Record of Investigation into Death
Coroners Act 1995
Coroners Rules 2006
I, Olivia McTaggart, Coroner, having investigated the death of
Geoffrey William Higlett
BY AN INQUEST HELD in Hobart in Tasmania on 26 November 2012 find as follows:
(a) Geoffrey William Higlett died on 17 December 2010 at 992 Coolangatta Road, Bruny Island in Tasmania.
(b) Mr Higlett was born in Southampton, England on 3 February 1940. At the time of his death he was aged 70 years and a retired man.
(c) Mr Higlett died as a consequence of asphyxia, secondary to chest compression as a result of being trapped under tractor equipment (slasher).
After a detailed investigation, I find that Mr Higlett died in the course of his part-time work undertaking general duties for ‘Mangana Mountain Holiday Accommodation’. Mr Antonio Meer operated the business and was Mr Higlett’s employer. At the time of his death Mr Higlett was operating a tractor with slasher attachment for the purpose of slashing long grass around the holiday units. For the reasons detailed in this finding he died when he became trapped under the slasher.
A public inquest was held into Mr Higlett’s death pursuant to Section 24(ea) of the Coroners Act 1995. However, almost all of the evidence was tendered in documentary form without witnesses being required at the inquest. Such material revealed a thorough investigation that has allowed me to make the findings required by Section 28(1) of the Coroners Act. The only issue requiring to be resolved by oral evidence at inquest was a conflict between the evidence of Mrs Higlett and Mr Meer regarding the circumstances leading to Mr Higlett’s use of the slasher. Mrs Higlett therefore gave evidence at the inquest so that I could resolve such dispute. Despite all attempts to locate Mr Meer, as detailed below, he was unable to be located and summonsed to attend the inquest. I was satisfied, in the circumstances that the inquest should proceed without oral testimony from him.
Mr Higlett lived with his partner, Maree Janet Higlett at 4537 Bruny Island Main Road, Bruny Island. Mr Higlett had been in a relationship with Mrs Higlett for in excess of 25 years. Though they had not married she had changed her surname to ‘Higlett’ by poll. Mr Higlett has three sons from a previous marriage who reside in Victoria.
In December 2009 Mr Antonio Meer engaged both Mr and Mrs Higlett, both retired, to undertake work on the property situated at 992 Coolangatta Road, Bruny Island. At that time Mr Meer leased the property from his sister, Maria. He operated the property as holiday accommodation, namely ‘Mangana Mountain Accommodation’. There are three units on the property.
Mrs Higlett undertook cleaning duties in the units. Mr Higlett’s main duties were to remove rubbish, collect firewood, light wood heaters and attend to water pumps. At times both Mr and Mrs Higlett would assist one another in the duties they carried out. They were paid by Mr Meer in cash or by money order. The amounts they were paid did not affect their pension entitlements. For a significant part of the employment period Mr Meer lived in Victoria and had very little contact with Mr and Mrs Higlett.
Mrs Higlett’s evidence was in the form of an interview with Workplace Standards inspectors, several affidavits and in oral testimony at the inquest. Her evidence can be summarised as follows;
In mid-December 2009, at the time of the commencement of their employment, Mr and Mrs Higlett and Mr Meer had a conversation at the property where the units were located. Mr Meer told Mr Higlett he wanted rubbish taken from the accommodation up to a tip area several hundred metres into the bush, Mr Higlett told him he was not prepared to use his car for this duty. Mr Meer told him to use the tractor. He said using the tractor would keep the battery charged. He also told him to use the tractor to check the water tank and to go to the creek to start the pump.
Mr and Mrs Higlett commenced their duties. Mr Higlett drove the tractor at the Coolangatta Road property for the purposes discussed with Mr Meer. The tractor was a red and grey coloured Massey Fergusson 135 diesel and formed part of the lease agreement between Mr Meer and his sister. It was operated by and under the control of Mr Meer. It was always available for use with the ignition key kept in it. The tractor had a slasher attachment for cutting long grass around the property. This was a duty normally undertaken by Mr Meer. However on the day of his death Mr Higlett, for the first time, undertook slashing of the grass using the tractor and slasher.
