Undertaking Effective Investigations A Guide for National Human Rights Institutions 30 November 2004: THE SECOND AUTOPSY Due to the sensitive nature of the death of Mulrunji and the community response, the State Coroner ordered a second autopsy. On 30 November 2004, three forensic pathologists conducted the second autopsy, including a senior pathologist from outside Queensland. The second autopsy confirmed that the cause of death was intra-abdominal hemorrhage due to the massively ruptured liver, caused by a significant amount of force. The injuries were said to be consistent with someone who had been involved in a fatal car accident. 8 December 2004: FURTHER INTERVIEWS On 8 December 2004, the CMC investigators conducted audio-taped interviews with S/Sgt. Hurley, Sgt. Leafe and PLO Bengaroo. Cst. Steadman was also interviewed by the CMC that day. It was the first time he had been interviewed regarding this case by any investigative agency. February 2005: THE FIRST INQUEST In Queensland, every sudden or unexpected death is investigated by a Coroner. However, the first Coroner appointed declared a conflict of interest, as he had had previous dealings with S/Sgt. Hurley. He stepped down. March 2005 to September 2006: THE SECOND INQUEST The Deputy State Coroner was appointed to take over the inquest, which began in March 2005. It took 18 months to complete, apparently due to legal wrangling, and included 17 days of actual hearings. Witnesses included members of Mulrunji’s family, officers on duty at the time of Mulrunji’s death, the Commissioner of the Queensland Police, the Palm Island Aboriginal Council and the Aboriginal and Torres Strait Islander Legal Service. The Australian Human Rights Commission (the Commission) also exercised its powers and applied to intervene in the inquest to raise issues of systemic reform. The Commission submitted 40 recommendations. They focused on improving the independence and impartiality of investigations into custody deaths, along with other systemic issues relating to the Aboriginal community that, in the Commission’s view, the case highlighted.7 One of the key issues that the Coroner focused on was the independence and impartiality of the QPS investigation. In her report, delivered in September 2006, she found a range of factors had adversely affected the credibility of that investigation, including: • officers from Townsville and Palm Island were on the investigation team • some officers on the investigation team knew S/Sgt. Hurley personally • S/Sgt. Hurley transported the investigating officers from the airport 7 6 The Commission’s full submission is available at www.humanrights.gov.au/commission-submissions-mulrunji-1.