Record Of Investigation Into Death

Coroners Act 1995
Coroners Rules 2006
Rule 11

I, Stephen Raymond Carey, Coroner, having investigated the death of:

Pamela Mary Tipper


Find That :

(a) The identity of the deceased is Pamela Mary Tipper (Mrs Tipper) who died on 13 February 2011at 18 Edinburgh Crescent, Goodwood.

(b) Mrs Tipper was born in Australia on 25 March 1953 and was aged 57 years.

(c) Mrs Tipper was divorced and was retired at the time of her death.

(d) Mrs Tipper died as a result of probable asphyxia due to choking on food with complicating factors of chronic alcoholism, alcohol intoxication (0.216 g/dL), marked emphysema and respiratory bronchiolitis, hypertensive cardiovascular disease.

Circumstances Surrounding the Death :

On Sunday 13 February 2011, Mrs Tipper’s nephew, Mr Dieter Leahy consumed alcohol with Mrs Tipper between approximately 1.00pm and 2.00pm. After this there is some suggestion that Mrs Tipper may have attended the Glenorchy Football Club Rooms and following which she attended the home of Bradley Leahy, her grandson to attempt to resolve a dispute between him and his uncle, Mr John Tipper. She has consumed further alcohol during the afternoon. When she returned home at approximately 7.00pm or 8.00pm she appeared to Mr Dieter Leahy to be affected by alcohol.

Mr Dieter Leahy left Mrs Tipper’s residence approximately 15 minutes later to go to the home of a friend in Lutana. Mrs Tipper advised him that she was going to cook a steak for her evening meal. He returned at approximately 11.00pm and found Mrs Tipper on the floor near a table at the rear of the house. He noted vomit near her head. He could not feel a pulse and could see that she was not breathing and was cold to touch. He called Ambulance Tasmania who instructed him to place Mrs Tipper in the recovery position.

Tasmanian Ambulance Service received a call at 10.55pm on 13 February 2011 to attend 18 Edinburgh Crescent, Goodwood. When they arrived at 11.01pm resuscitation was commenced on Mrs Tipper and backup called. Mrs Tipper had copious quantities of vomitus in her airway which required continuous suctioning and clearing. After a period of time resuscitation efforts were ceased.

Tasmania Police Officers attended Mrs Tipper’s residence at approximately 11.30pm. Several amounts of vomit were noted on the floor near her body, one of which contained a large partly chewed piece of meat. A plate containing a half eaten steak was noted on a bench in the kitchen. A plastic bag was on the kitchen bench which contained various medications.

Dr Wojtek Majchrzak, Mrs Tipper’s General Practitioner reports that Mrs Tipper was an alcoholic and heavy smoker. He last saw Mrs Tipper in January 2011 at which time he reports that she "did not report any depressed thoughts or did not have any suicidal ideations".

Mrs Tipper’s daughter, Cassandra Webb reports that Mrs Tipper was a regular drinker and had battled alcoholism with several admittances for detoxification. She was also aware that she suffered from emphysema .

Dr Donald Ritchey, Forensic Pathologist, Statewide Forensic Medical Services carried out the autopsy of Mrs Tipper. Dr Ritchey notes that he reviewed records of the Royal Hobart Hospital which reveal a "history of anxiety and depression and multiple admissions for alcohol intoxication". He reports:

"The cause of death of this 57 year old woman, Pamela Mary TIPPER, was probable asphyxia due to choking. Significant contributing factors were chronic alcoholism and alcohol intoxication.

"Ms TIPPER’s body was found on the floor adjacent to a table in her home where she had been eating a meal. There were large fragments of partially chewed food on the floor adjacent to her body. Ambulance crew attending the scene removed additional food debris from the airway."

"The autopsy revealed a well developed, well nourished adult Caucasian woman with copious food debris in the upper and lower airways. There was severe lung disease caused by smoking (emphysema and respiratory bronchiolitis) and cardiovascular disease probably caused by high blood pressure although a history of hypertension is not known."

"These findings are interpreted by me to suggest that Ms TIPPER has likely aspirated a large bolus of food causing her to choke, lose consciousness and die of asphyxia. The contusion (bruise) seen on the right side of the scalp likely occurred during an unprotected fall sustained when she lost consciousness while seated at the table. This bruise was not associated with significant head injury and is unlikely to have directly contributed to her death. Toxicology testing of blood obtained at autopsy revealed the presence of a markedly elevated blood alcohol concentration. Intoxicated individuals are at increased risk of choking while eating".

Comments :

I am satisfied that a full and detailed investigation has been undertaken in relation to the death of Mrs Tipper and that there are no suspicious circumstances.

I accept that Mrs Tipper died as a result of asphyxia due to choking on food with contributing factors being chronic alcoholism, alcohol intoxication (0.216 g/dL), marked emphysema and respiratory bronchiolitis and hypertensive cardiovascular disease.

I wish to conclude by conveying my sincere condolences to the family of Mrs Tipper.

Dated : 23 September 2011 at Hobart in the State of Tasmania.

Stephen Raymond Carey