Coronial findings 

To access a finding not listed here, please make application (DOC , 61.5 KB) to the Court. In some inquests recommendations are made to Ministers and Government and non-government agencies.

Showing 1-10 of 92 results

  • Recommended
    Decision of State Coroner O'Sullivan
    CORONIAL LAW – general inquiry, cause, origin and circumstances, explosions at the Israeli Consulate and Hakoah Club in 1982, cold case investigation, act of international terrorism, May 15 terrorist organisation
  • Recommended
    Decision of Deputy State Coroner Kennedy
    CORONIAL LAW – Wollongong Hospital, tracheostomy, subarachnoid haemorrhage, thunderclap headache, PICA, speaking valve, tracheostomy cap, Swedish nose, tracheostomy management, multidisciplinary team
  • Recommended
    Decision of Deputy State Coroner Ryan
    CORONIAL LAW – death of inmate at Long Bay Hospital – natural causes death – care and treatment appropriate.
  • Recommended
    Decision of Deputy State Coroner Lee
    CORONIAL LAW – death as a result of a police operation, critical incident, use of lethal force by police, Active Armed Offender, Tactical Options Model
  • Recommended
    Decision of Deputy State Coroner Grahame
    CORONIAL LAW – suicide of 15-year-old First Nations boy in out-of-home-care; out-of-home care for First Nations children; out-of-home care involving interstate relocation of child; cultural safety of out-of-home care for First Nations
  • Recommended
    Decision of Deputy State Coroner Grahame
    CORONIAL LAW - Public interest immunity claim, non-publication orders
  • Recommended
    Decision of Deputy State Coroner Grahame
    CORONIAL LAW – Safe Driving Policy (SDP); Police Pursuit; whether re-initiation of pursuit; vehicle stop
  • Recommended
    Decision of Deputy State Coroner Ryan
    CORONIAL LAW – death of child at Broken Hill Base Hospital – can cause of death be ascertained – was medical care and treatment adequate – were transfer decisions managed appropriately – recommendations
  • Recommended
    Decision of Deputy State Coroner Ryan
    CORONIAL LAW – death of First Nations man at Junee Correctional Centre – was medical care and treatment appropriate
  • Recommended
    Decision of Deputy State Coroner Kennedy
    CORONIAL LAW – Unfractionated Heparin compared to Enoxaparin for prevention of DVT, police operation, police pursuit for mental health welfare concern, care and treatment at Royal North Shore Hospital
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Last updated:

12 Nov 2021

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