Information About DCSI Coronial Guidelines

CORONIAL FRAMEWORK

For office use only

1 | DCSI –DCSI Coronial Guidelines and Mandatory Procedures

DCSI

CORONIAL GUIDELINES

AND

MANDATORY PROCEDURES

Document number / For OIS use.
Version / 3.1
Date of version / September2014
Applies to / All DCSI staff
Issued by / Financial Services
Delegated authority / Andrew Thompson, Executive Director Financial Services
Procedure custodian / Nancy Rogers, Director Business Affairs
Date Published / For OIS use.
Due for review / June 2015
Confidentiality / For Office Use Only FOUO
DCSI strategic objective / -- If relevant --
SA Strategic Plan / -- If relevant --

1. / Introduction
2. / Background and context
3. / Scope
4. / Definitions
5. / Reportable deaths
6. / Police requests for information - provision of records and witness statements
7. / Insurance
8. / Communication with the Coroner’s Office
9. / Inquests of interest to DCSI
10. / DCSI employees giving evidence at an inquest - legal and media assistance
11. / Coroner’s Court findings and recommendations
12. / Reporting
Appendix 1 – DCSI roles & responsibilities
Appendix 2 – Guide to determining reportable deaths

1.Introduction

1.1The Department for Communities and Social Inclusion (DCSI) Coronial Guidelines and Mandatory Procedures (the Guidelines and Procedures) provide guidance on how to manage and respond to a reportable death and comply with resulting responsibilities in the event of a Coronial investigation or inquest of interest to the department. These Guidelines and Procedures should be read in conjunction with the Coronial Policy.

Appendix 1 lists the DCSI roles and responsibilities for the Guidelines and Procedures.

2.Background and context

2.1The role of the Coroner is to ensure the proper management of investigations and inquests into deaths, fires, accidents and the disappearance of missing persons.

2.2Following the report of a death, the Coroner must decide if it is necessary to hold an inquest into the cause and circumstances of the death. As part of a Coronial investigation, DCSI staff may be approached for further information by police assigned to the Coroner’s Court.

2.3If the Coroner believes that the cause or circumstances of a death are a matter of substantial public importance, if they relate to public health or safety, or in certain prescribed circumstances, an inquest may be held.

2.4An inquest is a court hearing in which the Coroner gathers information to assist in determining the cause and circumstances of a death. If appropriate, the Court makes recommendations that may prevent similar deaths occurring in the future. Generally, inquests are open to the public and Coroner’s findings are available online.

2.5An inquest is not classified as a trial as it is not the Court’s role to establish whether a crime has been committed or to find a person guilty of a crime.

2.6These Coronial Guidelines and Mandatory Procedures support DCSI in complying with the Coroners Act 2003 and fulfilling the intent of the DCSI Coronial Policy.

3.Scope

3.1These Guidelines and Procedures are intended to support all divisions with Coronial matters, from reporting a death to the Coroner, through to acting upon recommendations arising from an inquest.

4.Definitions

Coroner means the State Coroner, or a Deputy State Coroner, or any other Coroner appointed under Part 2 of the Coroners Act 2003.

Coronial matters of interestto DCSIincludes but is not limited to reportable deaths; deaths in custody; deaths of clients, former clients and staff; deaths of people particularly vulnerable at the time of death (e.g., transient Aboriginal and Torres Strait Islander people; a person experiencing domestic violence or other form of abuse); and disappearances, fires and accidents.

DCSI Coronial Officer means the DCSI staff member located within Business Affairs, Financial Services Division,who is responsible for the monitoring of Coronial investigations and inquests of interest to DCSI and for assisting DCSI service divisions with compliance with this policy. Contact details are published on the intranet.

