00:02Kobe Shepardson was born into a life dominated by her father's violence, including threats
00:08to kill her and her mother.
00:10Three times in her short life, SA Police failed to identify them as high-risk victims, contravening
00:17their own assessment tool.
00:19That would have triggered a multi-agency response to help to protect them.
00:23It's one of the errors the coroner found could have prevented the toddler's murder
00:27at the hands of her 38-year-old father in April 2021.
00:31They fell from the whispering wall in the Barossa Valley.
00:34On the first day, a non-contact order against him was lifted.
00:38I think the coroner's report makes for her difficult and quite frankly horrific reading.
00:44It is a wake-up call and a call to action which we will heed.
00:47The coroner found that while facing charges of unlawfully imprisoning and assaulting Kobe
00:52and her mother, Shepardson had almost unlimited opportunities to harass her mother into dropping
00:58the charges.
00:59He described a campaign of extremely manipulative and coercive behaviour through phone calls
01:05from prison, 149 phone calls not detected by prison authorities, breaches which would
01:11probably have kept him behind bars.
01:13Two letters were intercepted but not passed on to police.
01:17The coroner criticised the police commissioner's submission that Kobe's mother could have refused
01:21to answer the calls, saying that could be interpreted as victim-blaming.
01:26She was a single mother of a newly born child, a victim of terrifying violence and coercive
01:31control who'd been relentlessly pursued.
01:34In other words, she was still a true victim of his domestic violence and abuse that was
01:39still occurring even though he was in custody.
01:42The coroner's made nine recommendations including reviewing how domestic violence offenders make
01:49calls from within prison and how SAPOL assesses victims' threat levels.
01:54He's also called on the government to implement key recommendations of the Domestic Violence
01:59Royal Commission.
02:01We're very sorry that what's happened to Kobe's family has happened and we need to do things
02:06better.
02:06the
02:06You
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