The family of Jeffrey Winmar has called for accountability and systemic change following the conclusion of a coronial inquest into his death in custody, describing their ongoing grief and lingering questions.
Mr Winmar, a 28-year-old Noongar man, died in hospital on 11 November 2023, two days after his arrest by Victoria Police in Melbourne’s east.
The inquest, held over two weeks in the Coroners Court of Victoria, examined the circumstances surrounding his arrest, medical treatment and cause of death.
Findings and recommendations are expected at a later date.
In statements delivered to the court at the close of proceedings, Mr Winmar’s family spoke of their loss and their frustration with the process.
His mother, Ursulla Winmar, described her son as “the strength that kept us together,” telling the court her family "is falling apart. We are so broken.”
“I’ve been robbed of a son and I feel broken I couldn’t protect him,” she said.
“A parent should not have to bury their child.”
Incoming ambulance was cancelled before Winmar fell unconscious
The inquest heard that on 9 November 2023, police attended a property in Melbourne’s east to arrest Mr Winmar in relation to alleged offences including motor vehicle theft and aggravated burglary.
Eleven officers were involved, alongside a canine unit and drone operators.
Evidence given during the hearings outlined a pursuit in which Mr Winmar climbed onto the roof of a property before descending and being apprehended by police.
Officers told the court he appeared alert at certain points, though it was also established that he had lost consciousness during the incident.
A key focus of the inquest was the handling of medical care at the scene, including decisions to request, cancel and later re-request an ambulance.
One officer told the court he called off an ambulance after forming the view that Mr Winmar was responsive, but acknowledged he had not been fully informed about his condition at the time.
He said that, in hindsight, he would have acted differently had he known Mr Winmar had been unconscious.
“I would have kept the ambulance coming,” he said.
The court also heard evidence about Mr Winmar’s condition deteriorating while in police custody.
He was later transported to hospital in a critical state and died two days later. Medical issues examined during the inquest included cardiac arrest and internal injuries, including liver damage.
Mr Winmar’s family raised concerns throughout the proceedings about the level of force used during the arrest, the role of the canine unit, and whether earlier medical intervention may have altered the outcome.
They also questioned whether systemic factors, including the treatment of Aboriginal people in custody, had influenced events.
Family say questions still remain
The coroner will now consider the evidence and is expected to deliver findings and any recommendations at a later date.
Mr Winmar's mother said the inquest had not resolved key questions about what happened in the moments leading up to her son’s collapse.
“After this inquest I still have more questions about what happened to my son,” Ms Winmar said.
“I don’t feel like I have the whole story.”
Mr Winmar’s father, Jeffrey ‘Pep’ Anderson, told the court he believed his son’s death must be understood within a broader pattern of deaths in custody affecting Aboriginal communities.
“My son was 28 years old when he died in police custody,” he said.
“You can’t ignore that he was Aboriginal. There is a history and a pattern here and it can’t just be ignored.”
“There’s been too many Blak deaths in custody,” he added. “What’s it going to take for people to start taking us seriously?”
The family also described Mr Winmar as a devoted father and a central figure in a large extended family.
In a statement read earlier in the proceedings, his sister said he had “so much love to give” and was known for regularly checking in on relatives and supporting those around him.
Outside court, supporters gathered during the inquest, including at a smoking ceremony marking its commencement.
The Victorian Aboriginal Legal Service (VALS), which represented Mr Anderson, said the case highlighted ongoing concerns about deaths in custody.
Chief executive Nerita Waight said the circumstances of Mr Winmar’s death were “devastating” and that his family “deserve answers and they deserve justice.”
“We know that the coronial process is inherently unsafe for our people,” she said.
“Time and time again we see our people dying in custody. This shouldn’t have been the end to Jeffrey’s story.”
Victoria Legal Aid, which represented Ms Winmar, also acknowledged the significance of the case.
Chief executive Toby Hemming said the issues examined “go to the core of accountability and fairness in the justice system,” and expressed hope that the coroner’s findings would provide “some measure of justice” for the family.
