391
Total cases
53%
Preventable or possibly preventable
61%
With coroner recommendations
29%
Escalation failure identified
Specialty tagging, error classification, and clinical flags are AI-generated and may contain inaccuracies. Always refer to the original finding.
63y · Female·1a: Aspiration pneumonia in a woman with acquired brain injury, 1b: Cerebrovascu…
Susan Czudar, 63, died of aspiration pneumonia complicated by acquired brain injury from a 2017 subarachnoid haemorrhage and multiple strokes. Residing in NDIS-funded specialist disability accommodation, she was admitted…
14y · Female·unascertained natural causes – possibly encephalitis leading to seizure or sudde…
SMS, a 14-year-old previously healthy girl, collapsed unexpectedly at home on 10 October 2021 and was found unresponsive and not breathing. Immediate resuscitation was commenced by family members and emergency services, …
21y · Male·Cerebral temporal lobe uncal and cerebellar tonsillar herniation
Brady Hubbard, 21, died from traumatic brain injury with cerebral herniation after falling from an unsecured utility vehicle driven by Andrew Hilfenhaus at West Ulverstone Football Club in June 2023. While riding on the …
76y · Male·Traumatic head, ribs, pelvic and spinal injuries sustained in a motor vehicle in…
A 76-year-old man with schizophrenia, depression, Klinefelter syndrome, and poorly controlled diabetes was struck by a car as a pedestrian on 19 December 2024 while crossing Middleborough Road in Box Hill South outside a…
69y · Female·Hydrocephalus and subarachnoid haemorrhage in the setting of a fall in a woman w…
A 69-year-old woman with cerebral palsy, intellectual disability, and B cell acute lymphoblastic leukaemia, residing in Specialist Disability Accommodation funded through the National Disability Insurance Scheme, sustain…
51y · Male·Traumatic brain injuries resulting from blunt head trauma: multiple calvarial an…
Adrian Garcia, 51, died from traumatic brain injuries sustained during an assault in a public park in Sorell, Tasmania on 10 March 2021. He was heavily intoxicated when struck by a baseball bat multiple times by his fian…