Individual at Altcourse

Investigation into the circumstances surrounding the
death of a man in September 2009, at hospital, whilst
released on temporary licence from HMP Altcourse
Report by the Prisons and Probation Ombudsman
for England and Wales
May 2011
This report considers the circumstances surrounding the death of a man at HMP
Altcourse in September 2009. He died as a result of a brain tumour. He was just 26
years old.
I offer my sincere condolences to the man’s family and all those who knew him. I
also apologise for the time taken to issue this report and the additional distress which
this must have caused.
The investigation was conducted by an investigator on my behalf. I would like to
thank the Director of Altcourse and the Controller for their co-operation. I also
extend thanks to the liaison for the Ombudsman’s office. In addition, I thank the
clinical reviewer who conducted a review of the man’s clinical care.
The man was sentenced to four years’ imprisonment in May 2006, having been
remanded to HMP Altcourse in December 2005. He remained there as a sentenced
prisoner. Shortly before being released in March 2008, he was diagnosed with a
brain tumour and he underwent surgery whilst in the community. He returned to
custody in June 2009 after breaching the conditions of his licence. He went to
outpatient appointments at hospital, and a new brain tumour was found. A course of
radiotherapy was started, but proved ineffective. Although very poorly, he returned
to the prison and four days later was released to a hospice before being transferred
to a hospital nearer to his family, where he died. It is unfortunate that the hospice
place was not arranged whilst he was in hospital and he had to go back to prison for
four days.
This is the eighth death from natural causes at Altcourse since 2004, when the
Ombudsman’s office began investigating all deaths in custody.
I have investigated the man’s clinical care, his release on temporary licence and
liaison with his family. I believe that the prison healthcare staff gave every attention
to his needs, which were complex and unusual. In particular care was taken to
release him with a minimal level of restraints and to make sure that his family were
enabled to spend time with him. I make no recommendations.
This version of my report, published on my website, has been amended to remove
the names of the man who died and those of staff and prisoners involved in my
investigation.
Jane Webb
Acting Prisons and Probation Ombudsman May 2011
2
CONTENTS
Summary
The investigation process
HMP Altcourse
Key events
Issues
Conclusion
3
SUMMARY
1. The man appeared at Magistrates’ Court on 15 December 2005, and was
remanded to HMP Altcourse. He was convicted at Crown Court on 21 March
2006, and on 5 May the same year, he was sentenced to four years’
imprisonment.
2. After being sentenced, he saw a counsellor regularly and had a mental health
review on 6 September. He was diagnosed with depression and continued to
attend appointments with a counsellor throughout 2006.
3. In January 2007, the man complained of recurrent tension headaches and
was prescribed pain relief medication. In April and May, he attended further
appointments and reviews about his ongoing depression. He complained of
headaches, aching limbs and running eyes and nose in November.
4. He was seen for further appointments in January 2008. He appeared
depressed and lethargic and had a poor appetite, and was also very pale. A
doctor at Altcourse referred him to a consultant endocrinologist at hospital,
because he suspected that he was suffering from hypopituitarism (decreased
secretion of hormones from the pituitary gland), specifically testosterone
deficiency. This was confirmed in February, and a magnetic resonance
imaging (MRI) scan was also carried out.
5. In March, the consultant from the hospital wrote to Altcourse to confirm that
the MRI had detected a large brain tumour. The consultant was given the
man’s home address because he was due to be released from Altcourse.
6. He was released from prison on 14 March 2008. He remained in the
community until February 2009, when his licence was revoked after he
breached the conditions of his licence. Due to his hospital treatment, he did
not return to custody until June. During his time in the community, he
underwent surgery to remove his brain tumour. He had scarring to the right
side of his head, and parts of his skull were removed. When he returned to
prison, he was drowsy, sleepy and suffered from headaches.
7. As a result of his imprisonment, his outpatient care was transferred to a
different hospital. He attended appointments at the hospital under escort from
prison staff. On 8 July, he had a further MRI scan which revealed a large
remnant of the tumour. A six-week course of radiotherapy was
recommended.
