Coronial findings - 2014 and earlier

The Magistrates Court (Coronial Division) publishes a small but important amount of records of investigations and findings.

The decision to make these findings available has been made by the Chief Magistrate, or their delegate, or the coroner presiding over the particular investigation, under Coroners Rules 2006.

Publishing a finding is decided on an individual basis, but the coroner may take into account a number of factors:

  • the work of the courts being available to public scrutiny
  • the death prevention role of the coroner
  • family privacy
  • sensitivity of the findings
  • possible harm from making an investigation publically available

In general, authorised findings for publication will include:

  • all public inquest findings
  • motor vehicle crashes
  • long-term missing persons cases
  • homicides after the criminal process has been completed
  • any other death which has been reasonably widely reported in the news media for clarification of the factual findings
  • any death where health and safety recommendations can result in improvements and death prevention (for example, child protection systems issues, deaths in medical settings with recommendations for improvement)
  • any other matter which the coroner believes is in the public interest

Tip: please enter in a search box a name, year or a number of the coronial finding you are looking for.

Table: Coronial findings - 2014 and earlier
Title & TASCD number Keyword
York, Joanne Jean
2013 TASCD 038
Inquest, RHH, Coroners Recommendations
Xepapas, Stephen Sotorios
2014 TASCD 345
Drowning, Roaring Beach
Wrathall, Andrea Lee
2007 TASCD 360
Gunshot wounds, Restraint Order, Family Violence
Work Related Traffic - De-identified
2010 TASCD 248
Findings, Coroner, Recommendations, Magistrate, Truck, Work, Irishtown, Crash, Bolt
Woolley, Damien Leigh
2013 TASCD 067
Orchard, death, Hydraulic mat roller, 'extenday'
Wood, Beverley Joan
2013 TASCD 186
Neck and Chest Injuries, Own Car, Older Persons
Williams, Rodney Alan
2013 TASCD 58
Coroner, findings, Product related, Gas, Fridge, Carbon Monoxide Toxicity, Caravan, Coroner's Recommendations
Williams, Matthew Keith
2013 TASCD 59
Coroner, findings, Product related, Gas, Fridge, Carbon Monoxide Toxicity, Caravan
Fisher, William (PDF, 402.8 KB)
2001 TASCD 48
Body in fountain, Burnt body, Open Finding, Undetermined Death.
Whiteley, Nicholas Martin
2013 TASCD 122
Single Gunshot, Westbury,
White, Yvonne Lorraine
2014 TASCD 21
Motor Vehicle Fatality, Blunt Injuries, Vehicle Occupant, Passenger Car,
Whiley, Stanley Valentine
2013 TASCD 144
Tamar Park, Inquest, Morphine, Ischaemic Heart Disease, Coroners Recommendations
Whayman, Timothy Glenn
2013 TASCD 211
Professional Fisherman, Port Davey, Probable Drowning
Wells, Kerry John
2013 TASCD 171
Conflagration, Vehicle Burnt, Motor Vehicle Crash,
Webb, Zane David
2013 TASCD 21
Death in Custody, SUDEP, Coroners Recommendation
Walker, Frances Victoria
2013 TASCD 172
Cardiac Arrest, Acute on Chronic Renal Failure, Femur Fracture of Neck, Fall, Blunt Force
Wagg, Christopher.pdf (PDF, 1.3 MB)
2014 TASCD 199
Inquest Findings, Workplace, Factory Plant, Zinc Works, Brain Damage, Mechanical Asphyxia, Cherry Picker, Coroner's Recommendations
Unidentified Female Infant
2013 TASCD 374
Unidentified Female Infant, Willow Avenue and Hawthorne Drive Kingston, Coroner's Recommendations
Trotter, Monty William
2010 TASCD 25
Safety, Recommendation, ANL, Workplace, Health, Compliance Audits, Rail Safety Regulator, Wagon
Triffett, Nicholas Edwin
2010 TASCD 422
Saltwater Drowning, Boating Accident
Trezona, David Kenneth
2012 TASCD 312
Multiple Blunt Traumatic Injuries, Motorcycle Crash, Loss of Control
Thomas, Andrew Michael
2013 TASCD 221
Accident, Blunt Force, Vehicle Occupant, Transport Injury
The Deceased - de-identified
2005 TASCD 428
Skateboard, Accident, Alcohol
The Deceased - de-identified
2006 TASCD 132
Motor Vehicle Accident, Recommendations
The Deceased - de-identified
2006 TASCD 16
Alcohol, Student, Fall, University, Head Injury, Intoxicated, Responsible Serving of Alcohol
The Deceased - de-identified
2006 TASCD 104
Hospital, Recommendations, RHH, Overdose, Drugs, Osteoporosis, Self-Administered, Coroner's Recommendations, Intentional Overdose
The Deceased - de-identified
2007 TASCD 004
Recommendations, Fall, Scaffolding Work, Maintenance
The Deceased - de-identified
