A coroner's inquest into the death of 17-year-old Brighton Grammar student James Tsindos has found missed opportunities in his treatment after he suffered an allergic reaction to cashew nuts in May 2021. The teenager was incorrectly triaged as a category 3 patient at Holmesglen Hospital despite showing signs of returning anaphylaxis, when he should have been category 2. The coroner stopped short of laying blame but recommended stronger Victorian guidelines for food safety and triage procedures involving allergies.

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