Coronial
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SAcommunityNew2026-08-28

Coroner's Finding: Spiess, Thomas Wolfram and Byrne, Jacqueline

Unknown·Thomas Wolfram Spiess: head, neck and chest injuries; Jacqueline Byrne: multiple…

On 18 August 2014, a 14-tonne effluent truck lost control on South Eastern Freeway's steep downhill section and struck multiple vehicles at high speed, killing Thomas Spiess (aged 56) and Jacqueline Byrne (aged 41). Spie…

proceduralsystem
SANew2026-08-28

Coroner's Finding: von Einem, Bevan Spencer

79y · Unknown·complications of metastatic malignancy on a background of chronic obstructive pu…

This case concerns Bevan Spencer von Einem, a 79-year-old long-term prisoner who died at Yatala Labour Prison on 5 December 2025 from complications of metastatic malignancy. Contributing conditions included chronic obstr…

SAaged careNew2026-08-21

Coroner's Finding: Biermann, Hans

92y · Male·respiratory failure secondary to bilateral pleural effusions on a background of …

Hans Biermann, aged 92, died on 1 March 2023 following respiratory failure secondary to bilateral pleural effusions and rib fractures sustained in a fall at Regis Playford aged care facility on 23 February 2023. Mr Bierm…

geriatric medicineemergency medicine
SAaged careNew2026-08-21

Coroner's Finding: Bubner, Richard Scott

75y · Male·combined effects of subdural haematoma and facial fractures following a fall com…

A 75-year-old man with advanced Alzheimer's dementia residing in aged care died in hospital following a fall at his residential facility. He was assessed as high falls risk at the aged care facility. After collapsing and…

occupational therapygeriatric medicine
SAaged careNew2026-08-21

Coroner's Finding: Clark, Wayne Malcolm

84y · Male·bronchopneumonia complicating C2 odontoid fracture (palliated) due to fall on a …

Wayne Malcolm Clark, aged 84, with advanced Alzheimer's and vascular dementia, fell in a secure residential aged care facility and sustained a C2 odontoid fracture. He died on 23 August 2023 from bronchopneumonia complic…

general practiceparamedicineparacetamol
SAcommunityNew2026-08-21

Coroner's Finding: Holden, Richard Arthur

74y · Male·Pulmonary thromboembolism due to right deep vein thrombosis

Richard Holden, aged 74, presented to his GP Dr C. multiple times in August 2020 with progressive shortness of breath and wheeziness. Dr C. diagnosed and treated asthma despite worsening symptoms and failure to respond t…

general practiceemergency medicinediagnosticdelaysalbutamol
SAhospitalNew2026-08-19

Coroner's Finding: Mohammadi, Sohaila

47y · Female·head injury

Sohaila Mohammadi (47) was killed in a motor vehicle collision caused by driver Tristan Mourant, who had bilateral retinal dystrophy and was advised by three medical professionals not to drive. However, none of the docto…

ophthalmologygeneral practiceproceduralsystemalcohol
SAhospital2026-08-13

Coroner's Finding: Josipovic, Petar

62y · Male·multi-organ failure on a background of aortic regurgitation and ischaemic heart …

A 62-year-old man with aortic regurgitation and coronary artery disease died from multi-organ failure after emergency cardiothoracic surgery. His elective surgery was cancelled twice (14 and 22 Aug 2023) due to prioritiz…

cardiothoracic surgerycardiologycommunicationsystem
SAhome2026-08-12

Coroner's Finding: Sylvia, Kate Marie

32y · Female·cerebral venous sinus thrombosis complicated by right intracerebral haemorrhage

Kate Sylvia, 32, presented on 2 December 2021 with severe headache, vomiting, and neurological symptoms including slurred speech. Paramedics transported her to Sefton Park intermediate care instead of hospital. Dr H. mis…

paramedicinegeneral medicinediagnosticcommunicationoral contraceptive pill
SAhospital2026-08-06

