An Aboriginal woman died in custody in Victoria one month after she was denied parole for not having suitable accommodation.
An inquest into the death of Heather Calgaret, whose sister Suzzane found her in a critical condition at the Dame Phyllis Frost Centre prison, is set to begin on Monday.
The inquest will examine Victoria's parole system for the first time since parole laws were toughened in the state.
Heather died at Sunshine Hospital in November 2021, one month after she was denied parole, the Victorian Aboriginal Legal Service said.
She was 31 years old and eligible for parole for almost one year by the time she died.
A proud Yamatji, Noongar, Wongi and Pitjantjatjara woman, Heather was a mother of four and described by loved ones as the rock of her family.
Her mother, Aunty Jenny Calgaret, said she believed her daughter did not get the healthcare she deserved while in prison or a fair chance at parole.
"I got my house specifically so Heather and Suzzane could stay here when they got parole," she said.
"I had it set up and we were all so excited to be together again.
"There's no way she would have died if she was living with us."
Suzzane said her sister was her best friend, and the prison system and parole board had "gambled" with her life.
The inquest will investigate Heather's treatment in prison, where she was given the opioid medicine Buprenorphine the day before she was found unconscious.
VALS chief executive Nerita Waight said the system failed Heather like it had so many people before her.
"The Allan government should have been forced to act a long time ago, and if they had, Ms Calgaret may still be here with us today," she said.
"Instead, her family is fighting to make Victoria better, safer for our community."
Ms Waight called on the Victorian government to expand transitional housing support systems and increase housing supply for vulnerable people.
The inquest, before Coroner Sarah Gebert, begins at 10am on Monday and is set to run for four weeks.
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Aboriginal Counselling Services 0410 539 905