2007 TASCD 061
Recommendations, Drug Use, Medical Care, Methadone
The Deceased - de-identified
2006 TASCD 414
Drowning, Kings Pier Marina
The Deceased - de-identified
2007 TASCD 163
Aged care, Nursing Home, Wheelchair, Maintenance, Mobility, Duty of Care, Elderly Person, Wheelchair
The Deceased - de-identified
2005 TASCD 99
COAD, Methadone, Drugs, Trimipramine, Medication, Overdose
Tetley, Barry Lindsay.pdf (PDF, 253.8 KB)
2014 TASCD 246
Sepsis, ED, Coroner's Recommendations
Templer, Bryan Eldred
2011 TASCD 414
Coroner's Recommendations, Smoking, Elderly, Fire, Oxygen, Fire Training, Smoking Policy, Older Persons
Taylor, Zack Wayne
2012 TASCD 369
Talcum Powder, 8 months, Abused Child
Taylor, Samuel George
2012 TASCD 264
Struck by Car, Fracture of Skull Bone,
Taylor, Craig Ewen
2014 TASCD 262
Drowning, Body of water, Threat to Breathing, Canoe, Kayak, Row Boat, Watercraft
Sullivan, Craig (PDF, 522.0 KB)
2013 TASCD 336
Ashley Detention Centre, Rupture of a Left Frontal Cerebral Abscess. Coroner's Recommendations
Knight, Larry (PDF, 3.2 MB)
2009 TASCD 25
Inquest, Coronial Recommendations, Beaconsfield Gold Mine
Sullivan, Craig Anthony
2013 TASCD 337
Rupture of Left Frontal Cerebral Abscess, Death in custody, Ashley Detention Centre
Stewart, Robert Claude
2012 TASCD 194
Multiple Organ Failure, Sepsis, Colon Cancer
Stein, Joshua Phillip
2010 TASCD 418
Recommendation, Vehicle, 4WD, Snatch Straps, Tow Bar, Recovery Operations
Smith, Neville Robert
2010 TASCD 248
Drowning, Recommendation, Couta Rocks, Arthur River
Skinner, Timothy Mark
2014 TASCD 202
Drowning, Threat to Breathing, Open Sea, Ocean, Water, Rocks, Surf
SIDS - Four Infants - De-identified
2008 TASCD 187-190
Coroners Recommendations, SIDS, Alcohol, Co-Sleeping, Smoke, SUDI, Training,
Shaw, Albert
2010 TASCD 342
Recommendations, Fall, Elderly
Scott, Ricky Charles
2014 TASCD 256
Drug overdose, Poisoning, Mixed Drug Toxicity
Scott, Beverley Dawn
2012 TASCD 340
Hypoxic Respiratory Failure, Fall, ED
Saunders, Hamish.pdf (PDF, 906.7 KB)
2004 TASCD 503
Workplace Health and Safety Act 1995, DPIWE, Coroner's Recommendations, Drowned, Pedra Branca Island
Saunders, Craig Steven
2015 TASCD 54
Bicycle Collision, Motor Vehicle, Negligent Driving
Salter, Phillip John
2013 TASCD 143
Acute Myeloid Leukemia, Coroners Recommendations
Sallese, Nicola
Roundhill Fatalities - Thorp, Bianca, Keating, Sherilea, Heron, Larissa Anne, Tapson, Claire Helen, Gourley, Bianca
2006 TASCD 213-217
Recommendations, Motor Vehicle Accident, Bass Highway, Burnie, Round Hill Road, DIER
Rosen, Elyssa Suzanne
2014 TASCD 210
Diving, Drowning, Tinderbox
Rogers, James Tasman
2010 TASCD 278
Acute Ethanol Toxicity, Obesity, Sporting Activity
Robertson, Kylie
2014 TASCD 252
Drug overdose, Alcohol, Alcoholic Disease, Poisoning by Chemical
Robbins, Leanne
2013 TASCD 102
Motor Vehicle Crash, Fatal Blunt Trauma
Rigby, Dayna Louise
2014 TASCD 264
Mixed Drug Toxicity, Suppression of Evidence
Richards, Ruth Mary
2014 TASCD 149
Blunt Traumatic Injuries, Pedestrian hit by Car, Blunt Force, Transport Injury
Rhodes, Luke Dale
2014 TASCD 425
Findings, Coronial Division, Magistrates Court of Tasmania, Drug Overdose, Coronial Recommendations
Renison_Decision_21-5-_08.pdf (PDF, 1.5 MB)
Renison Bell Tin Mine, Rock Fall, Heemskirk 1670 Level, Coroner's Recommendations
Rainbow, Zac Cameron
2013 TASCD 213
Asphyxia, Emmaljunga Pram, Coroners Comments
Pugh, Stephen Montague
2007 TASCD 361
Murder, Family Violence, Gunshot Wound
Proposch-Quarrell, Frances
2009 TASCD 147
Hospital, surgery, dangers, warning, lab band, weight reduction, hospital, RHH, Hobart Private Hospital, Doctor,
Pohlner, Kenneth Kim
2012 TASCD 144
Motor Vehicle Crash, Blunt Traumatic Injuries, Arthur Highway, Coroners Recommendation
Perry, David
2013 TASCD 215
Coroners Recommendations, Scuba Diving, Physical & Medical Condition
Percy, Noel Alan
2014 TASCD 236
Death in Custody, Inquest, HMP, Asphyxia.
Pearce, Sidney Thomas
2008 TASCD 140
Miner, Rock Fall,
Pearce, Evan Redmond
2008 TASCD 116
Motor Vehicle Accident, 3 Vehicles, Alcohol, THC
Parremore, Ricky James
2010 TASCD 371
Saltwater Drowning, Submerged Car, Mixed Drug Intoxication
Osborne, Liam
2013 TASCD 095
Infant Death, Death Unable to be Determined
Nichols, Timothy David
2010 TASCD 387
Hanging, LGH, Coroners Recommendations
Nichols, Ian David
2012 TASCD 231
Lake Sorell, Missing Person, Mental Illness, Vietnam Veterans Association.
