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The drowning of three people on a boat trip off Tasmania's north-west coast was "wholly avoidable" and down to "a combination of alcohol, illicit drugs and a failure to take basic safety precautions," a coroner has found.
Coroner Simon Cooper said Isaiah Solomon Dixon, Bree-Anna Mary Jennifer Thomas and Thomas Courto died of drowning on October 18, 2021, in the Bass Strait waters, near Table Cape.
In his report, released on Tuesday, Mr Cooper said Mr Courto and Mr Dixon arrived at the Wharf Hotel in Wynyard where Ms Thomas was working at 3pm on Sunday October 17, and "spent the rest of the afternoon and evening in the bar drinking and socialising".
After the hotel closed, Ms Thomas joined them on "the other side of the bar", where they drank with another friend, Ethan Jones, before leaving and continuing to drink at Mr Jones' home until at least 4am, where they made plans to take the boat out later that day.
On October 18, Ms Thomas, Mr Dixon and Mr Courto picked up the 17-foot fibreglass Caribbean half-cabin cruiser from Mr Dixon's father, who noticed his son appeared to have "had a few drinks".
The three then bought six four-packs of vodka cruisers and a 10-pack of cider, before heading to the Wynyard Auto and Fishing Supplies Shop, where Mr Dixon told the owner, James Lowe, that they were heading out on the water "for a fun drinking trip".
Although Mr Dixon had a motorboat licence and had previously owned a half-cabin runabout, Mr Lowe was "shocked" when Mr Dixon asked about the correct petrol-to-oil ratio, because it suggested he lacked boating experience.
He said he thought Mr Dixon appeared "drug or alcohol affected" and another witness said all three appeared "very intoxicated".
Mr Cooper found they left the Wynyard Yacht Club at 10am, stopping at the beach at Boat Harbour after a couple of hours, before embarking again.
Police immediately commenced a search after being notified at 5:35pm that the boat was overdue.
Two days later, searchers found Mr Dixon's and Ms Thomas's bodies on the shore between Table Cape and the mouth of the Inglis River, neither wearing a personal floatation device (PFD).
No evidence of Mr Courto's body was found until April 21 the following year, after his femur was recovered by a recreational diver below the Table Cape lighthouse.
The boat was never found.
The autopsies found at the time of death, Mr Dixon had a blood alcohol level of at least 0.110, and Ms Thomas 0.063. Methylamphetamine was also detected in both bodies.
The pathological cause of death was unable to be determined from Mr Courto's femur, however Mr Cooper said "it seems more likely than not that he also drowned".
"It is difficult to escape the conclusion that a combination of alcohol, illicit drugs and a failure to take basic safety precautions was the reason for these deaths," he said.
"There is no evidence that adverse weather conditions, the lack of a seaworthy boat or the actions of a third party caused or contributed to the deaths of Mr Dixon, Ms Thomas and Mr Courto.
"Rather, no-one was wearing a PFD and all were affected by alcohol, methylamphetamine and fatigue.
"Having regard to the evidence as a whole, it is my firm opinion that Mr Dixon, Ms Thomas and Mr Courto should not have been on the water that day.
"The tragedy was wholly avoidable."
Mr Cooper said there was no direct evidence to give a definite conclusion as to why the boat sank.
"However, in all the circumstances and having regard to the evidence as a whole, the most likely explanation is some type of mishap, probably as the result of poor boat handling, attributable to impairment caused by alcohol and illicit drugs," he said.
The coroner made no findings, but commented that had they been wearing PFDs, "it is likely each would have survived".
Mr Dixon's father said his boat, ED Dog, was powered by a 115hp Mercury two-stroke engine, but had no auxiliary engine, and was fitted with a two-way radio and navigation lights, and had PFDs, oars, flares, a fire extinguisher and an anchor onboard.
It is unclear whether or not the vessel carried an Emergency Position Indicating Radio Beacon, but there was no evidence that one was activated in the area where the three went missing.
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