Coroners Court New South Wales

Coronial findings and recommendations

To access a finding not listed here, please make an application (PDF, 112.1 KB) to the Court. In some inquests recommendations are made to Ministers and Government and non-government agencies.

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Showing results 61 - 70 of 976 results

Inquest into the death of Fiona Goodberg (674.5 KB,PDF File)

Decision of Deputy State Coroner Lee

CORONIAL LAW – manner of death, intentionally self-inflicted death, mental health diagnosis, mental health assessment, subacute mental health care, postpartum

Inquest into the death of Alen Imbrisak (347.5 KB,PDF File)

Decision of Deputy State Coroner Forbes

CORONIAL LAW – death in custody – manner and cause of death during COVID-19 outbreak at Junee Correctional Centre – adequacy of care

Inquest into the death of Cecilia Devine (263.4 KB,PDF File)

Decision of Deputy State Coroner Ryan

CORONIAL LAW – death of a person reported missing in Katoomba area – can cause of death be established? Can manner of death be established?

Inquest into the death of Kevin Edwards (552.6 KB,PDF File)

Decision of State Coroner O'Sullivan

CORONIAL LAW – death as a result of a police operation – 23(1)(c) and 27(1)(b) of the Coroners Act 2009 – diagnosis of drug-induced psychosis – diagnosis of su

Inquest into the death of AX (447.9 KB,PDF File)

Decision of Deputy State Coroner Baptie

CORONIAL LAW – death as a result of fall from height –Queen Victoria Building – acute psychotic illness – adequacy of care and treatment provided by Prince of

Inquest into the disappearance and suspected death of KL (220.5 KB,PDF File)

Decision of Deputy State Coroner Elizabeth Ryan

CORONIAL LAW – disappearance and suspected death of KL - is KL deceased? – if so, can manner and cause of KL’s death be ascertained – was hospital care of an a

Inquest into the death of Robert Phair (215.5 KB,PDF File)

Decision of Deputy State Coroner Ryan

CORONIAL LAW – death of a person in Parklea Correctional Centre - can cause of death be established – was nursing and medical care appropriate and adequate.

Inquest into the death of Andrew Seton (3.1 MB,PDF File)

Decision of State Coroner O'Sullivan

CORONIAL LAW – circumstances of accident and death – survivability – response by NSWPF to report of person missing – search and rescue – search urgency assessm

Inquest into the death of Denis Ives (377.1 KB,PDF File)

Decision of Deputy State Coroner Pearce

CORONIAL LAW – death in Corrective Services NSW custody - whether care and treatment concerns

Inquest into the death of Geoffrey Fardell (235.5 KB,PDF File)

Decision of Deputy State Coroner Kennedy

CORONIAL LAW – homicide- in lawful custody- mandatory inquest - section 23 Coroners Act 2009 – compatibility assessment – appropriateness of shared cell placem

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