in her police…

correctional healthemergency medicineproceduralcommunicationmethadone
QLDhome2024-07-22

Non-inquest findings into the domestic violence related death of a First Nations woman

31y · Female·Pressure applied to neck (asphyxia); not ascertained due to advanced post-mortem…

A 31-year-old First Nations woman was killed by her partner during intimate partner violence. She was pregnant at the time of death. Despite multiple contacts with police, court services, employment agencies, and domesti…

general practiceobstetricscommunicationsystemmethamphetamine
QLDprison2021-11-23

Row Row, Frederick Arthur James

34y · Male·Neck compression by hanging

Frederick Row Row, a 34-year-old Aboriginal man, died by suicide in Capricornia Correctional Centre following a precipitous change in risk assessment from high to low in less than 48 hours. After assaulting another priso…

psychiatrypsychologydiagnosticcommunication

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