Frederick Barrie Dunbavin · Prevention of Future Deaths report

On the 14th December 2023, an investigation was commenced into the death of Frederick Barrie Dunbavin, born on the 30th June 1948.

The investigation concluded at the end of the Inquest on the 9th July 2024.

The Medical Cause of Death was:

1a Multiple Injuries

1b

1c

2 Complete Occlusion of the Left Coronary Artery

The conclusion of the Inquest recorded that Frederick Barrie Dunbavin died as a consequence of an accident.

Frederick Barrie Dunbavin, who was diagnosed with dementia and who experienced periods of confusion, fell from a wooded area in the grounds of the Treetop Apartments ████████ onto a concrete path that runs to the rear of the St Stephen’s church hall.

As a consequence of the fall, Mr Dunbavin sustained multiple injuries, which caused his death. A police investigation revealed there is a low wooden fence separating the wooded area from a parking area at the apartment complex. However, there is a gap in the fence, allowing easy access to the woodland, and no barrier between the wooded area and the drop onto the path that runs to the rear of the church hall.

1. During the inquest evidence was heard that:

i. There is open access from the carpark area at The Treetops Apartment complex to the wooded area that Mr Dunbavin accessed before he fell. In addition, there is no barrier between the edge of wooded area and the pathway that runs to the rear of the church hall. Finally, there is no signage to warn that there is a dangerous drop from the edge of the wooded area onto the path below.

2. I have concerns with regard to the following:

i. Mr Dunbavin sustained multiple injuries following a fall from the wooded area at the Treetops Apartment complex, having accessed the wooded area from the parking area. There was nothing that prevented him from accessing this area, or warning him of the drop from the wooded area. I understand that no changes have been made subsequent to Mr Dunbavin’s death. Therefore, there remains a risk that access can be easily gained to this area, with a risk of life-threatening injuries should anyone fall from the wooded area to the path below.