Coroner's Court of Western Australia

Inquest into the Death of Child C (Name Subject to Suppression Order)

Inquest into the Death of Child C (Name subject to Suppression Order)

Delivered on : 24 January 2023

Delivered at : Perth

Finding of : Coroner Urquhart

Recommendations : N/A

Orders/Rules : N/A

Suppression Order :

Suppression of the deceased’s name from publication and any evidence likely to lead to the child’s identification.

The deceased is to be referred to as Child C.

Summary : Child C was in the care of the Chief Executive Office (the CEO) of the Department of Communities (the Department) at the time of her death. She was 15 years old. As Child C was a person held in care, her death was subject to a mandatory inquest.

Child C’s family first came to the attention of the Department in September 2008. On 15 August 2014, the Department made an application in the Children’s Court for Child C to be placed into the provisional  protection and care of its CEO. That application was granted, and Child C was placed into the care of foster and family carers.

On 20 October 2016, the Children’s Court granted the Department’s application for a time-limited Protection Order for Child C. This was for a period of two years and Child C remained the responsibility of the Department’s CEO. She continued to live with foster carers.

On 9 May 2019, the Children’s Court granted the Department’s application for a Protection Order for Child C until she was 18 years old (i.e. 11 January 2023). At the time, Child C consented to the application as she was happy and settled with her foster carer.

Shortly after the application was granted, Child C became disruptive and non-compliant at school and at the home of her foster carer. On 10 July 2019, she self-selected to return to the care of her mother who lived in Pinjarra with Child C’s older brother and sister. The Department subsequently monitored the living arrangements at the home of Child C’s mother and was satisfied that it was suitable for Child C to remain living there.

At about 1.30 am on 27 November 2020, Child C was in a group of five young people that was in a car driven by a 17-year-old girl who held a provisional driver’s licence. At one stage, the four passengers were seated on the boot and bonnet of the car as it was being driven. When Child C moved from the boot to stand on the tow bar, she fell and struck her head on the road, rendering her unconscious. Despite a nearby resident administering CPR and attending ambulance officers continuing resuscitation efforts before taking Child C to hospital, she died at Royal Perth Hospital from a head injury on the afternoon of 27 November 2020.

The driver pleaded guilty to the manslaughter of Child C and she was sentenced to 16 months’ detention by the President of the Children’s Court on 22 June 2021. She was also disqualified from holding a driver’s licence for three years.

Aside from some minor oversights with its record-keeping, which included not making Child C’s self-selection an endorsed placement, the Coroner was satisfied that the standard of the Department’s overall supervision, treatment and care of Child C was appropriate.            

Catch Words : Mandatory Inquest - Care, supervision and Treatment While in Care: Department of Communities


Last updated: 27-Feb-2023

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