The coroner investigating the death of 22-year-old Aboriginal man Gordon Copeland has recommended New South Wales Police review its training on the history of First Nations peoples to ensure it is as "comprehensive as possible".
Mr Copeland's name and photos have been used with permission from the family.
The Gomeroi man waded and drowned in the flooded Gwydir River in Moree in the state's north-west in July 2021, when he ran from police who had been following him and his two friends in a car.
The inquest into his death heard police spent about 10 minutes searching for Mr Copeland before concluding he had escaped.
NSW State Coroner Teresa O'Sullivan was told a second, larger search commenced in the hours after, when police saw Mr Copeland in the water and heard him groaning, but it was again called off after police determined all occupants of the car were accounted for.
His body was found 500 metres from where he was last seen alive three months later, after the family pushed the police to keep searching.
In handing down her findings at the Moree Courthouse today, Magistrate O'Sullivan said it was "completely inappropriate" that Mr Copeland's family members did not receive more support when they first attended the police station to file a missing persons report.
Training for police officers in communicating with families experiencing trauma was among six recommendations Magistrate O'Sullivan made to the NSW Police Commissioner.
"Mistakes were made in the treatment of Gordon's family, and these mistakes should be the subject of ongoing reflection," she said.
Magistrate O'Sullivan said if those officers had shown "just a little more care" they might have heard enough evidence to warrant restarting the search for Mr Copeland much earlier.
She found the officer whose advice led to the abandonment of the initial wide-scale search, Detective Sergeant Brad Beddoes, did not show the family the "respect and empathy they deserved".
"Even in giving evidence to this court he appeared somewhat dismissive," Magistrate O'Sullivan said.
"I hope he has since reflected more deeply."
'No concern'
Magistrate O'Sullivan also said that to understand the "pain" and "frustration" of Mr Copeland's family, it was important to understand the history of the relationship between police and the Aboriginal community, especially in Moree.
She said "comprehensive" training should be delivered by Aboriginal liaison officers and must address the ongoing impact of colonisation.
The inquest previously heard a family member label some of the evidence as "disgusting" and "inhuman", and felt authorities had "no concern for Gordon".
Some officers told the coroner Mr Copeland's death would stay with them for the rest of their lives, and others apologised to the family after body cam vision revealed them laughing, swearing, and joking while looking for him.
Other recommendations included creating critical thinking training and reviewing the adequacy of its debriefing process.
Magistrate O'Sullivan also recommended the New England Police District review its rescue resources and its unique environment — including river systems — and work out what other equipment it needed.
NSW Police noted the coroner's findings and will consider the recommendations.
'No justice'
Family members said the inquest gave them "clarity" but not justice.
"Today is the end of the inquest, but it isn't the end for us," cousin Leslie Fernando said.
"After 22 long months of fighting for justice for Gordon, we will continue — there was no justice here today.
"Most people at court get to move on from this — not our family, not our community.
"That night will change our lives forever."
Magistrate O'Sullivan praised the family's daily efforts to find Gordon after he disappeared.
"Without their tireless advocacy, it is doubtful that a third search for Gordon would have been undertaken," she said.
Magistrate O'Sullivan also commended what she noted as apologies, thoughtful concessions and reflections made by some of the police officers who gave evidence.
"I hope that the [police] and family can continue a dialogue and work towards a better relationship, so that the children of Josephine and Gordon, and all First Nations children in Moree, can have the bright future they deserve," she said.
