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WAhome2026-01-23

Inquest into the Death of Sean Theo WINMAR (Mr STW)

46y · Male·Complications of ligature compression of the neck (hanging)

Sean Theo Winmar, a 46-year-old Aboriginal man, died by suicide on 11 August 2022 while on an interim supervision order after his release from prison. He had depression, substance use disorder, and chronic suicidal ideat…

general practiceaddiction medicinesystemdelaymethamphetamine
WAAugust 2024

Inquest into the Death of Matthew Francis LEACH

50y · Male·ligature compression of the neck (hanging)

Matthew Francis Leach, a 50-year-old man with longstanding alcohol dependence, depression, and a history of suicide attempts, died by ligature hanging in his cell at Hakea Prison shortly after being sentenced to 12 month…

psychiatrypsychologysystemdelayvenlafaxine
WA2024-11-15

Inquest into the death of Kingsley Dean Garlett

32y · Male·ligature compression of the neck (hanging) in a man with methadone and methylamp…

Kingsley Garlett, aged 32, died by hanging in a maximum security prison cell on 31 July 2022. The evidence indicates his death was an impulsive response to relationship conflict with his partner revealed through prison p…

psychiatrypsychologysystemdelaymethadone
WA2022-07-15

Inquest into the Death of Sarwan Hekmat Salman AL JHELIE

21y · Male·complications of ligature compression of the neck (hanging)

Sarwan Al Jhelie, a 21-year-old Iraqi-born man in immigration detention, died by suicide on 5 September 2018 after hanging himself. He had a history of trauma, depression, drug abuse, and prior self-harm and overdose att…

psychiatryaddiction medicinecommunicationsystemmethamphetamine
WAcustody2020-11-04

Inquest into the Death of Damien PURNELL

47y · Male·organ failure following cardiorespiratory impairment in a man with arteriosclero…

Damien Matthew Purnell, a 47-year-old prisoner with a long history of polysubstance abuse and undiagnosed coronary artery disease, collapsed in his cell after smoking synthetic cannabinoids (Kronic). Despite immediate re…

emergency medicineintensive caresystemmethadone
WA2020-02-05

Inquest into the Death of Tania Marie HODGKINSON

48y · Female·Ligature compression of the neck (hanging)

Tania Marie Hodgkinson, a 48-year-old Aboriginal woman, died by suicide via ligature compression while remanded at Bandyup Women's Prison on 23 March 2017. She had been admitted with heroin withdrawal symptoms, grief fro…

psychiatrypsychologycommunicationsystemheroin
WAcommunity2019-08-01

Inquest into the Death of Matthew James BALE

38y · Male·Unascertained; death in the waters of the Indian Ocean off Rottnest Island

Matthew James Bale, a 38-year-old man, disappeared from Rottnest Island on 21 March 2016 while on holiday with his wife and parents. He had a history of depression, alcohol and drug addiction, and recent drug-induced psy…

psychiatryaddiction medicinecitalopram
WAhome2019-06-12

Inquest into the Death of Ellie Marlene HARE

25y · Female·complications of opioid toxicity

Ellie Marlene Hare, 25, died from opioid toxicity after injecting methadone on two consecutive nights with Matthew Drake. She was opioid-naïve, having not used regularly for several years. On the morning of her death, Dr…

toxicologyemergency medicinedelaymethadone
WAcommunity2016-09-13

Inquest into the Death of Anthony Charles EURA

42y · Male·unascertained

Anthony Charles Eura, a 42-year-old Aboriginal man with long-standing mental health problems, alcohol and drug dependency, and chronic suicidality, disappeared in November 2006 and is presumed deceased. In the month befo…

psychiatryemergency medicinesystemdiagnosticfluphenazine
WAhospital2016-06-28

Inquest into the Death of Geoffrey Mark REID

23y · Male·combined drug toxicity (methadone, clozapine, quetiapine, diazepam, chlorpromazi…

