Australian Capital Territory

Coronial Inquests published by the Australian Capital Territory Coroner.

Adrian Pitman

Inquest into the death of Adrian Pitman

Adrian Pitman was born in 1961. There is no dispute that he died from multiple injuries after his car hit a stone retaining wall and caught on fire on Fairburn Avenue, Campbell, ACT. This happened at about 12.01 am on Tuesday 15 March 2016. The Court is aware of the sadness caused by my determination that the manner of Mr Pitman’s death was suicide by intentional motor vehicle collision. Those interim findings were made on 13 June 2019.\r\nMr Pitman had a long history of mental illness. He had completed school and commenced studying architecture at university. Mr Pitman’s mental health declined to the point where he had a long term diagnosis of treatment-resistant schizophrenia by the time of his death. Unfortunately, by March 2016 Mr Pitman was a social recluse, was subject to a community treatment order to enforce medication regimes and he was obsessed with delusions. He had been in the care of 33 different case managers since the year 2000.

Coroner Stewart on 14 October 2019


Jandy Renia Shea

  1. The death of Jandy Renia Shea, a 27 year old woman at the date of her death, was reported to then ACT Chief Coroner Walker as she was thought to have died unnaturally in unknown circumstances.  Jandy was located by her husband Christopher (Chris) in the early morning of 4 March 2018 hanging from a bathroom door handle by a tie-down strap.

Listen to this case report:

Kurt Mellick Andriske

Inquest into the death of Kurt Mellick Andriske

2. Mr Andriske was born in 1964. Not much is known of Mr Andriske’s life prior to 2006, when he started seeing general practitioner Dr Helen Wessell. Mr Andriske was being treated by Dr Wessell for the following conditions: bipolar disorder, neuropathic pain, Hepatitis B and C, and chronic airways disease. Dr Wessell prescribed him number of medications including Valium, Serepax, and Lithium. Medicare records suggest that Mr Andriske saw Dr Wessell (or in her absence, other doctors in her practice) virtually exclusively during the period September 2012 to December 2016.

Acting Chief Coroner Theakston on 20 September 2019


Sebastian Nicholas Pelle

Inquest into the death of Sebastian Nicholas Pelle

3. Mr Pelle lived with his parents in Canberra. He was a generally fit and well young man.\r\n4. On 3 April 2015 Mr Pelle saw a dentist. A gum swelling on his right side, indicative of infective process, was identified although no dental abscess was observed.\r\n5. In August 2015 Mr Pelle started to complain of headaches. On 8 November 2015 Mr Pelle had a seizure and became unconscious. He was taken to The Canberra Hospital (TCH) by ambulance, where he underwent emergency surgery to remove a lesion on his frontal lobe 50x20x19 mm in size. An examination of the cyst found that it was benign, but Mr Pelle was recommended to have regular screening tests to check on possible regrowth of the cyst and prescribed a short course of anticonvulsant medication. The first few screening tests returned negative results.\r\n6. On New Years Day in 2016 Mr Pelle suffered another seizure while in Sydney and he was admitted to St Vincent’s Hospital. Mr Pelle was released with instructions to continue taking his anticonvulsant medication. A subsequent MRI on 7 April 2016 showed no further growth of the lesion.

Coroner Boss on 22 August 2019


Cheyse Williams-Empson

Inquest into the death of Cheyse Williams-Empson

2. At the time of his death, Cheyse was living in a cottage at Karinya House (‘Karinya’) with his mother, Ms Amanda Williams. Karinya is a community organisation which provides accommodation, transitional housing and outreach services to pregnant and new mothers in need of specialised support.\r\n3. At about 5:30am on 25 June 2017, Cheyse woke up. He was breastfed and bottle-fed with formula then placed back in his bassinet by his mother. A blanket was placed over him and a face washer underneath his head. At about 7:00am, Ms Williams fell asleep on the lounge watching television. At about 11:00am, Ms Kimberley Castles, a staff member at Karinya, went to Ms William’s cottage to conduct a routine welfare check. Ms Williams appeared to have just woken up and told Ms Castles about feeding Cheyse earlier that morning. After Ms Castles left, Ms Williams went inside the cottage and found Cheyse unresponsive in his bassinet. His blanket was covering his mouth and half of his face. She immediately called out for assistance. Ms Castles re-attended the cottage and commenced cardio-pulmonary resuscitation while Ms Williams called 000. ACT Ambulance Service officers attended shortly thereafter. They determined on arrival that Cheyse was deceased. Police also attended.

Chief Coroner Walker on 31 July 2019