This article originally appeared in the The Age and Sydney Morning Herald on 6 March 2023.
On 2 January 2020, 37-year-old Aboriginal woman, Veronica Marie Nelson, died alone in substantial physical and psychological pain in a Victorian maximum security women’s prison. Veronica made forty-nine pleas for help over an intercom, which were repeatedly ignored by those responsible for her care.
Following her death, evidence provided to the Coroners Court by the private health service provider, Correct Care and the Department of Justice revealed a series of self-serving cover-ups.
The inquest heard that a critical witness was discouraged from coming forward, medical records were fabricated, and two supposedly independent medical reviews designed to assess Veronica’s medical care were ultimately deemed “grossly inadequate and misleading” by the Coroner.
These reviews influence whether the coroner will decide to hold an inquest (or not) and, if someone is deemed to have died of “natural causes”, the coroner does not need to examine witnesses.
In this case, if Veronica had not communicated her calls for assistance through an intercom (where those calls were recorded), her death could have been covered up as “natural causes” without scrutiny from the Coroners Court.
This tragic story calls into question whether there have been other misleading reviews into past deaths in custody. It also calls into question the standard of healthcare provided to prisoners and the Department of Justice’s portrayal of prison healthcare systems as being equivalent to that within our community.
In a strongly worded article published by The Age, Robinson Gill Principal Lawyer Ali Besiroglu and Dr Crystal McKinnon of Melbourne University highlight the need to consider amending the Coroners Act so that every Aboriginal death in custody is examined by a mandatory inquest. It also calls for accountability so that independent reviews by the Department of Justice do not serve to mislead the Court.
It is hoped that Veronica’s case is the last time bereaved families ever encounter cover-ups.
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