In late October 2010 Mr and Mrs Higlett were in their garden at home during the day. While they were there they heard a backhoe drive past. Mrs Higlett looked up and saw Mr Meer driving and stop near the petrol pump at the Lunawanna Store. Mr Meer then walked over to them. They had not seen him for several months. They had a brief conversation, with Mr Meer concluding by proposing a meal at the local hotel together.
One or two nights later they met at the hotel at Alonnah and had a meal with Mr Meer, Mr Meer’s daughter,Yannick, and her boyfriend. At the table at the hotel Mr Higlett was sitting to Mrs Higlett’s left, Mr Meer to Mrs Higlett’s right and Yannick and her boyfriend opposite.
They discussed the holiday units and Mr Meer told them that Yannick was going to take over the administration of the property. He said that he wanted Mr Higlett to repair the hot tub. He asked Mr and Mrs Higlett to do more cleaning up and he “really needed” Mr Higlett to do some slashing of the grass as the paddocks were overgrown with bracken. These requests were over and above the usual duties being done by Mr and Mrs Higlett.
Mrs Higlett said to Mr Meer that they didn’t want to be “caretakers” as they had enough to do at home, and they just wanted a few hours work per week. Mr Meer made numerous requests for Mr and Mrs Higlett to do more for him than they were engaged to do and more than they wished to do. In the conversation at the hotel Mr Higlett agreed to generally tidy up and agreed that he would slash around the driveway but he would not slash the paddocks. Mrs Higlett states that there was never any doubt in her mind that Mr Meer was requesting that Mr Higlett undertake the slashing using the tractor and slasher that available for use on the property.
Mr Meer telephoned Mr Higlett numerous times over the several months before Mr Higlett’s death requesting extra work to be performed.
The last conversation between Mr Higlett and Mr Meer occurred a few days before Mr Higlett’s death. It was a telephone call made by Mr Meer to Mr Higlett. Mr Higlett did not initiate the call. Mrs Higlett said she heard her husband say that he would do the job.
Mrs Higlett states that the requests were the subject of discussion between her and Mr Higlett as the request to slash was onerous and it was not intended that Mr Higlett’s casual employment include such a duty. After the last telephone conversation Mr Higlett agreed to do the work because guests with children were to shortly arrive and he felt obliged to remove the grass due to the possibility of snakes. However, as a result of their discussions it appears that Mr Higlett told Mrs Higlett he would not undertake slashing again. Mrs Higlett’s evidence is that the specific request by Mr Meer was for the grass to be slashed using the slasher rather than the ride on mower. Her evidence was that Mr Meer conveyed his knowledge that the grass was so long it couldn’t be done with ride on mower alone. Mr Higlett told Mrs Higlett that he planned to use the slasher in a wide arc and then complete the work with the ride on mower.
There are differences between the above evidence of Mrs Higlett and the account of Mr Meer. Mr Meer’s account is taken from an interview with the police officer attending the scene of Mr Higlett’s death and also an interview with Workplace Standards inspectors. Both of these interviews took place on 21 June 2011. Mr Meer states in the interviews that he did not know that Mr Higlett used the tractor at all in the course of his duties. He stated that it was not the duty of Mr Higlett to operate any machinery, even the ride on mower. He stated however that the key to the tractor was always kept in the tractor on the property and conceded that the rubbish tip is a long way to the back of the property. He stated that it was Mr Higlett’s suggestion, 3 days before his death, to cut the grass. Mr Meer states that he replied to Mr Higlett’s suggestion by stating that Mr Higlett would need to charge the battery in the ride on mower to use it to cut the grass. Mr Meer’s account appears to be that there was just one conversation between him and Mr Higlett regarding the matter. His account is that he did not expect Mr Higlett to use the ride on mower, the tractor or the slasher attachment as part of his duties. He did not at any stage know that Mr Higlett used any of this equipment, and he did not give him permission to do so. He did not therefore provide any instruction or training to Mr Higlett in the use of the equipment. He did know that Mr Higlett previously had experience in farm work but he did not know when he last had such experience or exactly what type of machinery he dealt with.
