Ten years ago I sat in the front room of the late Elliott Johnston's QC's home reflecting on the Royal Commission into Aboriginal Deaths in Custody (RCIADIC). At the time, it had been over a decade and a half since the final report had been released and on this occasion, I was lamenting the lack of implementation of recommendations. At one point, Elliott, who had been the Royal Commissioner, looked at me over his coffee cup, paused and said "We could have done more."
Australian society certainly could have done more for young Mrs Dhu, who suffered a prolonged, agonising and humiliating death while in police custody. Too many of the Royal Commission’s recommendations have not been implemented. 
If they had, then for Mrs Dhu… Imprisonment would have been only been used as a last resort (rec. 92). Mrs Dhu would not have been imprisoned for a paltry fine default (rec. 120 and 121). On entering custody, her health would have adequately assessed (rec. 126). Mrs Dhu would not have been put in a cell alone (rec. 144). Her family, friends or other support would have been contacted and could have advocated for Mrs Dhu (rec. 145). An ambulance would have been called (rec. 136). The Police’s duty of care would have been exercised (rec. 122).  
And if RCIADIC recommendation 134 where police are obligated to treat people in custody humanely had been observed, then in her dying moments Mrs Dhu would not have been manhandled, dragged through the police station like a carcass at an abattoir and shoved onto the bare metal of the floor of a paddy wagon. 
The Western Australian Coroner’s Report has been tabled and it makes some recommendations principally calling for systemic change. These are only recommendations as we have failed to make coronial recommendations mandatory (rec 13). We failed Mrs Dhu, as we have failed so many others. Yes, Elliott, we could have done more. 26 years on, we must do more.

Dr. Elizabeth Grant is an architectural anthropologist and Senior Research Fellow within the Office of the Deputy Vice Chancellor and Vice President (Academic), who researches in collaboration with the Centre for Housing, Urban and Regional Planning (CHURP) and the School of Architecture and Built Environment at the University of Adelaide.