17 results
57y · Female·Multi-organ failure due to drug-induced liver injury caused by sodium valproate …
Mrs Doherty, a 57-year-old woman with CADASIL syndrome, was prescribed sodium valproate for migraine prophylaxis in November 2019. She developed acute hepatitis approximately 5 months later, presenting with jaundice, nau…
26y · Male·Multi-organ failure due to pneumococcal septic shock
A 26-year-old man presented with chest and abdominal pain, initially diagnosed with possible hepatitis based on elevated liver function tests. He developed an atypical blanched rash not recognised as varicella zoster (ch…
30y · Female·Acute ethanol toxicity on a background of chronic alcoholism
Kathleen Arnold, aged 30, died from acute ethanol toxicity on a background of chronic alcoholism. She had a 20-year history of alcohol dependence, complex trauma from a childhood near-drowning incident, eating disorders,…
98y · Female·Multi-organ failure following amanita poisoning
A 98-year-old woman died from multi-organ failure following amanita (death cap) mushroom poisoning. She had foraged wild mushrooms from her garden in April 2024 without incident, then consumed mushrooms from the same loc…
64y · Male·bronchopneumonia and sepsis with chronic obstructive pulmonary disease in a man …
Edward Ivan Africh, a 64-year-old sentenced prisoner, died from bronchopneumonia and sepsis with chronic obstructive pulmonary disease (emphysema) in the setting of advanced chronic myelomonocytic leukaemia and heart fai…
45y · Male·Intra-abdominal haemorrhage due to ruptured spleen due to splenomegaly due to ci…
Hayward Rasmussen, a 45-year-old man with cirrhosis and severe splenomegaly, died from intra-abdominal haemorrhage due to ruptured spleen while in custody. He collapsed in prison after sustaining possible rib injuries fr…
59y · Male·complications of viral liver cirrhosis with hepatocellular carcinoma
Mervyn Morgan, aged 59, died from complications of hepatocellular carcinoma arising from cirrhosis while in prison custody. Critical failures included: delayed monitoring of known liver cirrhosis (no ultrasound despite M…
51y · Female·Multiple injuries sustained from a fall from the top floor of a multi-storey car…
Justine Painter, aged 51, died from multiple injuries sustained jumping from a multi-storey carpark while an inpatient at Royal Perth Hospital (RPH). She had severe treatment-resistant schizoaffective disorder, command h…
62y · Female·Hypovolaemic and cardiogenic shock (hysterectomy) in the context of cardiomegaly…
A 62-year-old woman with significant comorbidities (cirrhosis, cardiomegaly, thrombocytopenia, chronic kidney disease, COPD) died from hypovolaemic and cardiogenic shock during elective total laparoscopic hysterectomy fo…
47y · Female·Traumatic closed head injury likely sustained in a fall from standing
TS, a 47-year-old woman with a 18-year history of anorexia nervosa, bulimia, and severe alcoholism, died from a traumatic closed head injury sustained in a fall from standing. At autopsy, blood alcohol concentration was …
62y · Male·metastatic hepatocellular carcinoma
Michael Anthony Curran, a 62-year-old prisoner, died from metastatic hepatocellular carcinoma in 2015. He had been diagnosed with hepatitis C in 2005, which is a significant risk factor for liver cancer. A liver biopsy i…
56y · Male·urosepsis
Duncan John Hancott, aged 56, died in Mount Gambier Prison from urosepsis secondary to urinary tract infection caused by E. coli. He had significant comorbidities including hepatic cirrhosis, portal hypertension, and his…
41y · Male·Fulminant sepsis (Klebsiella pneumoniae) with multi-organ failure complicating s…
A 41-year-old man with newly diagnosed severe Crohn's colitis was prescribed 6-mercaptopurine (6-MP) after only 5 days of hospital treatment. He had a homozygous TPMT gene deficiency (present in ~0.3% of population) that…
53y · Male·decompensated alcoholic liver disease in the setting of gastro-intestinal haemor…
A 53-year-old man with advanced alcoholic liver disease (Child-Pugh C) died of decompensated liver disease with gastrointestinal haemorrhage. He was arrested for drunk in public place, lodged in police cells, and release…
33y · Female·multiple organ failure complicating sepsis in a woman with cirrhosis of the live…
Amy Tinker, a 33-year-old Aboriginal woman with unrecognised cirrhosis from chronic alcohol abuse, died from sepsis-related multi-organ failure while imprisoned. She had been admitted to Royal Perth Hospital in 2004 with…
66y · Female·Complications following paracetamol overdose
A 66-year-old woman died from complications of paracetamol overdose after ingesting Mersyndol (codeine/paracetamol combination tablets). She had developed dependence on over-the-counter Mersyndol over approximately 8 yea…
37y · Male·combined ethanol and drug toxicity
Kenneth Agnew, a 37-year-old male, died from combined ethanol and drug toxicity involving methadone and benzodiazepines. He was resident in supported residential care at Ferntree Manor and had a methadone prescription fo…
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