8. In order to facilitate the radiotherapy, and because of a deterioration in his
health, the man was transferred to hospital as an inpatient on 30 July. He
remained there for more than two weeks under escort from prison staff. On
13 August, medical staff at Altcourse were informed that all intervention
regarding the tumour had ceased as it was proving ineffective. He returned to
Altcourse on 18 August but was extremely unwell. The following day, he saw
a palliative care consultant, who recommended that he should move to a local
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hospice. Rather than being transferred under escort, he was released on
temporary licence to a hospice on 21 August.
9. One week later, on 28 August, the man was transferred from the hospice to a
hospital which was closer to his family. He died at the hospital in September.
10. I have investigated his clinical care, his release on temporary licence and the
prison’s liaison with his family and make no recommendations.
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THE INVESTIGATION PROCESS
11. One of my senior investigators opened the investigation on 3 September
2009. At HMP Altcourse, he met the PPO’s liaison officer. The liaison officer
facilitated access to all of the records regarding the man’s period in custody,
including his clinical record.
12. One of my family liaison officers (FLOs) wrote to the man’s mother to explain
the purpose of the investigation and offer the opportunity to raise any
questions or concerns. The FLO and investigator visited her on 17 November
2009. She said that she had been treated well by Altcourse, and explained
that the prison had arranged transport for her to see her son.
13. The local Primary Care Trust (PCT) appointed a clinical reviewer to review the
man’s clinical care whilst he was in custody. The purpose of the clinical
review is to examine the medical care that a prisoner received whilst in
custody, which should be of an equivalent standard to what might have been
expected in the community. The draft clinical review was sent to my office in
October 2010, with the final version following in December. This inevitably
delayed the issue of my own report. His findings are summarised in this
report and the full clinical review is included as an annex.
14. During the course of the investigation, the investigator consulted the man’s
prison and medical records, and liaised with the liaison officer about decisions
that had been made regarding his release.
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HMP ALTCOURSE
15. Altcourse is a prison near Liverpool. It is contracted out by the National
Offender Management Service (NOMS) and run by G4S, a private company.
It serves the courts in Merseyside, Cheshire and North Wales, and holds up to
1324 sentenced and unsentenced adults and young offenders. There are
seven residential units and a separate healthcare unit.
16. Healthcare services at Altcourse are commissioned by the local PCT and
delivered by G4S. An outpatients clinic is available every weekday, and the
inpatients unit provides 24 hour staffing by nurses. Additionally, doctors are
on call 24 hours a day for more serious incidents.
17. This report refers to the man moving from Altcourse to hospital and back
again. When prisoners attend hospital appointments, they are escorted by
prison officers and are usually restrained using handcuffs. The accompanying
prison staff members are known as bedwatch officers.
18. The process of Release on Temporary Licence (ROTL) allows prisoners to be
released from prison temporarily, whilst continuing to serve their sentence.
Such an arrangement can involve various restrictions, such as a prescribed
place of residence.
Performance
19. The Ministry of Justice provides quarterly figures for all prisons in England
and Wales. Every establishment is given a rating between 1 and 4 based on
34 agreed performance indicators. During quarter 2 of 2009-2010 (July,
August and September 2009), Altcourse received the maximum rating of 4,
indicating exceptional performance. The prison maintained its rating during
quarter 3 (October, November and December 2009.) The most recently
available figures are from quarter 4 of 2009-2010 (January, February and
March 2010). For this period, Altcourse received a rating of 3. This indicates
good performance, but nevertheless represents a drop in rating from the
previous two quarters.
20. The former HM Chief Inspector of Prisons inspected Altcourse on 15-22
January 2010, four months after the man’s death. Her report was generally
positive, finding that time spent out of cell was “outstanding, and for much of
that time prisoners were engaged in purposeful activity”. Healthcare staffing
was generally good, but some areas of the healthcare unit were run-down or
untidy. Inpatients had little structured activity to occupy their time.
Previous deaths at Altcourse
21. The Ombudsman’s office has been responsible for investigating deaths in
custody since April 2004. Prior to the man’s death, seven prisoners have died
from natural causes whilst at Altcourse. Two of these deaths were heart-
related, four were from cancer, and in one case a cause of death could not be
identified.
7
KEY EVENTS
22. The man appeared at Magistrates’ Court on 14 December 2005, and was
remanded to HMP Altcourse. On 21 March 2006, he was convicted at Crown
Court and returned to Altcourse to await sentencing. He was sentenced to
four years’ imprisonment on 5 May and returned to Altcourse as a sentenced
prisoner.