Na Champassak, Luc Ryan
2010 TASCD 55
SUDI, Hobart Private, Respiratory Distress
Myer Fire
2009 TASCD 239
Myer Fire, Reportable, Liverpool Street Hobart, Coroners Recommendations
Munnings, Helen
2012 TASCD 138
Inquest, Missing Person
Muirhead, Samantha
2012 TASCD 142
Multiple Stab Wounds, Strangulation,
Ms W de-identified
2013 TASCD 99
Drugs, Toxicity, Mixed Prescription Drugs, Bipolar Affective Disorder
Ms W de-identified
2012 TASCD 316
Global Hypoglycaemic Brain Injury, Insulin Overdose
Ms R de-identified
2012 TASCD 286
Fall, Cliff near the Leven Canyon Lookout
Ms M de-identified
2013 TASCD 100
Drowning, Mixed Drug Intoxication, Amitriptyline, Tramadol, Benzodiazepine, Child and Family Services
Ms M de-identified
2012 TASCD 272
Blunt Trauma, Drowning, Fall
Ms L de-identified
2012 TASCD 303
Fall, Financial Situation, Mental Health
Ms I de-identified
2014 TASCD 325
Mixed Drug Toxicity, Morphine, Methamphetamine, Olanzapine, Quetiapine, Citalopram, Metronidazole, Drug and Alcohol Services, Mental Health
Ms F de-identified
2014 TASCD 124
Mixed Drug Toxicity, Methadone, Amitriptyline, Diazepam
Ms F de-identified
2012 TASCD 314
Extensive Blunt Traumatic Injury, Drowning, Fall
Ms C de-identified
2012 TASCD 377
Hanging, Suicide,
Mrs N de-identified
2012 TASCD 206
Drowning, Misadventure
Mrs M de-identified
2010 TASCD 417
Drowning, PFD, Doughboys
Mrs M de-identified
2012 TASCD 152
Older Person, Incised Wounds, Nitrazepam Intoxication, Ailing Health
Mrs K de-identified
2010 TASCD 412
Paracetamol, Stress. Anxiety
Mrs D de-identified
2013 TASCD 255
Suicide, Depression, Motor Vehicle, Exhaust, Gas, Poisoning, Pressured Hose, Pipe
Mr W de-identified
2013 TASCD 144
Cerebral Trauma, Depression, Rifle, Weapon, Firearm, Shot by Firearm
Mr W de-identified
2013 TASCD 150
Mixed Drug Toxicity, Substance Abuse
Mr T de-identified
2013 TASCD 157
Firearm, Injury to Head, Shotgun, Firearm, Weapon, Mental Health
Mr T de-identified
2013 TASCD 438
Motor Cycle Accident, Cranial Fractures, Alcohol, Unroadworthy, No Helmet
Mr M de-identified
2012 TASCD 354
Hanging, Alcohol and Drug Abuse
Mr M de-identified
2011 TASCD 318
Overdose, Mixed Drug Toxicity, Propranolol, Venlaxafine, Nortriptyline, Cardiac Conduction Pathway, Mental Health Act, ED, National Clinical Handover Initiative
Mr K de-identified
2013 TASCD 141
Motor Vehicle Accident, Blunt Force, Transport Injury Event, Vehicle Occupant, Motor Vehicle Crash,
Mr K de-identified
2014 TASCD 393
Combined Drug Intoxication, Methadone, Mirtazapine, Quetiapine, Benzodiazepine, Accidental Overdose, Chronic Back Pain, Mental Health
Mr K de-identified
2013 TASCD 153
Gunshot, Wound of Head, Weapon, Firearm, Rifle, Shot by Firearm
Mr H de-identified
2013 TASCD 163
Motorcycle Accident, Union Bridge Road, Paradise, "Duty to Report"
Mr H de-identified
2014 TASCD 318
Brain Haemorrhage, Fall, Ladder, Coroner's Recommendations
Mr H de-identified
2010 TASCD 467
Hypoglycaemic Episode, Diabetes
Mr G de-identified
2014 TASCD 317
Blunt Force, Fall, Ladder, Australian Standards, Coroner's Recommendations
Mr D de-identified
2013 TASCD 154
Drowning, Mental Illness
Mr C - de-identified
2012 TASCD 444
Combined Drug Intoxication, Illicit Drugs, Poppy Tea
Mr B de-identified
2013 TASCD 274
Extracting Morphine, Poppy Heads, Opium, Accidental Overdose, Thebaine Crop, Trespass Signs
Mr B de-identified
2012 TASCD 188
Motor Vehicle Crash, Bass Highway, Weather Conditions
Mr B de-identified
2012 TASCD 246
Hypoxic Brain Damage Insulin Intoxication.
