Darcey was thrown from the West Gate Bridge in Melbourne by her father Arthur Freeman on January 29, 2009.
The coroner Judge Ian Gray emphasised that there was scope for improvements in training and education of GPs who were working with people in danger of family violence and abuse.
In particular, he called for compulsory training of the members of the Royal Australian College of General Practitioners (RACGP).
“General Practitioners are at the frontline and have a role identification, responding to and follow-up support of patients and their children experiencing family violence,” Judge Gray said.
“They can contribute to prevention. I therefore recommend that the RACGP consider the introduction of compulsory family violence training for GPs.”
The training and education for GPs would make clear what their mandatory reporting obligations were, added Judge Gray.
Prior to her death, Darcey’s mother Peta Barnes told more than one GP that she was worried about her children because of her ex-husband’s history of abusive behaviour. However, the reports did not result in the police being notified.
Judge Gray made no adverse finding against any of the treating GPs, finding that the law did not require a report to have been made by any of the doctors.
He found that no one could have predicted that Freeman was going to harm his daughter that day, and that responsibility for the event is solely that of the father.
An inquest into the tragic death of Darcey Iris has resulted in Victoria’s chief coroner recommending compulsory family violence training for all GPs.