23. After his sentencing, he saw a counsellor regularly. On 6 September, he was
referred to Nurse A, a mental health nurse, and complained of being
depressed. The nurse wrote in the clinical record that he presented as
“troubled and disorganised”. The man wanted to see a doctor regarding
medication, and did so five days later. He told Prison Doctor A he was angry
that his partner had not visited him in prison. The doctor noted that he was
low in mood and had been for several months. He prescribed 20mg of
fluoxetine (an anti-depressant drug) daily.
24. The next day, 12 September, the man saw his counsellor, who wrote that he
appeared to have had a slight lift in mood. Two days later, he saw Prison
Doctor A and complained that he was getting headaches as a result of taking
the fluoxetine. He was advised to continue taking the medication.
25. He continued to go to appointments with the counsellor; then on 1 November
attended an appointment with Prison Doctor B for a review of his medication.
The doctor noted that, whilst the fluoxetine had helped slightly, he was still low
in mood with a poor sleep pattern. His medication was increased from 20mg
to 40mg daily.
26. On 15 January 2007, the man saw Prison Doctor C and complained of
recurrent tension headaches. The doctor wrote in the clinical record that
there were no “red flag symptoms” (signs of a serious condition) and advised
simple pain relief medication when required. He saw Prison Doctor B on 19
February, when he asked for a repeat prescription for paracetamol. He
explained that he used paracetamol for his occipital headaches (towards the
back of the head).
27. He saw the counsellor on 23 April and appeared unhappy, which the
counsellor thought was due to the death of his grandfather. Four days later,
he saw Prison Doctor B and complained of low mood. He said that his
grandfather had died suddenly and unexpectedly, and the fluoxetine was no
longer relieving his symptoms. He was referred for a review by a mental
health nurse, with a view to a possible increase in his medication.
28. Nurse B saw the man for a mental health review on 14 May. He recorded that
he thought his problems were mainly social, domestic and relationship based.
He encouraged him to continue working with his counsellor, but did not think
an increase in medication would be helpful. Over the next few months, he
continued to attend appointments with his counsellor, who wrote in the clinical
record that he worked “extremely hard both during and outside of sessions”.
8
29. The man saw Nurse C on 15 November 2007, and said he had experienced
headaches, running eyes and nose, and aching limbs for four days. He was
coughing up green phlegm in the mornings which cleared as the day went on.
He was advised to produce a specimen, and he would then be reviewed. The
planned review does not appear to have happened, and it is unclear whether
this was because he did not produce a specimen, or for some other reason.
30. He saw Nurse B for a mental health assessment on 21 January 2008. The
nurse reported that he was low in mood, with a flat voice tone and little eye
contact. He wrote that he experienced a lack of appetite and a poor day/night
routine which affected his ability to work in the prison. He told the nurse that
he had stopped taking his anti-depressants around eight months previously.
He was referred to the doctor for a review of his medication, which took place
the next day. He told Prison Doctor A that he felt increasingly tired and would
often fall asleep between 5.00pm and 9.00pm. He would then be unable to
sleep through the night. He was not eating properly and was worried about
his release from prison. The doctor noted that he appeared pale and was low
in mood. He prescribed 15mg of mirtazapine (an anti-depressant medication)
daily. He thought that there was no strong evidence for hypothyroidism (a
condition caused by insufficient production of thyroid hormones from the
thyroid gland) but asked for an urgent full blood count and thyroid function
test.
31. Prison Doctor A next saw the man on 29 January. He wrote in the clinical
record that he was very pale, and was not eating or sleeping well. His blood
test results were normal. He increased his mirtazapine prescription to 30mg
daily.
32. Following the results of the thyroid hormone test, the doctor wrote to a
consultant endocrinologist at hospital. In his letter dated 31 January, the
doctor described the man’s history of depression and also mentioned that he
suffered from long-term hoarseness. The doctor thought that he was suffering
from hypopituitarism (decreased secretion of hormones from the pituitary
gland), specifically testosterone deficiency, and asked the consultant to see
him in his clinic at the earliest opportunity.
