Finding into death of KW
Deceased
KW
Demographics
4y, unknown
Coroner
Coroner David Ryan
Date of death
2020-12-13
Finding date
2021-12-17
Cause of death
Drowning
AI-generated summary
A 4-year-old boy drowned in a resort pool during a family birthday party on 13 December 2020. Despite wearing a buoyancy vest initially, he removed it to use water slides more freely. While approximately 8 adults were present, supervision was inadequate and divided—his father was watching a 2-year-old sibling in a separate toddler pool while his mother was away collecting party favours. The coroner found that KW's death was preventable through adequate adult supervision. Key lessons: designated supervisors with constant visual contact (not occasional glances) are essential; children under 5 should be within arm's reach; buoyancy aids do not replace active supervision; busy party environments create dangerous distraction; pool gates should not be left open. The coroner emphasised pre-planning and discussion of water safety among caregivers.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.
Specialties
Error types
Clinical conditions
Procedures
Contributing factors
- inadequate adult supervision
- divided attention of supervising adults
- removal of buoyancy aid
- busy party environment
- open gate between pool and splash park
- assumption that supervision would be provided
Coroner's recommendations
- Caregivers should designate specific adults to actively supervise children in and around water during group events
- Children under 5 must be within arm's reach and have constant visual contact, not occasional glances
- Pool gates should never be left open or propped open
- Water safety should be discussed and planned by caregivers beforehand
- Buoyancy aids are not a substitute for close, focused and active supervision
Full text
Source and disclaimer
This page reproduces or summarises information from publicly available findings published by Australian coroners' courts. Coronial is an independent educational resource and is not affiliated with, endorsed by, or acting on behalf of any coronial court or government body.
Content may be incomplete, reformatted, or summarised. Some material may have been redacted or restricted by court order or privacy requirements. Always refer to the original court publication for the authoritative record.
Copyright in original materials remains with the relevant government jurisdiction. AI-generated summaries and tagging are for educational purposes only, may contain inaccuracies, and must not be treated as legal documents. We welcome feedback for correction — report an inaccuracy here.