Motorised Scooters - De-identified
2007 TASCD 306
Recommendation, Safety, Licensing, Scooter, Motorised scooter, Disability, Elderly Persons
Motor Vehicle Crash - De-identified
2009 TASCD 234
Recommendation, Motor Vehicle Crash, Driver, truck, Volvo, key, Keys, ignition, Nissan, Datsun, disengage Engine, Safety, keys in ignition, dangerous, Steering, education, Mechanics
Motor Vehicle Crash - De-identified
2009 TASCD 250
Coronial, Driver, Drinking, Alcohol, High Blood Alcohol Concentration, RSA, responsible service alcohol, 'P' plater, provisional licence, road, DIER, hospitality industry
Motor Vehicle Crash - De-identified
2010 TASCD 17
Magistrate, Court, Investigation, Motor Vehicle Crash, Coroner, Suicide, Midland Highway, Jericho, Mental Health
Miss N de-identified (PDF, 235.7 KB)
2013 TASCD 347
Hanging, Suicide, Anorexia, Coroner's Recommendations
Miss R - de-identified
2012 TASCD 267
Hanging, Suicide
Miller, Norman Leslie
2012 TASCD 13
Assault, Knife, Small Wood Axe, Weapons, Fire, Lack of Integration Services for Prisoners
McKinlay, James Stirling
2013 TASCD 142
Fungsl Infection, Abdominal Surgery, Medical/Surgical Device, Hospitial, Surgical Pack, Complications of Health Care
McGavin, Richard Kenneth
2014 TASCD 66
Workplace Fatality, Roadworks, Trucks, Blunt Force, Pedestrian, Heavy Truck, Crushing, Fulton Hogan, Inquest
Master P de-identified
2012 TASCD 376
Infant, Co-Sleeping, Threat to breathing, SUDI
Master B de-identified
2013 TASCD 101
Bicycle, Blunt Traumatic Injuries, Motor Vehicle, Transport Injury, Braking System, Pedal cyclist
Martinez, Josue
2009 TASCD 216
Motor Vehicle Crash, High Speed, Talbot Road
Marshall, Donald John
2011 TASCD 388
Drowning, Cray Fishing, Cape Portland, Fisherman, Fosters Island, 'Florence', Police Search and Rescue, Cold Case Unit
Marriott, Brendon Roy
2014 TASCD 25
Assault, Gun Shot to Head/Chest, Firearm, Rifle, Weapon, Drugs, Noel Alan Percy
Marikovszki, Bela
2013 TASCD 348
Multiple Organ Failure, Burns, Hot Bathwater, Domestic Accident, Dementia
Margaret J (Vessel) deaths of Hill, Ronald Clement, Giles, Kimm Ronald and Kirkpatrick, Robert Clyde
2002 TASCD 591
Inquest, Margaret J, Fishing Vessel, Class 3 C Licence, Modification, Life Raft, Search and Rescue, EPIRB, Weather, Salvage Coroner Recommendations
Male A, Male B, Male C, Male D - Alcohol Deaths
2014 TASCD 347, 348, 349, 350
Acute Ethanol Toxicity, Positional Asphyxia, Alcohol, National Health and Medical Research Council (NHMRC), Coroner's Recommendations
Macrow, Randolph Brian
2013 TASCD 065
Suicide, Carbon Monoxide Poisoning
Lyall, Jakyung Seo
2012 TASCD 28
Detoxification Unit, Alcohol and Drug Service, Hanging Points, Design and Construction, Coroner's Recommendation, Inquest
Lister, Matthew David
2008 TASCD 139
Mechanical Scaling Operations, Rock Fall
Lindsey, Glen Michael
2013 TASCD 236
Fall, Horse Racing, Harness, Industrial Accident
Levi, Rene
2012 TASCD 92
Inquest, LHS, School Excursion
Kuol, Kuol Piyom
2012 TASCD 141
Hanging, Suicide, Intentional
Knowles, Francis Joan
2013 TASCD 272
Fall, Subdural Haematoma, Dementia, Strathglen Nursing Home, Office of Aged Care Quality and Compliance, Hip Protectors
Knott, Alicia Ellen & Shaw, Rebecca Jane
2013 TASCD 22
Coroner, findings, Motor Vehicle Accident, Blunt Force, Tranport Injury Event, Vehicle Occupant, Motor Vehicle Crash,
Jones, Steven Paul
2014 TASCD 238
Drug Toxicity, Prescription Drugs, Oxycodone, Methadone, Chronic Pain, Mental Health,
Jones, Jarrod Keith
2008 TASCD 138
Renison Bell Tin Mine, Zeehan
Johnson, Ian Douglas
2014 TASCD 211
Pulmonary Thrombo-Embolism, Ischaemic Heart Disease, Recent Coronary Artery Stenting, Department of Cardiology’s Mortality and Morbidity Committee, Launceston General Hospital
Joblin, Robert John
2013 TASCD 256
Haemorrhagic Shock, Blunt Force, Transport, Ute, Car, Driver, Single Motor Vehicle Accident, Train, Railway, Australian Standards, Coroner's Recommendation
Jenkins, Nita Joan
2013 TASCD 155
Findings, Coronial Division, Magistrates Court of Tasmania - Fatal Arthymic Cardiac Event, Ischemic Heart Disease, Pulmonary, Fatty Liver, Heart Failure, Anemia, Health Care
Jaffray, Reginald John
2012 TASCD 339
Drowning, Stowport, Dementia
Intentional Firearm - De-identified
2008 TASCD 106
Self-Inflicted Injury, LGH, Gun Safe
Infant - de-identified
2006 TASCD 149
Infant Death, SIDS
Infant - de-identified
2009 TASCD 357
Co-Sleeping, SUDI, Coroner's Comments
Ind, Stephen David
2012 TASCD 285
Asphyxia, Norwood, Neena
Inches, Christine Anne
2014 TASCD 391
Sepsis, Cervical Cancer, Timely Diagnosis
Higlett, Geoffrey William
2013 TASCD 36
Coronial, Recommendations, Tractor, Farming, Slasher, Bruny Island
Hepburn, Blair Anthony
2010 TASCD 247
Trampoline Accident, Coroner's Recommendations
Heenan, Martin Francis
2014 TASCD 222
Overdose,, Drug, Alcohol, Morphine, Benzodiazepine, Liver Disease
Hayes, Adrian Brian
2010 TASCD 311
Inquest, Cornwall Coal, WST
Hayers, Aliesha Emily
2013 TASCD 349
Acute Asthma, Ambulance Tasmania, Second-Hand Smoke
Hay, Sandra Winidred
2012 TASCD 245
Mixed Drug Toxicity, Aspiration Pneumonia.
Hart, Connor Robert Lincoln
2014 TASCD 201
Drowning, Threat to Breathing, Open Sea, Ocean, Water, Rocks, Surf
Harris, David John
2012 TASCD 288
Acute Alcohol Toxicity
Grunwaldt, Nancy
2004 TASCD 182
Foul Play, St Helens and Bicheno, St Helens Hostel,
Gregson, Kellie Maree
2011 TASCD 78
Coroner, Tasmania, Crash, Accident, Passenger, Criminal Charges, Dangerous Driving, Collision, Tea Tree, Negligent Driving.