33. The consultant saw the man on 7 February, and wrote to the doctor on 15
February. In his letter, he agreed that the symptoms suggested
hypopituitarism. He recommended a course of hydrocortisone (a steroid
hormone) and said that he would arrange for the man to undergo a magnetic
resonance imaging (MRI) scan of the hypothalamic pituitary area of his brain.
34. It is unclear when the MRI scan took place, though the consultant wrote to a
consultant neurosurgeon on 3 March. In his letter, the consultant explained
that the man’s MRI scan showed a “large heterogeneously enhancing pituitary
adenoma extending into the supra sellar region with compression of the optic
chiasm” (a brain tumour). He asked the consultant neurosurgeon to see him
in the near future. Four days later, he sent a further letter to the consultant
neurosurgeon, explaining that the man would shortly be released from
custody, and requesting that the appointment was sent to his home address.
9
35. The man was released from Altcourse on 14 March. Prisoners are normally
released at the halfway point of their sentence, and serve the remainder in the
community, subject to a licence. A standard licence has a number of
conditions, including a requirement to live at a specified address. Additional
conditions can be stipulated. He was subject to an exclusion zone, meaning
that he was not allowed to enter a particular geographical area.
36. The man remained in the community until February 2009, when his licence
was revoked after he failed to attend three appointments with his probation
officer. He was found to have changed his address without informing his
supervising officer. He was not required to return immediately to custody
because he being treated for the brain tumour and was subsequently
hospitalised. In May, however, he was discharged from hospital and went to
live at his mother’s address. This was in breach of his licence conditions,
which did not allow him to live in that area, and he returned to Altcourse on 1
June.
37. Medical assessments completed when he arrived at Altcourse noted that he
had been diagnosed with a brain tumour and had undergone surgery as a
result. Nurse D wrote in his clinical record that he had scarring to the right
side of his head and parts of his skull had been removed. She also noted that
he was unsteady on his feet, had slurred speech, and was prescribed
significant amounts of medication. He was admitted to the prison’s healthcare
unit.
38. On 2 June, the man saw Nurse E. He spoke at length about substance
misuse, and said that he was prescribed methadone (used to treat
dependence on opiates such as heroin). He also saw Prison Doctor D, who
noted that he showed no signs of drug withdrawal but had obvious memory
problems. There was no further detail given about how his memory had been
assessed. Nurse E confirmed that he had been prescribed methadone whilst
he was in hospital, and he started the prison’s methadone programme.
39. The next day, Prison Doctor D wrote to Altcourse’s Director explaining that the
man had been receiving treatment at hospital, and that his care had been
transferred to another hospital. He explained that the man would be required
to go to the hospital every weekday for a six week period.
40. Also on 3 June, Nurse F wrote in the clinical record that the man had made
“slow but positive progress”. He had made his way with some assistance to
the dining area and had eaten his meal.
41. Over the next few days, several entries were made in the man’s clinical
record. He was consistently described as drowsy, sleepy and suffering from
headaches. On 7 June, Prison Doctor B wrote that there had been “little
improvement so far” and that he felt very cold and tired much of the time.
Later the same day, Nurse G wrote that he appeared much more alert and
had been mixing with other prisoners in the television room. However, he had
also “been complaining of an excruciating headache that had him sobbing in
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pain”. As a result of this, the doctor prescribed naproxen, an anti-
inflammatory medication commonly used for pain relief.
42. Clinical staff continued to monitor the man over the next few days. He
sometimes seemed confused, but showed some improvement, associating
with other prisoners and taking time outdoors in the exercise yard.
43. On 11 June, he went to an appointment at hospital, but did not return with any
hospital notes and was unable to remember the name of the doctor he had
seen. A member of the healthcare staff spoke to one of the officers who
accompanied him. The officer said the consultant had informed him that they
would be having a meeting about his care, as he would not be able to lie still
on a bed for 20 minute periods for radiotherapy.
44. The same day, the consultant neurosurgeon at hospital, wrote to the
consultant oncologist who had been responsible for the man’s care at another
hospital. He wrote that radiotherapy would “pose an extremely difficult
logistical challenge” because the man was handcuffed to prison officers and
had been told that the handcuffs could not be released. He also mentioned
that there were concerns about whether he would be able to remain still for
the duration of the radiotherapy sessions, and whether he would be prepared
to have a face shell fitted. He said he would arrange for him to undergo an
MRI scan.
