Inquest into the disappearance and suspected death of Caesar Llanto and death of Hector Collado
Deceased
Cesar Llanto and Hector Collado
Demographics
male
Date of death
2012-08
Finding date
2017-05-31
Cause of death
Cesar Llanto: foul play (thrown overboard or killed); Hector Collado: multiple injuries from being struck over the head and falling over handrail
AI-generated summary
Three deaths occurred on the bulk carrier MV Sage Sagittarius between August 30 and October 6, 2012. Cesar Llanto, the Chief Cook, disappeared in international waters; Hector Collado, the Chief Engineer, fell to his death from the second deck; and Kosaku Monji died in a loading device accident. The coroner found foul play in both Llanto's and Collado's deaths, likely involving Captain Salas. Critical evidence—audio recordings from the Voyage Data Recorder—was deliberately deleted. The investigation was hindered by crew intimidation, corruption (gun sales, assaults), witness reluctance, fragmented jurisdiction between AFP and NSW Police, and failure to inform Japanese authorities. Proper inter-agency coordination, VDR preservation protocols, and protecting vulnerable crew members should be prioritized in future maritime investigations.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Error types
Contributing factors
- Bullying and harassment of crew members
- Sale of firearms by Captain Salas
- Culture of intimidation and silence on vessel
- Deliberate deletion of VDR audio recordings
- Conflict between crew regarding ITF complaints
- Captain Salas's unorthodox and aggressive captaincy
- Failure to report disappearance and death to Japanese authorities
- Bifurcated investigation between AFP and NSW Police
- Lack of protection for vulnerable witnesses
- Language and cultural barriers in investigation
Coroner's recommendations
- The Japanese police and the Japan Transport Safety Board (JTSB) to be provided with a copy of the findings of this Inquest for their consideration of any further investigation into the death of Mr Monji.
- Consideration be given to establishing a permanent standing group with members from at least each of the following agencies: NSW Police Force (NSWPF), Australian Federal Police (AFP), Australian Maritime Safety Authority (AMSA), Australian Transport Safety Bureau (ATSB), for the purposes of liaising, contact and assistance in connection with any investigation of the death or suspicious death on board, or disappearance from, an international vessel in or bound for Australian waters.
- A principal point of contact, from each of the Agencies mentioned in recommendation 2, be nominated in relation to each investigation of the kind described in Recommendation 2.
- The principal points of contact should be responsible for providing all available expertise and assistance to ensure the proper downloading, seizure and storage of any Voyage Data Recorder (VDR) system on board the vessel.
- In any investigation(s) involving both the NSWPF and the AFP, the principal point of contact from the NSWPF and from the APF should regularly liaise for the purpose of ensuring the sharing, between each such agency, of forensic and other evidence (subject to legislative requirements) that may be relevant to each to the investigation(s).
Full text
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