Coroner's Finding: Burg, Claus Hartmuth

70y · Male·metastatic gastric adenocarcinoma

A 70-year-old man with prior bladder cancer was undergoing routine CT surveillance. Stomach cancer signs were clearly visible on February 2017 and February 2018 CT scans but failed to be detected by consulting radiologis…

radiologyoncologydiagnosticcommunication
SAcommunity2026-07-15

Coroner's Finding: Stockman, William Bruce

49y · Male·hanging

William Bruce Stockman, aged 49, died by hanging on 6 October 2019 in Renmark, South Australia, hours after arrest and release on bail. He was arrested for breaching an intervention order following a disturbance at a hot…

communicationsystemamitriptyline
SAhospital2026-07-14

Coroner's Finding: Rosenzweig, Colin Anthony

61y · Male·bronchopneumonia complicating cerebrovascular accident due to cardioembolism on …

A 61-year-old man with a mechanical aortic valve underwent colonoscopy requiring temporary warfarin cessation. Following the procedure, he was discharged with a plan to recommence warfarin but without clear postoperative…

general surgerycardiologymedicationcommunicationwarfarin
SAhome2026-07-13

Coroner's Finding: Low, David John

64y · Male·ischaemic and hypertensive heart disease (operated) with cardiomegaly with contr…

A 64-year-old man with ischaemic heart disease, cardiomegaly, diabetes and obesity died at home from cardiac failure after calling his care worker for assistance. A paramedic arrived but refused to force entry, instead a…

cardiologyparamedicinesystemdelay
SAhome2026-07-07

Coroner's Finding: Pastro, Dean

88y · Male·General inanition on a background of immobility secondary to thoracic spine frac…

Dean Pastro, aged 88, died at Bene St Clair residential care facility on 16 December 2022 from general inanition secondary to immobility caused by thoracic spinal fractures sustained in a June 2022 fall at home, complica…

geriatric medicinepalliative caremorphine
SAhome2026-07-07

Coroner's Finding: Morland-Shearer, Debra

64y · Female·choking on food on a background of Alzheimer's disease and antipsychotic therapy

Debra Jayne Morland-Shearer, aged 64, died on 11 January 2023 from choking on food while living in supported community care under a Guardianship Order. She had Alzheimer's disease, mild dysphagia diagnosed in November 20…

speech pathologypsychiatryquetiapine
SAcommunity2026-06-30

Coroner's Finding: Shanahan, Joanne and McNeill, Tania

Female·Multiple injuries sustained in motor vehicle collision

An inquest was held into the deaths of two women, Joanne Shanahan (55) and Tania McNeill (53), who were fatally injured in a catastrophic motor vehicle collision at an Adelaide intersection on 25 April 2020. A driver tra…

SAcommunity2026-06-26

Coroner's Finding: Morgan, Matthew Kim

24y · Male·Gunshot wounds to the chest

Matthew Morgan, aged 24, was fatally shot by a SAPOL STAR Operations marksman on 21 October 2017 during a siege at the Tollgate Motel. The incident began when Morgan evaded police after striking Senior Constable Solowij …

methamphetamine
SAcommunity2026-06-25

Coroner's Finding: Nan Lesley Walker, Ian Rex Walker and Suzanne Mary Skeer

[77, 80, 55]y · Unknown·Multiple injuries from motor vehicle collision

A motor vehicle collision on the Princes Highway near Suttontown killed three adults when a 16-year-old driver with significant neurological conditions momentarily lost concentration while ascending a hill. The driver ha…

general practicepaediatricssystemcommunication
SA2026-06-24

Coroner's Finding: Shepherdson, Kobi Anastasia Isobel and Shepherdson, Henry David (updated)

<1y · Female·Kobi: head injuries; Henry: multiple injuries

A nine-month-old infant and her 38-year-old father died in a homicide-suicide at the Whispering Wall dam in South Australia. The father deliberately jumped 36 metres while carrying his daughter in an infant harness. The …

systemcommunicationtramadol
SAhospital2026-06-19

Coroner's Finding: Clancy, Carmen Jayne

37y · Female·sepsis secondary to rectosigmoid perforation on a background of metastatic squam…

Carmen Jayne Clancy, aged 37, died on 27 September 2022 from sepsis secondary to rectosigmoid perforation caused by metastatic cervical cancer. Incarcerated on home detention following a cancer diagnosis in 2021, she und…

oncologycolorectal surgerypsyllium
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