Brian Mitchell

On 27/12/2023 this Court commenced an investigation into the death of Brian Mitchell aged 72 years. The investigation concluded at the end of the inquest held between 15/12/2025 & 17/12/2025. The court returned a short form conclusion of, “Accidental death”

Brian’s medical cause of death was determined as; 1a Multiple Injuries 1b Blunt Force Trauma

Mr Brian Mitchell was 72 at the time of his death

On 26/12/2023 at 15:20 hours, Brian was discovered on tracks at platform 13 at Stratford Underground Station. Brian was declared deceased by paramedics having sustained traumatic injuries that were incompatible with life.

CCTV was reviewed which showed the following:

• At 13:56:53 on 26 December 2023, Mr Mitchell alighted from a London Underground Jubilee line train at Stratford station and sat down on a bench on platform 13.
• At 14:45 hours Brian was seen to stand up and lurch towards the edge of the platform and fall onto the tracks.
• Brian moved and tried to climb back onto the deserted platform.
• At 14:50 hours, an incoming Jubilee Line train entered the platform and Brian was struck.
• The impact went unnoticed. The train reversed out of the station over Brian.
• Two further trains entered and left the platform each moving over Brian twice.
• A member of staff unsuccessfully tried to prevent a fourth train moving over Brian as it entered Platform 13.

The inquest heard that likely contributary factors to Brian’s death were, firstly that Brian was heavily intoxicated by alcohol.

Secondly, Jubilee Line trains use Automatic Train Operation (ATO). This means that Train Operators (TOs) do not drive the train. Acceleration and braking are automated.

The expectation of TOs is that they pay close attention to the train and the tracks before them and override the ATO system and apply brakes if they observe an object on the tracks.

In this case, at least 3 separate TOs failed to notice a man before them on the tracks or to override the automatic system.

The court heard that the initial collision with Brian was likely to have been avoidable. The track layout would have allowed Brian’s presence to have been noticed by an attentive TO. Additionally, it was asserted that a TO would have had sufficient time to react and bring the train to a stop many metres before Brian’s location.

The court heard that these omissions may have resulted from the fact that Platform 13 is a terminus platform which could result in a lowered level of attention on the part of TOs.