Death in Custodymeans the ‘death of a person where there is reason to believe that the death occurred, or the cause of death, or a possible cause of death, arose, or may have arisen, while the person –

(a)was being detained in any place within the State under any Act or law, including any Act or law providing for home detention (and, for the purposes of this paragraph, a detainee who is absent from the place of his or her detention but is in the custody of an escort will be regarded as being in detention, but not otherwise); or

(b)was in the process of being apprehended or was being held –

(i)at any place (whether within or outside the State) – by a person authorised to do so under any Act or law of the State; or

(ii)at any place within the State – by a person authorised to do so under the law of any other jurisdiction; or

(c)was evading apprehension by a person referred to in paragraph (b); or

(d)was escaping or attempting to escape from any place or person referred to in paragraph (a) or (b)’ (section 3, the Coroners Act 2003).

Delegate means a supervisor, manager or other seniorDCSI staff member to whom responsibilities under the Coronial Policy and/or Coronial Guidelines and Mandatory Procedures have been delegated for operational reasons. A delegate must be in a position to report the death within 24 hours to the Coroner/SAPOL.

Divisional Coronial Liaison Officer means the DCSI staff member located in each division of DCSI responsible for supporting their division’s compliance with the Coronial Policy and Coronial Guidelines and Mandatory Procedures. Contact details are published on the intranet.

Funded organisationsare organisations funded by DCSI that provide direct client services on DCSI’s behalf.

Minister means the Minister for Communities and Social Inclusion, Minister for Social Housing, Minister for Disabilities, Minister for Youth, Minister for Multicultural Affairs, Minister for Volunteers, Minister for the Status of Womenorany other portfolioresponsibility within DCSI.

Other Critical Incident means the disappearance of a person or fire or accident resulting to injury to person or property, as referred to in section 21 of the Coroners Act 2003.

Reportable death means ‘’...the State death…of a person –

(a)by unexpected, unnatural, unusual, violent or unknown cause; or

(b)on an aircraft during a flight, or on a vessel during a voyage; or

(c)in custody; or

(d)that occurs during or as a result, or within 24 hours, of-

(i)the carrying out of a surgical procedure or an invasive medical or diagnostic procedure; or

(ii)the administration of an anaesthetic for the purposes of carrying out such a procedure, not being a procedure specified by the regulations to be a procedure to which this paragraph does not apply;

(e)that occurs at a place other than a hospital but within 24 hours of -

(i)the person having been discharged from a hospital after being an inpatient of the hospital; or

(ii)the person having sought emergency treatment at a hospital; or

(f)where the person was, at the time of death-

(i)a protected person under the Aged and Infirm Persons’ Property Act 1940 or the Guardianship and Administration Act 1993; or

(ii)in the custody or under the guardianship of the Minister under the Children’s Protection Act 1993; or

(iii)a patient in an approved treatment centre under the Mental Health Act 1993; or

(iv)a resident of a licensed supported residential facility under the Supported Residential Facilities Act 1992; or

(v)accommodated in a hospital or other treatment facility for the purposes of being treated for drug addiction; or

(g)that occurs in the course or as a result, or within 24 hours, of the person receiving medical treatment to which consent has been given under Part 5 of the Guardianship and Administration Act 1993; or

(h)where no certificate as to the cause of death has been given to the Registrar of Births, Deaths and Marriages; or

(i)that occurs in circumstances prescribed by the regulations…’ (section 3, Coroners Act 2003).

5.Reportable deaths

5.1On becoming aware of a death that is or may be a reportable death, a staff member or their delegate must immediately notify the State Coroner (8204 0618) if it is a death in custody, or SAPOL (131 444) if it is any other type of reportable death.

A staff member is not required to report a reportable death to the Coroner if they are aware, or otherwise believe with good reason, that the death has already been reported by someone else[1]. If in any doubt – either about whether the death is reportable or about whether it has already been reported - the staff member or their delegate must report the death.

Appendix 2 provides a checklist to help staff determine whether a death is a reportable death.

The maximum penalty for failing to notify the Coroner or SAPOL is $10,000 or 2 years’ imprisonment.

5.2A staff member or their delegate, immediately upon becoming aware of a death that is or may be a reportable death, must advise their Manager/Team Leader/Supervisor of the incident either in person or by phone.

5.3The Manager must immediately report the matter to his or her Director and/or Executive Director either in person or by phone followed by an email.

