Coroner's Finding: BK

MAGISTRATES COURT of TASMANIA

CORONIAL DIVISION Record of Investigation into Death (Without Inquest) Coroners Act 1995 Coroners Rules 2006 Rule 11 (These findings have been de-identified in relation to the names of the parties by direction of the Coroner) I, Simon Cooper, Coroner, having investigated the death of BK Find, pursuant to Section 28(1) of the Coroners Act 1995, that a) The identity of the deceased is BK; b) BK died as a result of actions taken by him voluntarily, alone and with the express intention of ending his own life; c) The cause of BK’s death was hanging; and d) BK died in May 2018 in southern Tasmania.

In making the above findings I have had regard to the evidence gained in the comprehensive investigation into BK’s death. The evidence includes an opinion of the forensic pathologist who conducted the autopsy; the results of toxicological analysis of samples taken at autopsy; relevant police and witness affidavits; medical records and reports; and forensic and photographic evidence.

BK was born in Hobart, Tasmania in 1997. He was the son of FX and EK. He had a younger sister S. OT was his very close friend.

At the time of his death he was living with his partner PR in southern Tasmania. He was employed in the oyster industry.

BK was a regular user of both alcohol and cannabis. It is apparent from his medical records that he suffered from depression having first been diagnosed with that condition in March 2015. From that time until his death he received intermittent, ad hoc treatment for mental health difficulties although refused recommended psychological review and referrals.

His medical records record that when BK saw his general practitioner on 12 April 2018 his mood was “ok” and that he was at “no risk [of] self harm”.

A week before his death PR reports that while he was significantly intoxicated BK placed a rope over a support in the roof of the shed (the same shed where he subsequently committed suicide) whilst looking at a video on his mobile phone about how to tie a noose. PR comforted BK and took him inside to bed. The couple spoke about the matter the next morning at which time BK reassured PR that he had no actual intention of following through with any suicidal action.

A week later, late in the evening, BK and PR returned home. BK had spent the evening with OT. PR had been at work. BK had been drinking. The couple fought. PR described BK as drunk saying he smelt strongly of alcohol, was slurring his words and stumbling “a bit”. BK went to the couple’s shed. PR left in her car and drove to OT’s house nearby.

She returned to the residence with OT. OT and PR found BK standing on a couch in front of a rope tied to a rafter in the shed. OT was able to comfort and reassure BK. The two men stayed together for some time talking. Eventually OT and PR put BK to bed.

PR then drove OT back to his home. The pair sat and talked about BK, and his problems, for approximately 20 or so minutes.

Obviously distressed PR returned to her home. It was by now after 1.00am. She found BK hanging by the neck from the rope from the rafter in the shed. She described his tongue as blue and his neck looking “wrong”. PR rang OT and then 000. OT and his father arrived within minutes. The men cut BK down and attempted to resuscitate him.

Ambulance paramedics were quickly on the scene but were unable to revive BK.

Uniform, Criminal Investigation Branch and Forensic officers all attended the scene.

The area where BK died was carefully examined, searched and photographed. Nothing was identified where BK died suggesting the involvement of any other person in his death. Specifically, there was no disturbance or indication of any altercation at the scene. I am satisfied that there are no suspicious circumstances surrounding BK’s death.

After formal identification at the scene BK’s body was transported by mortuary ambulance to the mortuary at the Royal Hobart Hospital. At the Hospital an autopsy was carried out upon BK’s body by the State Forensic Pathologist Dr Christopher Hamilton Lawrence. The autopsy revealed changes consistent with hanging with a ligature mark. There were no other significant injuries detected at autopsy apart from some scratches on the left side of the neck which Dr Lawrence opined were likely to have been self-inflicted. I accept Dr Lawrence’s opinion both as to the likely cause of the scratches as well as the cause of BK’s death.

Samples taken at autopsy were subsequently analysed at the laboratory of Forensic Science Service Tasmania. Those samples revealed that at the time of his death BK’s blood alcohol level was 0.164 g per 100 mL of blood. There is no doubt in my mind that BK was substantially affected by alcohol at the time of his death.

The evidence when viewed as a whole, including BK’s history of mental health difficulties, suicidal action undertaken by him just one week prior to his death, the absence of any evidence suggesting the involvement of any other person in the circumstances in which his body was found, all satisfy me to the requisite legal standard that BK’s death was the result of actions undertaken by him voluntarily, alone and with the express intention of ending his own life.

Comments and Recommendations The tragic death of 20-year-old BK is yet another example of the terrible epidemic of suicide that is claiming the lives of our young people. No one close to him saw the signs of just how depressed he was or, if they did, were unable to do anything to properly assist him. I urge all young people suffering mental health difficulties to take the necessary steps to access proper support and treatment.

I convey my sincere condolences to the family and loved ones of BK.

Dated 23 May 2019 at Hobart in the State of Tasmania.

Simon Cooper Coroner