The death of 19-year-old Sophia Crestani in a crush on a stairwell at a Dunedin flat party was a tragic accident but “likely preventable,” a coroner ruled today.
Last weekend marked five years since the student’s death at the out of control party held on October 5, 2019.
Approximately 300 people attended the party at what was called “The Manor” flat in North Dunedin.
Coroner Heather McKenzie began delivering her ruling by taking time to look at a photo of Sophia and a picture of her headstone set up at the front of the court room and then a karakia was carried out by her family.
She found Crestani’s death was a “tragic accident,” however “likely preventable”.
“Because active oversight of the party by the tenants, or any guest phoning Police if they had become aware of what was happening, might have led to it being controlled or shut down earlier before it became a critical crush situation,” she said.
In her findings the coroner said the party was becoming crowded from about 11pm but that Sophia died closer to midnight.
“There was at least half an hour when intervention could have taken place which could have prevented or mitigated the pile up on the stairs given the rapid Police response with multiple units dispatched,” McKenzie said.
Crestani’s father Bede reacted by saying: “There was a half an hour that could have saved a life, there’s nothing that can take that pain away.”
A previous party at the same flat in July 2019 had seen noise control attend twice.
Typical student party
Among her findings the coroner said there was no evidence that the tenants or other partygoers forsaw what was going to happen or deliberately allowed a dangerous situation to develop.
“Their party was generally typical of a large student party in the North Dunedin area until things started to go wrong… In my view it is reasonable to observe that what happened at The Manor could just as likely have happened at any other large student party with the same features. In this sense, I do not single out the party from other large student parties in Dunedin at the time,” McKenzie said.
But she did also highlight that the tenants present on the night should have taken an active role overseeing and controlling the party.
“I find that if the tenants had taken active oversight of their party, it might not have grown to the size it did and the critical situation on the stairs might not have developed,” she said.
While not making any specific findings about the wider party culture in the North Dunedin area including noise control and alcohol use, Coroner McKenzie did acknowledge issues relating to Dunedin student party culture among some students and that these form the broad background to Crestani’s death.
“There is a lack of affordable and accessible student bars in North Dunedin which would be subject to commercial building regulations (including maximum occupancy) and the conditions of their alcohol licence. Cheaper alcohol than at the bars in town is available from off-licenced premises in the area. I acknowledge the ongoing work that Sophia’s parents are doing in these spaces,” she said.
The coroner also found that the property manager and/or landlord should have considered terminating the tenancy at The Manor following issues raised in July 2019.
“Had the tenancy been terminated, the party would not have occurred at that flat. This is not a finding that they should in fact have filed proceedings in the Tenancy Tribunal, it is a finding that as a responsible property manager and landlord, this option ought to have been actively considered,” she said.
McKenzie said she’d taken into account the Sophia Charter when considering whether any recommendations were appropriate in this matter.
The charter was was set up following Sophia’s death and brings together various groups including Otago University, Otago University Students’ Association, the police and Dunedin City Council with a focus on student safety and wellbeing. Crestani’s family are also heavily involved.
A general recommendation was made that students hosting large parties take active steps to be responsible hosts, including registering the party with the Good One party register and Campus Watch – as the tenants did, actively monitoring the number of people and atmosphere on site and calling police for help if need be. Also, that students leave parties if they do not feel safe for any reason or they can phone police, the Campus Cop or Campus Watch.
“This general recommendation may help promote safety at large parties. This is because help would come, as occurred swiftly once emergency services were alerted in the current case. There might not be as many people still at a party as some would have left, and at an individual level, individuals would be out of harm’s way as they would no longer be there,” she said.
University findings
Recommendations were also made regarding Otago University.
“I recommend that the University consider its approach to disciplining students following large events that breach the Code of Student Conduct, now contained in the Student Conduct Statute 2021, and in particular that engage in actions that can be reasonably expected to result in harm to a person or persons; are unreasonably disruptive to other members of the University or the local community; or result in or can be reasonably expected to result in, damage to property of any person,” the coroner said.
The University says the Student Code of Conduct has been in existence since 2007 and, since inception, has caused debate on how to meet the principles of the Code and how to best work with the community.
“We acknowledge the coroner’s comments about the Code, and the importance of on-going review of our work,” Otago University Vice Chancellor Grant Robertson said.
“There is an inherent tension in how involved the University should be in the lives of students. Our approach to safety, well-being and discipline in North Dunedin is constantly evolving and we will continue to develop it as suggested by the coroner,” he said.
The coroner also recommended Campus watch, a pastoral care support agency, provide new or regular refresher training to its front-line staff about assessing risk at large student parties, the practical steps they can take to seek additional help.
“We will work through those recommendations, obviously there’s a number of them there,” Robertson said.
The coroner did acknowledge the changes the University has already made since Crestani’s death.
Initiatives including the Proctor visiting two-storey flats at the start of the year and offering detailed safety advice to the tenants.
“I think there’s been a lot of progress in a number of the areas that have been raised … but also that there’s always more to do to create safe and inclusive environment here in Dunedin that we all want,” Robertson said.
Being safe at parties
Coroner McKenzie also recommended the Otago University Students’ Association further integrate into its student orientation and flatting resources information on being safe at parties.
“The dangers of being intoxicated at parties in terms of personal appreciation of risk and what is occurring, when to leave a party, how to get help if a party feels unsafe (including contact numbers for Police, the Campus Cop, and Campus Watch), and the safe hosting of parties.
“If students are aware of these things, situations like that which developed at The Manor might not occur because the factors above help raise awareness and mitigate them,” the coroner said.
She did also make it clear that the majority of students at Otago University do not engage in problematic behaviour.
“There are many positive aspects of student culture in Dunedin and these findings do not suggest otherwise.”
In closing she said: “Sophia’s death has resulted in a profound loss for her family and friends, the echoes of which will continue to sound. Alongside this, Sophia’s passing has also been channelled to bring about positive reverberations as seen in the work being done.”
The release of the findings concluding a long process for Crestani’s family.
Her mother Mum Elspeth McMillan said: “We talk of it as semi colon, we can now stop having to live over and over again the circumstances of Sophia’s death and start to remember the good times we had with her, but also put our energy back into the Sophia Charter to hopefully make this student culture safer and more exciting place to be.”