5.4If, following advice from the responsible Director in consultation with the responsible Executive Director, the reportable death is also deemed a critical client incident, the Director must immediately follow the internal reporting, briefing and incident management requirements in accordance with the Department’s Managing Critical Client Incidents Policy and their divisional Managing Critical Client Incidents Guideline.

5.5Staff who are informed by a funded organisation of the reportable death of a client must follow the same procedure, and immediately advise their Manager/Team Leader/Supervisor of the matter either in person or by phone.

5.6Having reported the death by phone to the Coroner or SAPOL, the staff member or their delegate must report and record the matter on Riskman, as soon as practicable. For divisions that do not use Riskman for client incidents, staff must complete the DCSI Reporting a Death form.

5.7In the event of a reportable death in a Disability Aged Care Facility (Highgate Park) staff must complete the State Coroner’s Court Death Report to the Coroner Aged Care Facility/Institutionform. A copy of the form must be uploaded to Riskman or sent to the Divisional Coronial Liaison Officer.

5.8The Divisional Coronial Liaison Officer must sendelectronically a copy of the completed Riskman report, DCSI Reporting a Death form or the Death Report to the Coroner Aged Care Facility/Institution form to the relevant Executive Director, the relevant DivisionalDirector, the Director, Legal Services Unit, DCSI Insurance Services and the DCSI Coronial Officer.

5.9In addition to the above procedures, staff must follow any departmental, divisional and joint-agency guidelines, procedures or protocols for reporting incidents and deaths.

5.10If the death is a death in custody, or a critical client incident, an urgent briefing from the Executive Director to the Chief Executive and Minister must be prepared. Copies of the briefing must be provided to the DCSI Coronial Officer, the relevant Divisional Coronial Liaison Officer and the Director, Legal Services Unit.

5.11The DCSI Coronial Officer shall record the reportable death in the Coronial Matters Register. The divisional staff member, delegate or Divisional Coronial Liaison Officer shall also record the incident in any divisional Coronial database, according to divisional policies and procedures.

6.Police requests for information – provision of records and witness statements

Please note: Police may request records and statements from DCSI staff as part of a criminal investigation. Since all reportable deaths must be investigated by SAPOL and SAPOL will, upon the conclusion of any criminal proceedings, prepare a report for the Coroner about the particular aspects of the incident of interest to the Coroner, it may be that records and statements obtained by SAPOL as part of a criminal investigation inform a subsequent Coronial investigation and inquest.

6.1RECORDS

6.1.1Following a reportable death, staff may be approached by SAPOL to provide relevant records. SAPOL requires original paper and electronic records and will not accept photocopies. It is an offence under the Coroners Act 2003 to hinder or obstruct a Coronial investigation.

6.1.2When approached by SAPOL to provide department records, staff can refer the SAPOL officer to the Divisional Coronial Liaison Officer or manager or supervisor on duty to manage the request if this person is available and on site at the time. Otherwise, the staff member must, themselves, respond to the SAPOL request.

6.1.3The Divisional Coronial Liaison Officer, manager, supervisor or other staff member managing arequest from SAPOL must:

sight an authority, either a Coroner’s Direction to Enter or SAPOL general search warrant, before providing paper and electronic records and, with the consent of the SAPOL officer, retain a copy of the Direction or warrant
deliver the original documentation to SAPOL and whenever possible, keep copy(ies) of the files/records.

In some instances, the Coroner’s Direction to Enter maybe sent electronically and the Coroner’s Office will dispatch a courier to collect the original documentation.

6.1.4In addition, the staff member managing the request from SAPOL, must:

note the provision of records in the relevant divisional records management database(s)
keep a copy of the Direction to Enter or the general search warrant as a receipt for DCSI files
advise the Divisional Coronial Liaison Officer and DCSI Coronial Officer of the records that have been provided to SAPOL.

6.2STATEMENTS AND OTHER INFORMATION

6.2.1If a staff member notifies the State Coroner or SAPOL of a reportable death they will be required to provide the State Coroner or SAPOL with information and/or a formal statement in relation to the death (s28 Coroners Act 2003).

6.2.2As part of a Coronial investigation, other staff members may also be approached by SAPOL to provide a formal statement of evidence and/or other information.

