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Coroner's Act In the matter of Coroner's Findings and Recommendations into the death of Kunmanara Forbes pursuant to section 46B dated 2 December 2009



Coroner's Act In the matter of Coroner's Findings and Recommendations into the death of Kunmanara Forbes pursuant to section 46B dated 2 December 2009

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matter which Ms Carlyle agreed would have been relevant to her risk assessment (Transcript p 80). She did not look at Kunmanaras medical notes when she visited in November 2005 to conduct her risk assessment, but rather relied on anecdotal information given to her verbally by the Aboriginal Health Worker already referred to. Ms Carlyle had no clear recollection of the reason why she did not see the notes on that visit, although she assumed based on other experience visiting Mutitjulu that it was because clinic staff did not have time to show them to her. It is clear that the medical records contained information highly relevant to any risk assessment being carried out by a FACS caseworker. In this particular case, those records indicated that Kunmanara had been sexually active, having tested positive to two sexually transmitted diseases at the age of 13 years. Further, there was an entry concerning an allegation she made that she had been beaten by her brother. This particular event was described to Ms Carlyle, by family members, as traditional punishment for petrol sniffing. The version (supported by injuries) contained in the medical notes was significantly different from that (Transcript p82). information was relevant to the assessment that FACS was there to carry out in relation to Kunmanara Forbes family situation and safety. 21. ! Similarly, this Ms Carlyle was asked a number of questions about her reliance upon verbal assurances rather than insisting upon seeing the medical records. At p 82: 22. Q What do you think about that [the assurance that sexual health screening would be carried out] now that you know that [the health worker] has told you there was going to be screening but in fact thered already been diagnosis of sexually transmitted infections, the information about which appeared on the medical file that you werent shown. Does that make any difference to how you now view that assurance? A Obviously, in hindsight, of course it does. I mean, but the reality at the time is the clinic was incredibly chaotic and it was often difficult to get 8