Source · Prevention of Future Deaths

Adetokunbo Ajakaiye

Ref: 2016-0209 Date: 27 May 2016 Coroner: Mark Beresford Area: South Yorkshire (East) Responses identified: 0 / 2 View PDF

Prison healthcare staff lacked essential knowledge and practical experience regarding malaria and tropical diseases, posing a significant risk in an era of increased foreign travel.

Date 27 May 2016
56-day deadline 22 Jul 2016 est.
Responses identified 0 of 2
Hospital Death (Clinical Procedures and medical management) related deaths State Custody related deaths

Coroner's concerns

AI summary
Prison healthcare staff lacked essential knowledge and practical experience regarding malaria and tropical diseases, posing a significant risk in an era of increased foreign travel.
View full coroner's concerns
In the circumstances it is my statutory duty to report to _ 1 _ It became apparent; from the evidence, that none of the healthcare staff who dealt with Mr Ajakaiye at HMP Doncaster; had, prior to November 2010,any practical experience of dealing with patient suffering from malaria and that there was a lack of knowledge and understanding of the signs and symptoms of malaria and of tropical diseases generally in circumstances where, in an era of increased foreign travel and inward migration; the incidence of malaria Is likely to increase_

Report sections

Investigation and inquest
On 14/12/2010 | commenced an investigation into the death of Adetokunbo Ohisaga Ajakaiye , 28 The investigation concluded at the end of the inquest on 27 May 2016. The conclusion of the inquest was (see attached questionnaire).
Circumstances of the death
Mr Ajakaiye was arrested when he entered the UK through Heathrow Airport, on 13th November 2010. He was seen by a doctor at Heathrow Airport Police Station and was then transferred to Lawcroft House Police Station, Bradford later that same Day. Mr Ajakaiye was seen by nurses at Lawcroft House Police Station on both 13th November 2010 and 14th November 2010. On all of the above mentioned occasions when Mr Ajakaiye was seen by healthcare staff, he raised the possibility that he was suffering from malaria. On each occasion observations were taken: Mr Ajakaiye was remanded into custody on 1Sth November 2010 and was transferred to HMP Doncaster. He was seen by a nurse who carried out the first reception health screen using the standard pro forma which it was said in evidence, followed a model prepared by Mr Ajakaiye again mentioned malaria_ Mr Ajakaiye was seen by a doctor at HPM Doncaster, on 16th November 2010.
4. Mr Ajakaiye remained at HMP Doncaster until 24th November 2010,on which date he was transferred to Doncaster Royal Infirmary: On the evening of the 24th he was transferred to the Royal Hallamshire Hospital, where he died, of malaria, early on the morning of 25th November 2010. Coroner'$ Court and Office; Doncaster Crown Court; College Road, Doncaster; DNI 3HS Tel 01302 737135 Fax 01302 736365
Action should be taken
In my opinion action should be taken to prevent future deaths and believe you Sir Bruce Keogh, have the power to take such action:

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Report details

Reference
2016-0209
Date of report
27 May 2016
Coroner
Mark Beresford
Coroner area
South Yorkshire (East)

Responses identified

Responses identified 0 of 2
2 responses not yet linked

Organisations named in PFD reports are normally expected to respond within 56 days. Deadline: 22 Jul 2016 (estimated).

Sent to

Ministry of Justice
NHS England

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