Coronial findings and recommendations

CORONIAL LAW; manner of death, arising from police operation, section 23, adequacy of planning for arrest, risk assessment, appropriateness of police actions in locating and arresting deceased, intentional self-inflicted death

CORONIAL LAW – cause and manner of death, unsolved homicide

CORONIAL LAW; Cause and manner of death, death in custody, Long Bay Correctional Centre, Ischaemic heart disease and coronary atherosclerosis

CORONIAL LAW; death in custody; Parklea Correctional Centre; methicillin-resistant Staphylococcus aureus; observations; antibiotic therapy; Therapeutic Guidelines: Antibiotic

CORONIAL LAW; spinal muscular atrophy; Shoalhaven District Memorial Hospital; Newborn and Paediatric Emergency Transport Service; handover; end of life planning

CORONIAL LAW - hospital death of a two month old boy - delayed recognition of sepsis - inadequacy of senior doctor overview - inadequate handover - prolonged attempts at intravenous access - delayed administration of antibiotic - inadequate

CORONIAL LAW – person found deceased – can cause and manner of death be established?

CORONIAL LAW – death of patient following colorectal surgery – was discharge planning and post discharge care appropriate - did retained surgical sponge cause or contribute to death.

CORONIAL LAW; death of a man while awaiting ambulance; ambulance dispatcher downgraded response code; ambulance not allocated until police arrived at scene; NSW Ambulance policies and procedures; recommendations

CORONIAL LAW – Manner of death – Residential Aged Care Facility – Resident to Resident Aggression in dementia unit – policies and procedures – identifying cause of behaviour and reporting incidents – actions taken to prevent escalation