Green, Mark Leslie
2010 TASCD 277
Blunt Trauma, Drug Intoxication, Alcohol Abuse, Fall
Greedy, Judd Robert
2010 TASCD 361
Motorcycle Accident, Multiple Blunt Traumatic Injuries, Coroners Recommendations
Grant, Steven John
2014 TASCD 221
Overdose, Alcohol, Intoxication
Glover, Patricia Edna
2013 TASCD 383
Complications of Health Care, Medical Care, Surgical, Operation, Gastroenterology Device
Glancy, Susan Helen
2013 TASCD 422
Otago Bay, Motor Vehicle Accident, Driver Error
Giuliani, Paul
2012 TASCD 196
Motor Vehicle Crash, Severe Atherosclerotic Coronary Vascular Disease
Fyle, Shirley Lorraine
2013 TASCD 421
Pedestrian, Truck, DeBruyns, Criminal Charges
Fox, Barbara Constance
2014 TASCD 327
RHH, Duodenal Ulcer, High Dependency Unit, Coroner's Recommendations
Foo, Janice Peow Chye
2013 TASCD 254
Motor Vehicle Accident, Tourist, Head and Neck Injuries, Blunt force, Transport Injury, Vehicle Occupant, Minibus, Passenger, Transport
Elderly Fall - De-identified
2009 TASCD 154
Recommendations, Falls, Elderly, Personal Alarms, Personal Protection, Reportable Death
Eaton, Jodi Michelle (PDF, 460.4 KB)
2019 TASCD 257
Homicide, Assault, Asphyxia, Bridgewater, Darren Dobson, Strangulation/choking, Coroner's recommendations, Recommendation of Enactment of Indictable Offence of Choking, Suffocation or Strangulation
Drug Overdose - de-identified
2008 TASCD 36
Mixed Drug Overdose, Septicaemia, Section 22 of the Alcohol and Drug Dependency Act 1968
Drownings Hippolyte Rocks - De-identified
2007 TASCD 372
Drowning, Hypothermia, Fishing, Competition, Tuna, EPIRB, Recommendation, Bravery, Weather
Drowning - De-identified
2007 TASCD 292
Recommendation, Drowning, Water Safety
Drowning - De-identifed
2008 TASCD 248
Saltwater Drowning, Roaring Beach, Weather Conditions, age, Alcohol
Dougan, Kim Marlene
2014 TASCD 344
Motorcycle Crash, Severe Trauma, Midland Highway, Coroner's Recommendations
Doodt, Russell Charles
2010 TASCD 110
Drug Toxicity, Mental Health, Alcohol Dependence, Inquest
Donnelly, Trevor Darren
2013 TASCD 182
'Time Out', Drowning, Alcohol
Dingle, Simon Duncan
2012 TASCD 349
Traumatic Subarachnoid Hemorrhage, Manslaughter
Dent, Jonathan Paul
2012 TASCD 268
Natural Causes, Bushwalking, Hyponatremia, Dial Ranges
Dean, Michael Laurence
2010 TASCD 209
Drug Toxicity, Mental Health, Complex Medical Problems
Daunt, Linda
2013 TASCD 253
Findings, Coronial Division, Magistrates Court of Tasmania, vehicle accident, blunt force, transport, passenger car, driver, rider, single motor vehicle accident, head and chest injuries
Dalley, Paul Nicholas
2013 TASCD 437
Asphyxia, Tractor Accident
Cyclist - De-identified
2007 TASCD 204
Burnie, Warning, Bicycle, Parental Supervision
Cracknell, Dorene May
2010 TASCD 413
Fall, St John's Campus, Coroners Recommendations
Cooper-White, Leo Thomas
2012 TASCD 192
Fall, Coats Patons,
Colson, David James
2010 TASCD 1
Recommendations, Workplace, Diving, Abalone, Water Safety
Clarke, Geoffrey Arthur
2014 TASCD 251
Drowning, Threat to Breathing, Open Sea, Ocean, Fishing Boat, Trawler, Watercraft
Clarke, Benjamin David
2013 TASCD 212
Fisherman, FV Kristie Lee, Unable to be Determined, Probable Drowning
Church, James Peter
2013 TASCD 189
Fall from Height, Older Persons
Beamish, Bruce and Chugg, Adrian (PDF, 63.9 KB)
2009 TASCD 324, 325
Multiple Injuries, Veolia, Occupational Health and Safety
Child de-identified
2005 TASCD 182
Hypoxic Brian Damage, Type 1 Diabetes
Chappell, Robert Adrian
2014 TASCD 4
Trial of Ms Neill-Fraser, Murder, Statutory Requirements, Four Winds Vessel
Casely, Gary Robert
2012 TASCD 209
Unexpected Death, Schizophrenia, Post-Traumatic Seizure Disorder.