45. Prison Doctor B wrote to the Director of Altcourse on 15 June, explaining the
man’s medical condition and emphasising that he would need to be uncuffed
for the duration of certain procedures at the hospital. The outcome of this
request is unclear, but he later underwent procedures (such as an MRI scan)
that would have required the handcuffs to be removed.
46. Throughout the remainder of June, the notes in his clinical record indicated
that his condition seemed to remain much the same. He was settled on the
healthcare unit, though he slept for long periods of time and often appeared
drowsy. He frequently complained of headaches and was prescribed pain
relief medication.
47. He underwent an MRI scan on 8 July. Two days later, the consultant
neurosurgeon saw him and then wrote to Prison Doctor A with the results. He
said that the MRI showed a large remnant of the tumour, and a six week
course of radiotherapy was recommended. The consultant said he had tried
to explain this to the man but his memory was extremely poor. He noted,
however, that he had signed a consent form and understood the side effects
of his treatment.
48. Throughout July, his condition appeared much the same. The medical team
at Altcourse continued to make regular entries in his clinical record. These
were primarily related to his level of alertness, mobility, diet and pain level,
and there was little information about his outpatient appointments at hospital.
11
49. On 30 July, the Release and Recall Section of the Parole Board wrote a
review about the man’s recall to prison. They considered re-release but did
not think it was appropriate. He was not allowed to move back to his mother’s
house because it was in the exclusion zone, and the Parole Board thought
that probation approved premises (hostels) might struggle to manage his
medical needs.
50. The same day, Prison Doctor D noted in the clinical record that the man’s
condition had deteriorated over the preceding few days. The appropriate
course of action was to admit him to hospital in order to examine his
endocrine system (responsible for the release of hormones into the
bloodstream) and commence radiotherapy. He was admitted to hospital the
same day.
51. On 31 July, Nurse H spoke to a member of staff at the hospital to ask about
the man’s condition and whether he was likely to remain in hospital for more
than three days. She was told that there had been no change and he was
likely to remain in hospital.
52. The next day, a Release on Temporary Licence (ROTL) form was completed
in view of the man’s poor health. It was acknowledged that he could not be
released to his mother’s address because of his licence conditions, but the
Director agreed that based on “the need to ensure dignity, respect and
compassion” he would be accompanied by bedwatch officers but without
restraints, such as handcuffs, whilst he was at hospital.
53. The prison’s family liaison officer introduced herself to the man’s mother and
sister on 2 August at the hospital. There was ongoing contact between them
from this time until his death one month later, and in the period that followed.
54. The healthcare staff at Altcourse retained some contact with their
counterparts at hospital whilst the man was an inpatient. However, this
contact did not always seem particularly harmonious. Nurse I wrote in the
clinical record on 13 August to suggest that there had been some
disagreement about discharging him from hospital. Prison Doctor D was
unhappy about this decision being made without any prior notice or
consultation especially as it was during the late evening, and was not willing
to accept him back on those terms.
55. Nurse I had been advised that the man was now blind, unable to use one of
his arms, and extremely unbalanced when trying to walk. He would need one
to one care, with a nurse at his bedside 24 hours a day. The hospital had
withdrawn all treatment for his cancer as it was ineffective. After 13 August,
there was one further entry in his clinical record before his return to Altcourse.
It was dated 17 August, and concerned the prison being fully briefed on his
medical needs before his return.
56. He returned to Altcourse from the hospital on 18 August. The notes in his
clinical record for 18 and 19 August suggest that he was extremely unwell.
He slept for long periods, fell on a number of occasions, and struggled to use
12
the toilet properly. He was given liquidised meals and extra fluids, and his cell
door was left open during the night (usually cells are locked at night when
staffing levels are reduced).
57. On 19 August, the man was assessed by a Macmillan Consultant in palliative
care. He recommended that he should move to a hospice for end of life
palliative care. Over the next two days, whilst a hospice place was being
arranged, he was given 24 hour care by two members of the healthcare staff.
58. The Macmillan Consultant confirmed on 21 August that a place was available
for him at a hospice. A Release on Temporary Licence (ROTL) application
was completed and it was agreed that he would be released, unaccompanied
by prison staff, to the hospice. The ROTL form was signed on his behalf as
he was unable to do so. On the same day, he was released to the hospice.
