- PRESS RELEASE: Coroner makes wide ranging recommendations for change as critical inquest concludes. Our family statement is available in full here.
The inquest into Gaia’s death was held in Bournemouth and lasted for 12 weeks, 26 April – 15 July 2022. One of the longest individual inquests in British history, it unearthed more than 50 missed opportunities in Gaia’s care and the search for her, as well as at least two officers who still work for Dorset Police who secretly altered the search records after Gaia’s death.
The inquest was held with a jury under Article 2 (Right to Life) of the European Convention on Human Rights because senior Dorset coroner Rachael Griffin said it was “arguable that acts or omissions by Dorset Police may have been or were contributory to Gaia’s death.” But we did not get the “full and fearless” investigation we were promised.
From the outset, the coroner directed that the failures of Dorset Police prior to Gaia’s disappearance be protected from scrutiny by the jury. She refused the police whistleblower, ‘Officer X’, who revealed Gaia’s contact with the Dorset Police that day, the anonymity they said they needed to come and give evidence. We had to fight tooth and nail to keep the issue of sexual violence on the table and at one point the coroner even tried to order bereaved relatives to use gaslighting language like “Gaia believed she was a survivor of rape” but we refused to be complicit in the same culture of denial and disbelief that killed her.
[Content Note: this video contains calls to emergency services that may be distressing.]
The jury sat through 8 weeks of evidence about a litany of police failures in the search, which by Dorset Police’s own admission was deficient and disorganised. Only one failing was considered by the police to amount to misconduct, that of acting sergeant Sean Mallon, who took literally no action to assist or direct anyone else to assist in the search for Gaia during his shift on the night she disappeared. He has since retired from the force with full benefits.
Despite all this, at the end of the inquest, the coroner prohibited the jury from considering whether any of these failings even possibly contributed to Gaia’s death. We consider this to be the single greatest opportunity missed, failing us, Gaia and the public interest.
The jury was unanimous in their support for the family’s position on every issue that was left to them. They found that Gaia’s death was probably caused by her mental state and “situational crisis” on the day she disappeared and that the failure to refer Gaia for community mental healthcare after she was hospitalised a fortnight before, possibly contributed to her death. The conclusions also recorded a series of failings admitted by both Dorset Police and Dorset Healthcare University Trust.
Dorset Healthcare University NHS Foundation Trust accepted that there were missed opportunities in terms of the assessment and onward plan of care on 22 October 2017, specifically:
- Not discussing the assessment with Gaia’s family;
- Not making a referral to Steps to Well Being;
- Not liaising with the neurology/epilepsy team involved in Gaia’s care, which resulted in further missed opportunities to open up an opportunity to review her epilepsy care and refer her for consideration of an electroencephalogram (EEG); and
- Not fully updating the GP about the outcome of the Mental Health Act assessment.
The following failings were admitted by the Chief Constable on behalf of Dorset Police:
- The second call made by Talia Pope (101 call at 16:24) should have been treated as a report of a missing person.
- Once Gaia had been reported as a missing person, she should have been graded as High Risk, not Medium.
- The Dorset Police response in the first 24-48 hours following Gaia being categorised as a missing person was deficient in that it was disorganised and lacked clear strategy, leadership and focus. Proper leadership and focus in particular would have provided the opportunity for:
- Oversight of the investigation and search efforts by senior and specialised personnel at an earlier stage
- Resources within Dorset Police and through partner agencies to be mobilised and allocated to the search for Gaia at an earlier stage
- The scale of the search for Gaia to have been escalated at an earlier stage
What we said before the inquest
Four years of waiting. Three closed-door reports, two from the Independent Office for Police Conduct and one from Dorset Healthcare Trust. And now, at last, time’s up.
Come along to hear for yourself and in support of Gaia’s family.
📍 Where: Town Hall Annexe, St Stephen’s Road, Bournemouth BH2 6EA.
📆 When: We expect court to be in session every day from 10am Monday-Thursday, 26 April until 8 July inclusive.
This will be a traumatic ordeal for us but with your support we hope the inquest can finally give us some answers about what happened to Gaia and what needs to change to save lives in future.
HOW CAN I HELP?
- Attend the inquest, which is open to the public, to hear the evidence for yourself and support the family
- Share media coverage and posts on facebook, twitter or instagram to help raise awareness and encourage friends to follow us on social media
- Take action online here to support the campaign
WHAT IS AN INQUEST?
An inquest is a formal investigation conducted by a coroner to determine how someone died. Inquests are held only in certain circumstances, such as deaths by unnatural causes or in the care of state agencies. It is an important principle of open justice that inquests are open to the public and to the press.
Inquests do not determine criminal responsibility but they can still be very important when it comes to defending human rights and the public interest. When combined with support from the public and local community, past inquests like those of Stephen Lawrence, Connor Sparrowhawk and Seni Lewis to name just a few, have helped pave the way for lifesaving changes to the law.
Gaia’s inquest will be held in front of a jury under Article 2 (Right to Life) of the European Convention on Human Rights. What is known as an Article 2 inquest is only held when the coroner believes there is a case to be made that the state bears some responsibility for the person’s death.
Senior Dorset coroner Rachel Griffin says: “It is arguable that acts or omissions by Dorset Police may have been or were contributory to Gaia’s death. I am satisfied there has been an arguable breach of the obligations under Article 2 of the European Convention on Human Rights.”
Not all inquests are held under Article 2 and even those which are often last just a few days. The fact Gaia’s is scheduled to last for 10 weeks reflects the complexity of this case and just how much important evidence has come to light that we can expect to hear about.
To find out more about Gaia’s story go to justiceforgaia.com/about
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If you are a journalist who is interested in covering the inquest, please contact us at firstname.lastname@example.org and ask to join our press list. Please respect the family’s privacy by only reaching out through Justice for Gaia.