Campbell, Donald Laird
2014 TASCD 260
Drowning, Water, Weather, Natural Disasters, Open Sea, Ocean, Body of water, Coroner's Recommendations
Cafasso, Victoria Anna Elizabeth
2005 TASCD 125
Beaumaris Beach, Exsanguination, Stab Wounds, Inquest,
Burns, Tanya Maree
2013 TASCD 431
Incineration, Smoke Inhalation, House Fire, Flame, Smoke, Smoke, Heating, Thermal Mechanism, Electric, Gas Radiator, Heater
Burmister, Garry Paul
2012 TASCD 315
Combined Prescription Drug (Diazepam and Metabolite, and Atenolol) and Alcohol Toxicity, Chronic Alcoholism, Alcoholic Liver Disease and Chronic Anxierty
Budd, Arthur John
2013 TASCD 57
Lagoon Beach, Sloping Main, Drowning
Bryant, Eileen Margaret
2010 TASCD 416
Hospital, coroner, Recommendation, Tas Ambulance Service, Fall, Medication, Care, Treatment
Brooks, William Vernon
2012 TASCD 289
Fall, LGH
Breen, Donald Martin
2012 TASCD 224
Intra-Cerebral Haemorrhage, Carvedilol, NWRH
Bourke, Simon Francis
2013 TASCD 439
Light Aircraft Crash, Microlight Aircraft, RAAI
Bourke, Melanie Patricia
2012 TASCD 290
Aspiration Pneumonia and Pyelonephritis, Mersey Community Hospital
Booth, Lonnie George
2012 TASCD 90
Hanging, Chronic Back Pain, Heart Problems
Blaschke, Gordon Stefan
2014 TASCD 14
Overdose, Hypoxic Brain Injury
Blake, Hannah Maree
2012 TASCD 171
Pneumonia, Drugs, Mental Health Services North
Blain, Arthur Macfarlane
2013 TASCD 266
Driver's Licence, Elderly, Interstate Licences, Crash, Transport, Registrar of Motor Vehicles, Coroner's Comments
Bingley, Andrew Bruce Erskine
2012 TASCD 266
Struck by Motor Vehicle, Cycling Crash, Bass Highway
Binge Drinking - De-identified
2007 TASCD 261
Binge Drinking, Intoxicated, Acute Alcohol Intoxication
Bellette-Coutts, Ashley
2012 TASCD 151
Motor Vehicle Collision, Chest, Abdominal Injuries, Seatbelt
Bartle, Terry Charles
2013 TASCD 58
Coroner, Findings, Product related, Gas, Fridge, Carbon Monoxide Toxicity, Caravan
Barnes, Janice Zoey
2013 TASCD 78
Findings, Coronial Division, Magistrates Court of Tasmania -Sepsis, Bacterial Infection, Ischemic Colitis
Bakes, Walter Charles
2013 TASCD 173
Older Persons, Smoke Inhalation, House Fire, Asphyxia
Baby W de-identified
2012 TASCD 200
Hypoxic Brain Damage, Asphyxia, RHH, Serious Incident Panel Review, Coroners Recommendation
Baby W de-identified
2014 TASCD 414
Aspiration Pneumonia, NWPH, Infant Death
Baby R de-identified
2014 TASCD 43
Recommendations, Tasmania, Co-Sleeping, Infant, Baby, Child Protection, DHHS, Department of Health & Human Services, SIDS, CPS, Alcohol, Depression, Family Violence, Suffocation, Safe Sleeping Guidelines,
Baby R de-identified
2014 TASCD 43
Motor Vehicle Fatality, Blunt Force, Passenger, Weather, Rain, Infant.
Baby J de-identified
2010 TASCD 423
SIDS, Coroners Comments
Baby H de-identified
2012 TASCD 82
Sudden Infant Death Syndrome (SIDS)
Baby A de-identified
2012 TASCD 202
SUDI, Co-Sleeping, Coroners Recommendations
ATV Death de-identified
2004 TASCD 371
ATV Death, All Terrain Vehicle, Margate,
Archer, Colin Gladstone
2012 TASCD 223
Cardiac Tamponade, Ruptured Acute Myocardial Infarct
Apted, Dale Robert
2014 TASCD 346
Alcohol, Intoxication, Smoking
An Elderly Gentleman de-identified
2010 TASCD 458
Fall, Elderly, Multiple Organ Failure, Coroners Recommendations
Alcohol Deaths de-identified A, B, C & D (Word, 221.0 KB)
Alcohol Deaths, 4 Males, Coroner's Recommendations
2012 TASCD 134 - PEGG, William Edward
2012 TASCD 131 - SHOOBRIDGE, Diana Muriel
2012 TASCD 124 - FUNARI, Rachel
2012 TASCD 115 - Sherriff, John Charles
Coroner, Calvary Hospital, haemoperitoneum, laparoscopic hemicolectomy, caecal tumour, complication of surgery
2012 TASCD 112 - ANDERSON, Brendan Kenneth
2012 TASCD 094 - NEWTON, Blake Marcus
Overdose, Coroner, depression, combined drug intoxication, RHH
2012 TASCD 087 - BATCHELOR, Ruth Marina
2012 TASCD 084 - SZABO, Eric Andrew
2012 TASCD 079 - RAYMENT, Dennis George
Coroner, warning, crushing, tree, tree fellers, hazardous, proper tree felling techiques
2012 TASCD 072 - DENMAN, Gloria Jean
Coroner, fire, housebound, television, carbon monoxide, operating smoke alarm, smoke alarm.
2012 TASCD 052 - GUNN, Donna Sharee
Motor Vehicle, Crash, Coroner, Tasmania, Driver, Fatigue, warning, driver fatigue, working fatigue
2012 TASCD 049 - FAZACKERLEY-WATSON, Corey Albert
Coroner, findings, court, drug overdose, alprazolam, drug treatment order, illicit drugs, Fazackerley-Watson, Robert Pearce
2012 TASCD 027 - SMITH, Christine Julie
Coroner, findings, mental health, Royal Hobart Hospital, RHH, hypoxic brain injury, drugs, emergency department, Psychiatry ward, benzodiazepine withdrawal.