59. Whilst the man was at the hospice, the prison’s family liaison officer made
arrangements to provide transport for his mother, so that she could maintain
daily visits. She was collected from her home in Macclesfield, and returned
there after visiting her son.
60. There were no further entries in the clinical record about his condition whilst
he was at the hospice. On 28 August, he was transferred from the hospice to
a district hospital, which made it easier for his family to visit him. He died at
the hospital six days later.
61. Following the man’s death, the prison’s family liaison officer remained in
contact with his mother whilst funeral arrangements were made. The prison
paid for the funeral, which was held on 18 September. A memorial service for
him was held at Altcourse three days later.
13
ISSUES
Clinical care
62. The clinical reviewer was appointed by the local Primary Care Trust (PCT) to
review the man’s clinical care. He produced a summary of the man’s medical
appointments, and commented on his admission to Altcourse and his
subsequent treatment by healthcare staff. In conclusion, he found no
significant shortcomings in how medical care was managed whilst he was at
Altcourse.
63. It is the clinical reviewer’s view that the palliative care team could have been
involved with the man’s care from an earlier stage. He was only treated on a
palliative basis from August 2009, less than a month before he died, when he
was admitted to hospital and treatment for his cancer was withdrawn. Until
then active treatment was given and it was only in August that palliative care
was deemed necessary.
64. The man returned to Altcourse on 18 August and was seen by a Macmillan
Consultant in palliative care the very next day. However, the information in
his medical records suggests that he was extremely unwell during this period
and that his condition had deteriorated significantly even before his discharge
from the hospital. Better communication between Altcourse and the hospital
might have resulted in him being assessed by someone from the palliative
care team without having to return to the prison. The clinical reviewer
observed in his clinical review that it would have been better for him to
transfer directly from the hospital to the hospice, rather than returning to
Altcourse. However, he concluded that his discharge from the hospital was
appropriate.
65. The man received 24 hour nursing care at Altcourse during the four days after
he came back from hospital. This is not something which the healthcare
centre is ordinarily staffed and equipped to provide but there are no concerns
about the quality of his care.
66. However, I question the necessity of the four days he spent in the prison
before being released to the hospice. I accept that the hospital wanted to
discharge him, though the fact that he went to a hospice four days later
suggests that his medical needs were ongoing and complex, and that he was
expected to die within a relatively short period of time.
67. Arrangements for his discharge are the responsibility of the hospital, which is
outside the Terms of Reference for my investigation, and so I make no
recommendations in this regard. I am embarrassed by the delay issuing my
report and, some 18 months after his death, does not seem to be the most
appropriate time to comment further. I am also conscious that his condition
was unusual and that the hospital, although a specialist regional cancer
facility, is not the prison’s local hospital. I have no doubt that, in the event of
similar circumstances in the future, the Director and Head of Healthcare will
wish to take every step to improve liaison with the hospital.
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68. The possibility of release to a hospice could have been explored by members
of staff at Altcourse before the man was discharged. Better planning by the
hospital and the prison could have avoided the disruption for him and his
family as well as reducing the burden of caring by healthcare staff.
Release on temporary licence (ROTL)
69. The man was admitted to hospital on 30 July. Two days later, in the light of
his very poor health, a ROTL application was completed. At the same time,
the decision was made that he should be accompanied by prison bedwatch
officers, but that he was unlikely to try to escape and did not need to be
handcuffed.
70. The arrangements were further reduced when he went to a hospice on 21
August, and his ROTL was amended so that he was no longer accompanied
by bedwatch staff. Although still a prisoner, he was able to spend the last two
weeks of his life without the indignity of bedwatch officers being present. This
is good practice to ensure that prisoners are afforded dignity during their last
days. It also means that valuable and scarce prison resources can be used
more effectively.
71. Although technically still a prisoner, no entries were made in his prison clinical
record after he was taken to hospice on 21 August. He was receiving medical
care from the hospice, and later from the district hospital, and was not
expected to return to the prison. However, he remained a prisoner under
Altcourse’s supervision. As such, it would have been good practice for clinical
staff at Altcourse to maintain contact with the hospice and the district hospital
about his condition and the medical care he was receiving, and to record this
in the clinical record.