6.2.3 In these events:

the staff member must immediately inform their supervisor or manager
the supervisor or manager must immediately inform the Legal Services Unit, Divisional Coronial Liaison Officer and DCSI Coronial Officer
departmental policies and practices regarding obtaining legal advice should be followed.

Staff must not hinder or obstruct the Coroner’s powers of inquiry (s 23Coroners Act 2003).

6.2.4If a staff member is required by SAPOL to give a statement:

the staff member (if an employee, not a contractor) may contact DCSI Legal Services Unit for support and direction in relation to the statement process
where the Crown Solicitor’s Office (CSO) has been instructed to act on behalf of the department and/or the individual employee, Legal Services Unit will liaise with the CSO to discuss the future conduct of the matter and whether or not a solicitor should be present while the statement is taken
the staff member must request a copy of the statement. However, before providing a copy of the statement, the SAPOL investigator will consider the person’s role and the circumstances of the investigation. If a copy of the statement is provided, the staff member must provide a copy of the statement to the Divisional Coronial Liaison Officer for inclusion in divisional records
the Divisional Coronial Liaison Officer must provide a copy of the statement to the Executive Director, Director, manager or supervisor, and to Legal Services Unit. They must also notify the DCSI Coronial Officer that a statement has been given.

7.Insurance

7.1Upon becoming informed of a reportable death or Coronial investigation, the relevant Executive Director shall give immediate consideration to whether the death or other incident may have insurance implications for the department and, as required, discuss with the Legal Services Unit and DCSI Insurance Services whether the South Australian Insurance Corporation (SAICORP) should be advised.

8.Communication with the Coroner’s Office

8.1Following a reportable death, or otherwise being informed that the Coroner is investigating the death of a client of interest to DCSI, the DCSI Coronial Officer shall, as soon as practicable,write to the Coroner’s Office requesting that DCSI be:

noted as an interested party in the death, explaining the nature of DCSI’s interest[2]
notified whether and when a Coronial inquest is to proceed
advised when a finding has been made by the Coroner about the death and of the terms of that finding.

8.2The DCSI Coronial Officer shall forward the details of any response(s) from the Coroner’s Office to the responsible Executive Director, Director, Legal Services Unit and the Divisional Coronial Liaison Officer.

9.Inquests of Interest to DCSI

9.1ADVISE CHIEF EXECUTIVE

Information that a matter of interest to DCSI has been listed for inquest may come to the department through various channels. The staff member who receives this informationmust ensure that the Director, Legal Services, Director Business Affairs, the DCSI Coronial Officer, the relevant Executive Director and the Divisional Coronial Liaison Officer are immediately informed.

9.2BRIEF MINISTER

Within 10 working days of being notified of the listing of an inquest, the Executive Director shall provide the Minister with a briefing. A copy of the briefing shall be provided to the Chief Executive, Director, Legal Services, Director Business Affairs, DCSI Coronial Officer, and the Divisional Coronial Liaison Officer.

9.3LIAISE WITH CROWN SOLICITOR’S OFFICE (CSO)

The Legal Services Unit shall liaise with the Crown Solicitor’s Office to:

where necessary, instruct CSO to represent the department
seek advice as to whether any employee requires separate legal representation
request to be notified of when an inquest is to commence and whether any employees are to appear as witnesses
request a copy of a Coroner’s Court finding(s) and recommendation(s) from CSO and, where necessary, a written report about the outcomes of an inquest.

9.4INDEPENDENT LEGAL REPRESENTATION

If the CSO cannot represent the department and/or the employee(s), due to a conflict of interest or otherwise, the Legal Services Unit will seek approval from the Crown Solicitor, consistent with the Treasurer’s Instruction 10, to obtain independent legal representation.

10.DCSI employees giving evidence at an inquest – Legal and Media assistance

10.1LEGAL REPRESENTATION OF EMPLOYEES

10.1.1Department employees required to give evidence at an inquest will be provided with support by the Legal Services Unit, in the first instance and where necessary, legal representation by the CSO. Employees may choose to obtain their own legal representation if they prefer.