Toddler Crushed By Monument 'Not Properly Attached To Base'
A large sandstone monument which crushed a three-year-old girl to death was not properly attached to its base, a coronial inquest has ruled.
In November 2016, Indy Lee Henderson was celebrating her grandmother's 50th birthday at Blackhead Bowling Club, on NSW's mid-north coast.
The toddler was playing outdoors near an Anzac memorial with other children when the sandstone structure's headstone suddenly collapsed and fell, crushing Henderson underneath.
Despite attempts by her mother and parademics to resuscitate the child as she lay pinned and unconscious beneath the headstone, Henderson died soon afterwards at Manning Base Hospital.
The post mortem report showed the three-year-old died of multiple injuries to her stomach and chest, including fractured ribs and collapsed lungs.
On Monday, an inquest heard the headstone had "not been properly affixed to its base" when constructed.
The coroner accepted expert evidence that when it was built in 1997, the stone mason used silicone as a fixing agent to secure the dowels to the surrounding stone which did not provide sufficient adhesion.
"As a result the dowels were unable to resist the lateral forces to which the headstone was subject, causing the dowels to dislodge and the headstone to collapse," the coroner's report said.
Based on evidence provided by witnesses, deputy coroner magistrate Elizabeth Ryan said in her report it was likely children had been climbing on the memorial, which may have triggered its dislodgement. However, this was not a significant focus of the inquest, she said.
"Indy's family did not lay blame on the actions of children, recognising that these ought not to have caused a properly built structure to collapse in this manner."
"Hope For Change"
As a result of the evidence provided during the inquest, the deputy coroner recommended the NSW Department of Planning and Environment consider changing the development standards around masonry structures higher than one metre, to ensure they are structurally sound.
This would involve imposing a height restriction on masonry structures falling within the description of "outdoor sculpture or other form of freestanding artwork".
"The purpose would be to address the current situation whereby a masonry structure of the same height as the Anzac memorial could be built as an exempt development," Ryan said.
The inquest saw no evidence to suggest the Anzac memorial had undergone any maintenance since it was constructed, nor was there evidence to suggest there was any requirement for such an inspection.
Since Henderson's death, the Mid North Council has commenced a process of inspecting all monuments on its land, including in cemeteries, to ensure their stability.
Though Ryan welcomed the initiative, a structural engineer with more than 40 years experience told the inquest a "properly constructed memorial would not require maintenance".
It was also suggested the initiative be extended to monuments on privately-owned land, but due to the difficulties and costs associated with locating and inspecting such structures, the recommendation was deemed unnecessary.
Henderson's mother and grandmother released a statement following the inquest's findings outside Glebe coroner's court on Monday, saying the toddler was a "much loved daughter".
"We hope that the coroner’s findings and recommendations will see due consideration and save other families suffering a similar tragedy,” the statement read.