Family liaison
72. Altcourse’s family liaison officer introduced herself to the man’s mother and
sister on 2 August 2009, when he was in hospital. Ongoing contact was
maintained during his illness and after his death.
73. She kept a detailed log of her contact with his mother, and this seemed to be
mostly positive. His mother confirmed to my investigator and FLO that the
family liaison officer’s involvement had been helpful. In particular, she praised
the prison for arranging to drive her from Macclesfield to the hospice to visit
her son.
Issues raised by the man’s family
74. The man’s mother told my investigator and FLO that she had experienced
difficulty arranging for a piece of her son’s artwork to be returned by the
prison. This was only rectified after intervention by my own FLO. Whilst I
acknowledge that the family liaison was, for the most part, supportive and
well-received, I remind the Director of the need to return property to family
members promptly.
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75. She was also concerned about her son’s recall to prison. In February 2009,
his offender manager (his probation officer in the community) started
proceedings to return him to custody after he failed to attend appointments.
However, he was later admitted to hospital and so was not returned to
Altcourse until June. His mother explained that his offender manager had
visited him in hospital and said that he would find a place for him to live when
he was discharged.
76. On 23 June, after his returned to Altcourse, his offender manager completed a
report assessing the risks if he were to be released. The section concerning
his accommodation needs states:
“The man’s accommodation is problematic in that because of his health
needs, he is in high need of support. He is technically homeless. We
have liaised with approved premises who would have difficulty
accommodating him because of his health needs. His mother has
informed us that she is working with the housing department with regard to
a transfer away from the area in which the victim resides, in order to
accommodate her son. His accommodation is linked to health care. He is
currently receiving medical treatment - radiation therapy - at hospital and
we understand the hospital is requesting ROTL arrangements for this
treatment. If he were to be released immediately he would be homeless
which would aggravate his risk to the public as he would be in a state of
anxiety. It is hoped that through liaison with his mother/medical
services/housing, progress could be made to progress his accommodation
situation.”
77. Whilst the purpose of this investigation is to consider the circumstances of the
man’s death, I understand his mother’s anxieties about his recall. The
evidence from the records is that it was difficult to find suitable
accommodation but that the problem had been identified and efforts were
being made.
78. On 30 July, which with hindsight was less than a month before the hospital
stopped giving active treatment, the Parole Board reviewed his recall to
custody, and concluded as follows:
“The panel noted the length of time during which the man had been
supervised in the community under the current licence, and considered the
benefits of him addressing his substance misuse problems and offending
behaviour within the community. Against this, the panel balanced the
seriousness of the index offences and his history of confrontational
behaviour towards his mother, together with his history of previous
convictions (including violence) and breaches of trust. The panel also took
into account the need for supportive accommodation for re-release which
is able to deal with his medical requirements, and the lack of confirmation
that such accommodation is currently available, and the request of report
writers that his case should be reviewed in three months. The assessment
of risk is such that it cannot be safely managed within the community at
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present. The panel therefore makes no recommendation regarding re-
release.”
79. As a result of the Parole Board’s decision, the man remained in the custody of
Altcourse. Had time allowed, at a later date, the Board may well have
reached a different decision. Given what was known about his condition in
July when the Board met, I believe that their decision took full account of his
circumstances and was appropriate.
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CONCLUSION
80. This report covers the sad death of a very young man. He was poorly when
he was first in prison and then underwent major surgery on release. He
breached his licence conditions and was recalled to prison where he lived in
the healthcare inpatient’s unit. There was evidence of some very good
practice by Altcourse, particularly the family liaison arrangements which were
put in place when it became clear that his condition was terminal. As well,
knowing that the Parole Board had recently refused to release him, the prison
applied for Release on Temporary Licence as the best alternative. This
meant that no restraints or bedwatch officers were needed. He and his family
had privacy and dignity during the last weeks of his life.
81. However, it is a great pity that he had to spend four days from 18 to 21 August
2009 back in prison, when he was clearly so very unwell. His discharge from
hospital was a matter for the doctors there. Better communication between
the hospital and the prison should have meant greater cooperation. Such a
poorly young man should not, to my mind, have been taken back to prison
when what he clearly needed was specialist palliative care.
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