Peter Moore: Death in custody – what really happens behind the scenes

There will not be too many tears shed for the death of Ian Huntley, the convicted murderer who killed two ten-year-olds, Holly Wells and Jessica Chapman. He was killed after an attack in HMP Frankland. 

How do the authorities handle a death in custody? I was once involved in reviewing deaths in prisons. We worked in teams of three, in which I was the only doctor. Our role was to read all the relevant paperwork and then visit the prison to interview the staff. All deaths in custody must be referred to the coroner who was sent our report.  The reports were also published with the names redacted. 

I had experience of working in prisons. It was important to treat all prisoners with the same compassion and care I would treat any patient. It was not my job to make judgements, that was the role of the court.

Deaths “in custody” included deaths of anyone who had recently been released. 

All cases were placed in one of three categories. The highest category, which will include the death of Huntley, were the most serious such as violence and murder. Luckily, these were rare and I was never involved in one of these cases. A colleague who had to write a report on a prisoner who had been murdered told me that it was one of his easier reports. There was no debate over how he died and all the legal aspects would be dealt with by the criminal court. 

The next category were cases such as suicide or drug overdose. In cases of suicide we looked at whether the risk had been picked up by the staff, whether the prisoner had adequate supervision and whether there were any specific dangers such as suspension points for hanging. It was important to look at the whole system and not blame one scapegoat. 

In one case, a woman who had recently been released accidently took an overdose of heroin. She had only a short sentence and, when in prison, was seen by the substance abuse team. It would be dangerous to stop all her drugs immediately and so she had been prescribed reducing doses of safter drugs under strict supervision. Despite the prison medical team contacting her local NHS substance team, not in Devon, they had put her on a waiting list. She was released with no immediate medical follow up. Predictably, she went straight back on street drugs with fatal consequences. Our report was strongly worded but I never heard whether the coroner or NHS took any notice. 

There has been an increase in deaths in custody. Is this a part of England becoming aa dangerous police state? Are we following Russia in sending dissidents to die in prison? Luckily there is no need for a complicated conspiratory. When a large number of men convicted of sexual offences in their seventies are sent to prison with a long sentence no one needs a conspiratory theory to realise that some may not live for another twenty years. The commonest reason for a death in custody was natural causes. 

In another case, an elderly man had terminal cancer. The prison medical centre used NHS doctors and nurses and his care was excellent. When it became clear that he had now moved on to end of life care he was offered compassionate leave but refused. Understandably being released for end-of-life care to return to the town where he had abused children did not appeal.  

In every report we had to compare the care given to the NHS. If the care was exemplary, we were told to conclude that it was “as good as the NHS”. Never, we were told, suggest that medical care in prison is ever better than the NHS. The published report might reach the Daily Mail. “Doctor claims medical care in prisons is better than the NHS”. 

The report on the death of Huntley will look at why he did not receive more protection and how any makeshift weapon was available but this will also be looked at by the Crown Court. Although his crime was evil and there will be little sympathy we still need to learn from his death.