Arabic version: قاضية تحقيقات تجد أن إخفاقات الإشراف في السجن أسهمت في الوفاة

According to ABC News, an ACT coroner has found that inadequate supervision and access to equipment contributed to the death of detainee Justin James Cordy at Canberra’s Alexander Maconochie Centre. Cordy, 34, died by suicide on February 26, 2023, two days after his arrest and five days after his release from prison.

Coroner Lucinda Wilson said Cordy was given access to items he used to take his own life and was not adequately observed in the hours before his death. He had been transferred to the jail on February 25 after appearing before an ACT court. The inquest heard he had a history of substance abuse, previous convictions and a prior suicide attempt while in custody in 2020.

Cordy was meant to receive hourly observations. CCTV showed an officer looking through his cell-door flap at 11:40am without opening the door, while no further checks were visible before 1:03pm. An observation form recorded a midday check. Wilson found that adequate supervision may have identified Cordy’s preparations and prompted intervention.

The coroner recommended changes to cell-inspection procedures, including requiring officers to enter cells during visual checks. She also recommended that correctional officers conduct and document spot checks of systems used to store and track cleaning equipment. The findings said failures in aspects of Cordy’s police custody care were substandard and raised public-safety concerns, but did not contribute to his death.

Wilson further recommended written guidance and training for ACT Policing officers on physical and mental health assessments, communicating concerns and arranging appropriate medical assessments. She also called for the Mental Health Court Assessment and Liaison Service to operate at every bail hearing, including weekends and public holidays, after noting it did not run for the ACT Magistrates Court’s Saturday bail list.