‘Nothing could have prevented drowning’
There was little that could have been done to prevent the “tragic accident” in which a teenage boy drowned at a popular Gold Coast waterfall,
a coroner has ruled.
Policy changes have been made in response to the 2021 tragedy, and while the adult who was supervising the 13year-old that day could have physically restrained him to stop him from entering the water, the coroner ruled this was “not reasonable” in the circumstances.
The deceased child, who cannot be named for legal reasons, had been intermittently under the care of the Department of Child Safety since 2016. It comes as the Coroners Court of Queensland releases for the first time a photo of the scene on the day the teen drowned.
At the time of his death on April 8, 2021, he was under the care of a department-approved service provider – Hope Support Services at Bahrs Scrub in Logan.
In the three days before his death, the boy had been absent from Hope without permission. But that day, a Hope employee – referred to as Mr La – met the boy and another child under Hope’s care at the Eagleby Police Beat.
In an effort to re-engage the boys and bring them back to Hope, Mr La took them for lunch at a local McDonald’s and asked them what they wanted to do that afternoon.
The boys agreed on swimming and suggested the Cedar Creek Falls at Mount Tamborine because they had both enjoyed swimming there before.
Mr La agreed to this on the proviso that he would check the intensity of the water before the boys swam, and they would go to a public pool if the water was too rough.
Mr La and two children arrived at the falls about 5pm.
“The water was flowing roughly and Mr La told the boys that it looked unsafe,” Coroner Carol Lee said when delivering her findings on Monday. “The boys rejected the suggestion of going to a public pool and ignored Mr La’s directions not to enter the water. The (deceased) child swam in the water in the rockpools for a short period of time under the supervision of Mr La. He then swam into a deeper area of the rock pool where, out of his depth, he could no longer swim in the turbulent conditions.”
Despite Mr La and a bystander trying to save him, the teenage boy drowned.
During the inquest hearings, the victim’s parents made submissions to the coroner.
The parents argued Mr La’s training was inadequate in risk assessment, he should have physically restrained the deceased child to prevent him from entering the water, and reasonable force was an appropriate option.
However, Ms Lee disagreed, describing Mr La’s decision not to physically restrain the boys as “reasonable”.
“Mr La was faced with a very difficult series of decisions to try and ensure the welfare of children who were refusing to follow his directions,” she said.
“The evidence does not suggest that any of those decisions, in balancing the competing considerations, were the cause of, or directly contributed to, the 13-yearold’s death.
“Mr La had been trained to use a physical restraint only as a last resort and he had never previously used a physical restraint on a young person in his care.
Ultimately, having considered the evidence regarding the chain of decisions made by Department of Child Safety officers and Hope Support Services workers, Ms Lee ruled “the child’s death was a tragic accident”.
The Department of Child Safety also faced scrutiny.
Mr La’s decision to take the boys to the Falls that day was not communicated to a department officer.
“The department is not able to assure itself that service providers are properly assessing and advising of high-risk activities being undertaken by young people,” Ms Lee said.
“I recommend that the department take steps to standardise the process by which services providers are to assess and report to the department on high-risk activities.
“I also recommend the department consider making it mandatory for out-of-home care providers to provide water awareness safety training to their frontline staff.
“The department acknowledges this and states that the recommendations will be incorporated into the relevant practices and procedures.”
Ms Lee also found deficiencies in Hope Support Services’ policies, but explained that the provider had already made changes since the boy’s death.
“The evidence suggests that Mr La received relevant training in risk assessment and responses from Hope Support Services before commencing his duties,” she said.
“The written policy that was in place at the relevant time was suboptimal in terms of guidance to workers about proper risk assessment processes.
“There is no evidence to suggest that the specific stepby-step risk assessment guidance documented in the booklet in 2022 was relevantly applied in or before April 2021 to the activity of swimming at the Falls.
“I find that Hope Support Services should have had that system in place prior to its introduction in 2022 after the death of the 13-year-old child.”