Coronial

600 results for emergency department assessment

VIChospital2012-01-31

Finding into death of Lee Patrica Collings

51y · Female·Multiple injuries sustained when struck by a car while lying on the Mornington P…

Lee Collings, 51, died by suicide after absconding from an Emergency Department. She presented with suicidal ideation and was triaged as Mental Health Category 4. Key failur…

emergency medicinepsychiatrycommunicationsystemsodium valproate
VIChospital2014-07-10

Finding into death of Peter Shane Nancarrow

52y · Male·Hanging

…following acute suicidal behavior including threatening self-harm with weapons. Police explicitly warned Emergency Department staff he was high-risk and knew how to deceive doctors into releasing him. While intoxicated …

emergency medicinepsychiatrycommunicationsystemalcohol
SA2015-05-06

Coroner's Finding: BLUNDEN Shane Rene

18y · Male·acute neck compression due to hanging

… not transferred to Yatala staff. Despite documented evidence of high suicide risk at ARC, his admission assessment at Yatala was inadequate: he scored 7 on stress screening instead of the correct 9; his scars and prior …

correctional healthemergency medicinediagnosticcommunicationcannabis
WAhospital2017-03-21

Inquest into the Death of Masaly MOSBY

<1y · Female·acute necrotising pneumonia

… 36-day-old Aboriginal infant, died from acute necrotising pneumonia after presenting to Broome Hospital Emergency Department three times in four days but never being seen by a doctor for formal assessment. On her first…

emergency medicinepaediatricsdiagnosticsystemparacetamol
VIChospital2017-05-25

Finding into death of Finding Baby Ahmed

<1y · Male·Urosepsis and renal failure in a child with acute on chronic pyelonephritis seco…

…ps of fluid given to a lethargic child showing signs of shock. The patient was discharged without proper assessment of renal function, sepsis exclusion, or written discharge advice. Urosepsis and renal failure rapidly en…

emergency medicinegeneral practicediagnosticcommunicationparacetamol
VIChospital2025-04-14

Finding into death of Joshua Gonzalez

35y · Male·Neck compression due to hanging

…l staff; absence of his previous mental health presentations from accessible records; and Dr S.-Parham's assessment focused on intoxication rather than mental health risk. While she likely would have discharged him anywa…

emergency medicinepsychiatrycommunicationsystemalcohol
WA2021-12-22

Inquest into the Death of Brett Ashley DUTURBURE

29y · Male·ligature compression of the neck (hanging)

…nging at Wyndham Work Camp on 14 November 2019. The coroner identified critical systemic failures in the Department of Justice's management of his care. The Department failed to obtain his Northern Territory prison recor…

correctional healthpsychiatrysystemcommunication
WAmental health2023-02-13

Inquest into the Death of Philip SULLEY

58y · Male·coronary artery arteriosclerosis (natural causes)

…ry arteriosclerosis on 27 April 2020 at Bentley Mental Health Unit. He presented to Royal Perth Hospital emergency department on 19 April 2020 with psychotic behaviour but was discharged; his presentation was judged app…

psychiatryemergency medicinecommunicationolanzapine
QLDhospital2016-06-16

Mr M - Non-inquest findings

53y · Male·Bilateral ACA stroke

A 53-year-old man presented to the emergency department with acute stroke symptoms (left-sided hemiplegia and dysphasia) with onset around 10:30 am. …

emergency medicineneurologydiagnosticcommunication
VIChospital2020-10-13

Finding into death of BABY C

<1y · Male·Myocarditis

…month-old infant, died from myocarditis (viral heart inflammation) after presenting to Sunshine Hospital Emergency Department with fever, breathing difficulty, and cyanosis. He waited 1 hour 52 minutes before receiving …

emergency medicinepaediatricsdiagnosticdelayparacetamol
VIChospital2024-12-02

Finding into death of Baby Patel

<1y · Unknown·unascertained

…curred: the infant was inappropriately triaged as Category 3 (requiring review within 30 minutes) in the Emergency Department when Category 2 (10 minutes) was indicated. Multiple signs of a seriously unwell neonate were…

neonatologypaediatricsdiagnosticcommunicationcefotaxime
VICcommunity2013-11-28

Finding into death of Linda May Hepburn

48y · Female·Metastatic ovarian carcinoma

Linda May Hepburn, a 48-year-old blind woman with intellectual disability, was under the care of the Department of Human Services and lived in DHS accommodation. After returning from holiday in Brisbane in July 2012,…

general practiceemergency medicine
TAShospital2016-06-27

Coroner's Finding: Mr P

64y · Male·Small bowel infarction due to a volvulus owing to adhesions in the small intesti…

Mr P, aged 64, presented to Royal Hobart Hospital's Emergency Department in October 2012 with severe central abdominal pain. The ED consultant diagnosed bowel obstruc…

emergency medicinegeneral surgerydiagnosticdelay
SAhospital2003-03-17

Coroner's Finding: DeIONNO Orazio

40y · Male·ischaemic heart disease due to coronary atherosclerosis

A 40-year-old man presented to an Emergency Department with chest pain lasting approximately a week and a half, presenting with symptoms including a…

emergency medicinecardiologydiagnostictriage
TAShospital2025-06-17

Coroner's Finding: de-identified RS

68y · Male·Exsanguination due to peptic ulcer of the duodenum with erosion into the gastrod…

A 68-year-old man presented to the emergency department with two episodes of fresh rectal bleeding and elevated blood urea. Despite stable vital sign…

emergency medicinegastroenterologydiagnosticdelay
QLDhospital2016-11-23

SPB - Non-inquest findings

36y · Male·hanging

… and his treating psychiatrist's recommendation for involuntary admission, he was discharged after brief assessment by junior staff who attributed his presentation to alcohol intoxication rather than acute psychosis. He …

psychiatryemergency medicinediagnosticcommunicationdiazepam
QLDhome2009-10-16

Anderson, Andrew Scott

14y · Male·gunshot wound to the head

Andrew Scott Anderson was a 14-year-old boy placed in Department of Child Safety care following his father's physical assault. He had a longstanding history of behaviora…

psychiatrypaediatricsdiagnosticcommunicationmarijuana
VIChospital2011-04-08

Finding into death of June Dianne Owen

63y · Female·Cardiomegaly and biventricular dilatation

…rdiac disease (cardiomegaly, biventricular dilatation, and chronic cardiac failure) presented to a rural emergency department with recurrent abdominal pain on 21 January 2008. She was assessed by nursing staff who reque…

general practiceemergency medicinediagnosticcommunicationpethidine
SAhospital2000-02-25

Coroner's Finding: STONEHOUSE Jarrod William (aka Scott)

23y · Male·aspiration of blood due to stab wound to trachea

23-year-old man with self-inflicted stab wound to neck presenting to emergency department while intoxicated and agitated. Ambulance noted 3cm laceration to midline trachea with minima…

emergency medicinesurgerydiagnosticcommunicationalcohol
SAhome2002-11-06

Coroner's Finding: JERICHO Patricia Susanne

43y · Female·neck compression due to hanging

A 43-year-old woman with longstanding depression and previous suicidal ideation presented to Emergency Department twice within 14 days and was referred to psychiatric services. She had persistently refused a…

general practicepsychiatrycommunicationsystemaurorix
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