An inquest was held primarily for the purpose of resolving these discrepancies in the evidence, particularly the issue as to whether Mr Meer specifically asked Mr Higlett to slash the grass using the tractor and slasher attachment. I consider this to be an important issue in the circumstances leading to Mr Higlett’s death, particularly in the context of the employment relationship and the obligation of Mr Meer to provide a safe workplace and appropriate training and instruction to Mr Higlett.
Attempts by police and Coroner’s Associates to contact Mr Meer have been made since early 2012 in an effort to seek his comments upon Mrs Higlett’s account and to foreshadow the possibility of adverse comments against him. Initially such contact was made with his legal advisors in Melbourne. However their efforts to locate Mr Meer were unsuccessful, except to the extent that they received information from a relative of Mr Meer indicating that he was in Italy with no scheduled date for return. Further efforts by Constable McKenzie stationed at Bruny Island in the later part of 2012 resulted in information that Mr Meer had split with his wife, had not been seen on Bruny Island for 12 months and was living in the Phillipines. Victorian Police were not able to locate him in that state to serve the inquest summons. Immigration Department enquiries have more recently confirmed that Mr Meer was listed as “being offshore” and no other details could be lawfully provided. I have received three affidavits in the inquest attesting to efforts made to locate Mr Meer.
I am satisfied that any further attempts would not have resulted in him either being located or providing the evidence requested. I am satisfied in the circumstances it was appropriate that the inquest be held in his absence.
I find Mrs Higlett to be a credible witness, providing a clear and detailed account in all respects. She detailed a persistent course of conduct by Mr Meer to have her and her husband undertake extra duties, specifically including a request to Mr Higlett to slash the grass. This request was made to Mr Higlett in person at the hotel and on the telephone shortly before his death. I accept her evidence over the accounts of Mr Meer. Mr Meer’s account lacks detail and plausibility. It is not feasible to accept that Mr Meer did not know that Mr Higlett was completing tasks using the tractor, particularly as it was available for use and rougher terrain was involved to travel to certain areas. He gave generalised, vague answers lacking in cogency. I reject his account where it conflicts with that of Mrs Higlett.
Circumstances of Death:
Based upon the evidence in the investigation, including Mrs Higlett’s evidence at inquest, I find that the circumstances of Mr Higlett’s death were as set out below.
On the morning of the 17 December 2010 Mr Higlett informed Mrs Higlett that he was going to the Coolangatta Road property to light a fire to heat the water for a hot tub in one of the units and, while waiting for the water to heat, he intended to cut the grass around the units. He left his residence at approximately 10.30am indicating that he would be back for lunch about 12.30pm.
When Mr Higlett arrived at the Coolangatta Road property he commenced to slash the grass, using the tractor with the slasher attached.
Whilst Mr Higlett was slashing the grass a section of green ‘garden hose’, which was lying about on the grass, became trapped around the blades and shaft of the slasher. I am satisfied Mr Higlett stopped the tractor on a slightly sloping grassed area and attempted to free the garden hose from the slasher. To do this Mr Higlett raised the height of the slasher (hydraulically) with the intention of freeing the hose. When fully elevated it was approximately a metre off the ground. In doing this he did not chock the slasher in the elevated position to prevent it from falling back towards the grass.
It appears that Mr Higlett was lying on his back and beneath the slasher unit attempting to free the garden hose when the slasher unit has collapsed from the raised position. Mr Higlett became trapped between the slasher unit and the ground, with the weight of the slasher compressing his chest and abdomen, causing asphyxia and, tragically, his death.
Mrs Higlett became concerned at about 1.10pm when Mr Higlett hadn’t arrived home for lunch. She spoke with a neighbour, Mr Peter Moody. Both she and Mr Moody attended the Coolangatta Road property where they found Mr Higlett under the slasher. At this time emergency services were notified and attended the scene.
Findings and Comments:
I am satisfied there are no suspicious circumstances surrounding the death to implicate any other person.
