A final verdict is now expected in May following completion of an extended inquest into the scuba-diving death of a British music producer in Australia in 2019.
The coroner is considering the evidence, after the final days of the hearing last week centred on the stumbling block of missing servicing logs for the rental regulator used by the diver.
Karl Bareham, 37, died on a dive in Byron Bay near Brisbane in New South Wales. A UK inquest in March 2020 had been adjourned, as reported at the time on Divernet, after the Suffolk coroner heard that Australian authorities were still investigating the diving equipment Bareham had been using, and the circumstances surrounding the incident.
What was meant to be a five-day hearing began at Sydney coroner’s court in December 2024 and has only now been completed after an extension, with the question of whether defective diving equipment or underlying health conditions related to alcoholism had been responsible for Bareham’s death. The proceedings were reported in the Guardian.
A former performer as a guitarist, Bareham had become producer and sound engineer for Canadian singer-songwriter Dallas Green and his group City and Colour. He had been based in Toronto for 16 years.
They had arrived in Australia for an appearance at the Brisbane Festival later in the month, and the recreational boat-dive had been booked for the following day, 24 September.
Bareham was physically out of shape and generally depressed, though in good spirits on arrival, deputy NSW state coroner David O’Neil was told.
PADI-qualified, the producer had previously carried out 21 dives and had done a refresher course with PADI 5* dive-centre Sundive Byron Bay that morning before heading 2.5km offshore to dive in the Nguthungulli Julian Rocks nature reserve.
It was a calm and sunny day. Both Bareham’s driver and dive-guide Yuko Inagaki said that they had detected alcohol on his breath but the coroner was told that though he might have been hung over or affected by jet-lag, he had not appeared to be adversely affected. Sundive was said to operate a no-alcohol policy for divers.
The fatal dive
Inagaki was initially guiding two buddy-pairs, one of which was Bareham and Sundive instructor Andrew Nieuwenhof.
Nieuwenhof said he had not noticed alcohol on Bareham’s breath nor considered him intoxicated and reported that he had been zealous in checking his equipment, including his regulator.
On reaching the seabed Nieuwenhof had looked up to see Inagaki helping Bareham with apparent equalisation issues. The instructor had therefore moved on to the Nursery site with the other buddy-pair knowing that Inagaki was with Bareham, and the next time he turned to check he had seen the pair ascending.
Inagaki confirmed that Bareham had indicated that he was having difficulty equalising on descent and then with his buoyancy control, but after she had provided assistance he had signalled OK.
They had headed for the Nursery, but the next time Inagaki saw Bareham he was lying 4m away face-up on the seabed, partly obscured by a rock. She swam over and saw that his regulator was out of his mouth.
Inagaki had tried unsuccessfully to reinstate the regulator, and moved Bareham upright to make an emergency ascent. Attempts to resuscitate him at the surface failed and he was pronounced dead on the Pass beach at about mid-day.
Regulator servicing
A scuba-diving expert witness told the inquest that while everyone needed to know who their buddy was, the system had not failed because Inagaki had effectively taken over that role from Nieuwenhof, and there had been no separation from the group.
The coroner heard that the Mares second stage Bareham had hired from Sundive had torn mouthpiece lugs. It was not clear whether these had been damaged before the dive, though Inagaki did not think so. The diver could have bitten through them if he had suffered a seizure.
A police diver found the cracking effort on the regulator to be unusually high and said that it was significantly harder to breathe from at depths beyond 9m, making it unsafe for diving.
A service technician rated the cracking effort as almost double the lower recommended limit, and rejected Sundive’s suggestion that this could have been caused later by salt or sand from the beach.
A Sundive equipment log entry from almost five months before the fatality had noted that the second stage had been leaking but had been manually tuned by Stephanie Rings, a Sundive employee who was not a qualified technician, having completed only half of the Mares-approved course.
Rings maintained that she had been trained by Sundive’s sub-contracted and certified technician Tom Hughes and that he had been overseeing her servicing work at the time, though Hughes, appearing for the company, denied either training her or overseeing her work.
Rings said she had carried out the routine on Bareham’s regulator an estimated 20 times before, with no problems arising.
Mares regulators required servicing every 100 dives or annually, with a major service every 200 dives or two years. Sundive’s regulators were serviced once a year but the company rejected as “very unlikely” the suggestion that they might be used up to 200 times during that period.
Hughes confirmed that Sundive’s maintenance records were inexact in terms of when and how often an item of equipment had been used.
Soon after Bareham’s death, Sundive co-director David Robinson had provided police with a photograph of a single page from the regulator service log. It showed that Rings had tuned Bareham’s regulator on 2 May, 2019.
However, Sundive had not been able to show the court the full logbook and it had not been found at the dive-centre. Rings’ own counsel wanted to know why no proof had been provided that the regulator had not been serviced again since early May.
Robinson offered no explanation when asked by the coroner whether he had concealed the records from the inquest.
Medical opinions
Expert medical witnesses felt that even though the work of breathing might have been elevated on the rental regulator, it would have been manageable for most divers and that Bareham would have been able to surface had that been his only problem.
The diver’s alcohol blood level had been found to be the equivalent of two drinks, possibly from the night before.
Three doctors who gave evidence agreed that Bareham’s alcoholism and related disease rendered him susceptible to a medical event triggered while submerged, but their theories as to the actual cause of death ranged from immersion pulmonary oedema (IPO) to an alcohol withdrawal syndrome seizure leading to drowning.
Bareham was reported to have had liver disease brought on by excessive drinking and might also have suffered from cardiomyopathy or heart-muscle disease, making him more susceptible to IPO (internal drowning). This would have rendered him hypoxic and then unconscious.
The diver had been incapacitated so suddenly that he was considered likely to have drowned after a sudden cardiac event or seizure, causing him to take out or accidentally lose his regulator in a panic.
Also on Divernet: Music producer’s inquest adjourned, Dive-school fined for explosion that cost instructor’s leg, Diving instructor dies in Sydney, Diver couldn’t save husband from shark
