Deceased
CS
Demographics
5y, male
Date of death
2017-03-02
Finding date
2022-07-15
Cause of death
Presumed drowning
AI-generated summary
CS, aged 5 years 9 months, died by presumed drowning on 2 March 2017 in the Murray River, Moama NSW. His mother LS, who was mentally unwell and using ice, forcibly held him underwater. Multiple agencies—FACS, NSW and Victoria Police, mental health services, and corrections—failed to protect him. FACS had 7 reports of risk but closed the case days before the death. Police dismissed grandmother SJ's 3am report that the children were missing despite clear risk factors: LS's recent release from prison, history of violence and mental health issues, drug use, erratic behaviour, and SJ's expressed concerns she would take the children. Mental health and police responses lacked critical analysis of risk, failed to share information effectively, and did not escalate concerns appropriately. No formal missing persons report was made by police despite meeting the definition. Children were not named as protected persons on an ADVO despite exposure to domestic violence, which limited police options. Systemic failures in risk assessment, inter-agency communication, and failure to use available statutory powers contributed to the tragedy.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Error types
Drugs involved
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