2012 TASCD 026 - SNAPE, Ann
2012 TASCD 014 - LOVELL, Marcus Dean
2011 TASDCD 127 - PARSELL, Sadie Olive
Coroner, Tasmania, Barrington Lodge, fall, elderly, broken nock of femur, broken hip, AT, Ambulance Tasmania, delay, RHH, Royal Hobart Hospital
2011 TASCD 450 - BLACKABY, Karen Elizabeth
2011 TASCD 449 - WILLIAMS, Jeffrey Ray
Findings, Coroner, Workplace Standards, unsafe work practices, tractor, crushing, farm, maintenance of equipment
2011 TASCD 442 - BEER, Vaughan Matthew
Tasmania, Coroner, vehicle, crash, methadone, recommendations, driver impairment, cannabis, fatigue, drugs
2011 TASCD 422 - MR. M
Hospital, coroner, recommendation, patients, communication, surgery, communication issues, medical staff, medical procedure
2011 TASCD 421 - CLARKE, Christine Jan
Coroner, findings, electrocution, frying pan, hypertensive heart disease.
2011 TASCD 415 - MONEY, Douglas
Coroner, findings, undetermined, 'Loru'
2011 TASCD 410 - MENNITZ, Russell, Alfred
crash, motor vehicle, Queenstown
2011 TASCD 408 - DOYLE, Zachary George
Coroner, recommendations, fatality, crane, farming, Perseverance, Roaring Beach, Dover, workplace, safe operation, training, risk assessment,
2011 TASCD 403 - MR W.
Coroner, findings, Langford, ashphyxia, death in care, recommendations, emergency alert device
2011 TASCD 402 - MR S
Findings, Coroner, drugs, medication, temazepam, sertraline
2011 TASCD 398 - NEWELL, Christopher James
Overdose, Coroner, depression, combined drug intoxication, RHH
2011 TASCD 393 - BEAMES, Norman Valentine
Hospital, NWRH, North West Regional Hospital, CT scan, contrast agent injected, reaction, Isovue, iodine
2011 TASCD 391 - CONNOR, Kelvin John
2011 TASCD 387 - SLACK, Bobby Ray
Coroner, shark, Bruny Island, diviing, abalone
2011 TASCD 386 HULL, David Jocelyn
Finding, Coroner, drowning, boat, fisherman, Historial Missing Person, 'The Narrows", Marion Bay
2011 TASCD 370 - Mr K
Coroner, hanging, mental health, mental health services, NWRH
2011 TASCD 364 - Mr. L
2011 TASCD 354- Suicide for Publication
Coroner, Suicide, Firearm, Depression
2011 TASCD 347 - HOWELL, Rodney Peter
Diving, Coroner, gas embolism, regulator, dive, Hookah, dangerous activity, equipment faults
2011 TASCD 344 - GLEESON, Cherry
Coroner, findings, hyperthermia, environmental heat exposure, entrapment in boot, alcoholic, alcohol
2011 TASCD 343 - TIPPER, Pamela Mary
Coroner, alchol, choking, food, steak, choking on food, emphysema, bronchiolitis, hypertensive cardiovascular disease, Goodwood
2011 TASCD 340 - BOWKETT, Damien Steven
Coroner, Motor Bike Accident, Blunt Force, Transport Injury, Motorcyclist/Motorcycle Rider, Fracture of base of the Skull, Fracture of Ribs, Pelvic Bones, recommendation, speeding, speed, unfamiliar road, correctly inflated tyres, maintenance
2011 TASCD 319 - WAUGH, Claire Louise
Coroner, recommendations, suicide, DHHS, 1E, Northside, suspension points, hospital , LGH, Launceston General Hospital, Mental Health, Mental Health Act 1996, involuntary patient, death in care, recommendation, suicide risk, THC, amphetamines, cannabis, methylamphetamine, Health Act, Tasmania, Launceston,
2011 TASCD 306 - MURRAY, Xavier
Coroner, findings, recommendations, multiple births, infant, twins, preganacy, "Multiple pregnancy policy" hospital, paediatrician, birth asphyxia, hospital, Calvary Hospital, Royal Hobart Hospital.
2011 TASCD 300 - Lovell, Robbie
2011 TASCD 298 - KUKULJEVIC, Peter Cecil
Coroner, Tasmania, Recommendations, Murchison Highway, Tullah, Crash, speed, lost control, overtaking
2011 TASCD 29 - WOOLLEY, Raelene Judith
2011 TASCD 271 - LIMBRICK, Jeffrey David -
Coroner, finding, recommendation, RHH, NWRH, Royal Hobart Hospital, North West Regional Hospital, liver, liver dysfunction, complications
2011 TASCD 268 - GRICE, Billy John
2011 TASCD 268 - ALLEN, Judith Louise
Findings, coroner, recommendations, lap band surgery, Jehovah Witness, surgery, blood loss, surgery, RHH, autologous blood transfusions,
2011 TASCD 258 - RANSLEY, Shane Allan
Coroner, Findings, recommendations, Tasmania, crane, 'Franna", "29 tonne Franna crane", crane driver, speed, cannabis, THC, seat belt
2011 TASCD 257 - Motorcycle Accident
Motorcyle Crash, Blunt Force, Motorcyclist/Motorcycle Rider, Motorised Two or Three Wheeled Vehicle
2011 TASCD 256 - Baby RL
Coroner, Tasmania, baby, infant, Child Protection, premature, inquest, RHH
2011 TASCD 254 - MAHER, Kayla Maree
Coroner, recommendations, findings, motor vehicle crash, THC, passenger, male drivers, young male drivers, Novice Licensing system, Road Safety, Road Safety Strategy, driver, safety, curfews, vehicle power restrictions, DIER, alcohol interlock,
2011 TASCD 249 - REYNOLDS, Chrystal Tina
Findings, coroner, tasmania, recommendation, recommendations, methadone, amphetamines, cannabis, methadone programme, prescribing guidelines, TOPP, Tasmanian, Opioid Pharmacotherapy Program Policy.