Geoffrey Reid, 23, died from combined drug toxicity while hospitalised for schizophrenia management. He was re-inducted onto methadone at 30mg with 10mg daily increments to 50mg over four days, escalated more rapidly tha…

psychiatryaddiction medicinecommunicationdiagnosticmethadone
WAhome2016-02-10

Inquest into the Death of Shayne Andrew BERRY

44y · Male·Combined drug effect (oxycodone and benzodiazepines)

A 44-year-old man with a history of heroin addiction registered as a drug addict in 2010 died from combined drug effect involving oxycodone and benzodiazepines. Despite being a registered drug addict, he obtained prescri…

general practicepharmacologysystemcommunicationoxycodone
WAhome2016-02-10

Inquest into the Death of Adrian Marcus WESTLUND

22y · Male·Combined drug toxicity (alprazolam, methadone, diazepam, dextromethorphan and op…

Adrian Westlund, a 22-year-old with complex drug-seeking behaviour and polypharmacy addiction, died of combined drug toxicity (alprazolam, methadone, diazepam, dextromethorphan). He manipulated multiple GPs by misreprese…

general practiceaddiction medicinediagnosticcommunicationalprazolam
WAhome2015-09-02

Inquest into the Death of Priscilla Fay STEPHENSON

28y · Female·combined drug toxicity (heroin and prescribed psychiatric medications)

Priscilla Stephenson, a 28-year-old Aboriginal woman with longstanding mental illness and polysubstance abuse, died from combined drug toxicity (heroin plus prescribed psychiatric medications) shortly after discharge fro…

psychiatryemergency medicineheroin
WA2013

Inquest into the Death of Lewis, Leslie Graham

57y · Male·Unable to be determined; circumstances suggest drowning in Mekong River or relat…

Leslie Graham Lewis, a 57-year-old Australian registered nurse, died in Thailand on 24 February 2011 in circumstances that remain unclear. He had been admitted to hospital in Nong Khai with severe alcohol intoxication an…

emergency medicinegeneral medicinedischargesystemalcohol
WA2012-01-12

Inquest into the Death of Brennan

38y · Male·Exsanguination due to penetration of arm veins

Declan Brennan, a 38-year-old sentenced prisoner at Acacia Prison due for release on 30 April 2008, died by suicide on 27 April 2008 from exsanguination due to penetrating wounds to his arm veins. Brennan had a long-stan…

psychiatrycorrectional healthsystemdelaylithium
WAhospital2005-09

Inquest into the Death of Vicki Anne Greaves

36y · Female·Pneumonia complicating combined drug effect

Vicki Anne Greaves, 36, died on 18 March 2004 at Royal Perth Hospital Emergency Department from pneumonia complicating combined drug effect. She was subject to an Intensive Supervision Order for drug-related offences. On…

addiction medicinepsychiatrycommunicationsystemheroin
WAhome2004-10-28

Inquest into the Death of Kelly

33y · Female·Combined drug toxicity, with thioridazine as the principal component, in the con…

Lou Ann Kelly, aged 33, died on 3 April 2003 at Royal Perth Hospital ICU from combined drug toxicity, primarily thioridazine, after consuming large quantities of prescription medications with alcohol. She collapsed at he…

general practicepsychiatrysystemthioridazine
WAhome2000-03-10

Inquest into the Death of Michael James Dwyer

30y · Male·acute combined heroin and alcohol toxicity; ingestion of alcohol and heroin

Michael James Dwyer, a 30-year-old man, died on 17 June 1999 at Royal Perth Hospital from acute combined heroin and alcohol toxicity. On 11 June, after returning from Melbourne, he consumed approximately one litre of gin…

emergency medicineintensive caredelayheroin
WAcommunity

Inquest into the Death of Dean Anthony POLLARD

41y · Male·unknown

Dean Anthony Pollard was a 41-year-old man with a long history of schizophrenia and amphetamine-induced psychotic disorder who disappeared in May-June 2010 and is presumed dead. He had multiple psychiatric admissions bet…

psychiatryemergency medicinesystemcommunicationmethamphetamine

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