A scene inspection by Workplace Standards Tasmania on the 17 December 2010 revealed the following:• The body of Mr Higlett was lying on his back. His head, shoulders and arms were free of the slasher and close to the left hand rear wheel while the remainder of his body was under the slasher.
A straw hat was lying close to the inside of the right hand rear wheel of the tractor.
The grassed area around the tractor had been freshly slashed.
The body of the slasher was guarded to an acceptable standard and constructed of solid steel.
The power take off (PTO) operating lever was in the ‘neutral’ position.
The ignition key was in the ignition and was in the ‘off’ position.
The hydraulic control levers for the three point linkage were in the manual raise position.
The park brake was engaged.
The gear lever was in the ‘neutral’ position.
Mr Higlett was lying with his legs pointing towards the centre of the slasher with his feet directly under the blades.
A portion of green garden hose was observed wrapped around the shaft of the slasher.
A pair of spectacles and a hearing aid were observed lying on the ground under the rear left hand side of the slasher, approximately a metre from Mr Higlett’s head.
A number of tests were undertaken on the tractor and slasher in relation to the collapse of the slasher when in the raised position. The tests revealed once the engine was shut off with the slasher raised it was prone to collapse dropping swiftly to the ground without warning after about 3 minutes. It is well-known that heavy equipment suspended by hydraulics will lower when the power shuts off. The rate at which an object lowers is dependant on the length of time the engine was running, the pressure build up and the rate at which the pressure is released when the power is shut off. Tests and inspection of the tractor and slasher failed to reveal any conclusive evidence that a mechanical failure has caused the death of Mr Higlett.
It is a very high risk activity for any person to work under machinery that is supported by hydraulics alone. Unfortunately Mr Higlett failed to chock the slasher when he raised it to remove the garden hose from the blades and shaft. On the evidence of Mrs Higlett, I find that Mr Higlett was aware from his past experience with farm machinery of the need to chock a slasher in such circumstances. However Mr Higlett’s last use of similar farm equipment before his death was in 1999. Given that lapse of time Mr Higlett may not have had such a safety practice in the forefront of his mind at the crucial time.
In relation to Mr Meer, I find that he;
Was aware Mr Higlett was an older retiree;
Was aware that Mr Higlett had some experience of living on a farm but was not aware of any other details of his experience;
Knew that the keys were in the tractor and it was readily accessible to Mr Higlett;
Knew that operating the slasher was not part of Mr Higlett’s regular duties;
Knew that on the day in question the grass was long and would require the use of the slasher;
Requested that Mr Higlett perform the slashing of the grass;
Had not trained Mr Higlett in the use of the slasher or tractor;
Had not warned Mr Higlett of the dangers of using the slasher, being under the slasher or disentangling objects from it.
In all of these circumstances Mr Meer should have been aware that Mr Higlett’s use of the slasher to perform the requested task carried with it a risk of injury or death if safety precautions were not taken.
Mr Meer did not take the steps of a prudent employer to ensure Mr Higlett’s safety. It may well have been that if Mr Meer had taken some basic steps to ensure Mr Higlett did not use the tractor and slasher, or alternatively to provide him with basic safety training in the event that he did use them, his death might have been prevented.
Workplace Standards has not charged Mr Meer with any offence under workplace legislation. However I will provide a copy of this finding to that organisation for its further review.
I also acknowledge that it was dangerous for Mr Higlett to have been under the slasher attempting to disentangle the hose when he ought to have realised the dangers inherent in not chocking it.
As a result of this incident ‘Workplace Standards Tasmania’ issued a safety alert to the general public in relation to carrying out repairs to tractor mounted slashers and attachments in the raised position.
The alert warned that such repairs should not be carried out unless:
They are supported on all four corners
Parked on a level surface
The tractor is switched off and hand/foot brake applied
The safety alert further urged persons to;
Follow the safety requirements of the manufacturer or supplier of the equipment being used.
Use safe work practices when using equipment and machinery.
I support the issuing of such a safety alert, given the serious risk of injury or death that may arise in these circumstances.
In conclusion, I convey my sincere condolences to Mrs Higlett and Mr Higlett’s family
Dated: 8 January 2013 at Hobart in the State of Tasmania.