2011 TASCD 212 - CUBIT, Ross Donald
Coroner, recommendation, Tasmania, drowning, alcohol, intoxication, race, life jacket, 'Storm Boy' yacht, "Pipe Opener", Derwent Sailing Squadron, rough, seas, weather, overboard, PFD, yachtsman
2011 TASCD 206 - WIGGINS, Charles Thomas
Coroner, recommendations, chainsaw, logging, clear felling, tree, bushman, tree-feller, Gunns, Work Place Standards, WST, safety helmetlogs, slippery, unsafe work practices, training, forest, harvesting, hazardous, Forestry Tasmania.
2011 TASCD 205 - BUENGER, Hans
2011 TASCD 204 -BUENGER, Gisela
2011 TASCD 2011 - LAWRENCE, Jay Harli
2011 TASCD 180 - Baby T
Findings, coroner, recommendation, safe sleeping, co-sleeping, sids, kids, DHHS, educating, parents
2011 TASCD 175 - HARRIS, Leonie
Coroner, coronial, magistrate, court, recommendations, missing, downed, boating,
2011 TASCD 174 - HARRIS, John Phillip
court,magistrate,magistrates,tasmania,australia,courts,coronial, Downed, Missing, Boating, Fisherman
2011 TASCD 172 -ARKINSTALL, Christine Alainie
2011 TASCD 171 - BEHREND, Adam Michael
2011 TASCD 170 - PEDDER, Danny Allan
2011 TASCD 169 - MOORE, Craig Robert
2011 TASCD 167 - STEELE, Roger
Coroner, Royal Hobart Hospital, RHH, ED, Emergency Department, protocols, triage, chest pain, ischaemic heart disease, Myocardial Perfusion Scan
2011 TASCD 166 - ZEWDU DESTA, Desalegn
Coroner, Tasmania, Cambridge, garbage truck, left hand drive, fatality, recommendations, seat belts, unsafe driveing, negligent driving
2011 TASCD 163 - HOWELLS, Theresa Rachael
Coroner, hanging, drugs, psychiatric problems, history of self harm
2011 TASCD 152 - CHAPMAN, Lennox Paul
2011 TASCD 132 - WAITE, Raymond Frederick
Findings, coroner, recommendations, recommendation, RHH, Royal Hobart Hospital, fall, X-ray, care, duty of care, DEM, Department of Emergency Medicine, doctor, geriatric, geriatric patients, elderly
2011 TASCD 131 - DAVIES, Joffre George
Coroner, Magistrate, Hobart, pedestrian, decreased mobility, poor eyesight, crash, unroadworthy.
2011 TASCD 130 -BARDENHAGEN, Guy Anthony
2011 TASCD 126 - LEE, Basil Alexander
2011 TASCD 125 - HOLLOWAY, Maxine Frances
Coroners, Findings, Coroner, drugs, drug, overdose, centrelink, pension, quetiapine, depression, paranoid delusions, schchizophrenia
2011 TASCD 121 - BAILEY, Elwyn Aubrey
2011 TASCD 115 - MS K
Coroner, magistrate, Court, swine flu, hospital, Mersey Community Hospital, Ambulance, Tasmania recommendation, Klippel-Feil, autism, flu, H1N1 90, management, patient, delay
2011 TASCD 114 - WILLCOX, Clint Anthony
Coroner, Findings, motor cycle, racing, endurance, riding, Preolenna, TERC, Tasmania Endurance Racing Club, crash
2011 TASCD 113 - PALECEK, Anna
Coroner, Tasmania, Hobart, Highway, Pedestrian, crossing, crash, injuries, car
2011 TASCD 070 -WILLIAMS, Sher-Ron Louise
Coroner, findings, recommendations, Tasmania, Australia, pedestrian, Brooker Highway
2011 TASCD 043 - VALENTINE, David Francis
Coroner, Coronial, Tasmania, Magistrates, Australia, Mental Health Patient, Bipolar,
2011 TASCD 042 - YOUNG, Jennifer Betty
Coroner, findings, recommendation, recommendations, overdose, drugs, quetiapine, benzodiazepam, pancreatitis, addiction, prescribed medication.
2011 TASCD 036- DAVIS, Timothy Graham
Coroner, Coronial, Magistrate, Court, Hobart, Tasmania, life jackets, boat, safety, warning, recomendation, drowning, alcohol, Dover Hotel, RSL, boat size, age of occupants, PFD's, weather conditions, personal floatation devices
2011 TASCD 030 - WILLIAMS, Claire Anne
Coroner, recommendations, Hobart, recommendation, hospital, nursing home, Freemasons, digitalis, toxicity, RHH, chronic renal failure, digoxin
2011 TASCD 026 - KELTY, Jackson
2011 TASCD 025 - DERMODY, Brendan William
2011 TASCD 024 - KILBY, Clement Bernard
2011 TASCD 023 - STURGESS, Ben Samuel
Recommendation, coroner, Tasmania, Magistrate, Court, vehicle, 4WD, snatch straps, tow bar, recovery operations, danger
2011 TASCD 01 MCLEOD, Alastair James Douglas
2011 TASCD 228 - LITTLEJOHN, Regan Anne
Coroner, findings, Tasmania, warning, tractor, farm, machinery, agricultural, children, infants, WST, work place standards, risk, danger, preventable, toddler
2011 TASCD 213 - LEE, Duncan Joseph
Coroner, Tasmania, mental health, mental illness, suicide, drowning, jump, bridge
2011 TASCD 073 - Suicide for Publication
Recommendation, coroner, Tasmania, Magistrate, Court, Suicide, Firearm, Smoking, Anti Smoking Drug, Champix, Weapon
2011 066 TASCD - JOHN, Glyn Edwin
Coroner, recommendations, ambulance, tasmania, AT, ladder, fall, domestic duties, home, safety