Prevention of Future Deaths reports · 2015

Jason Lawson

Regulation 28 report to prevent future deaths, reference 2015-0006, written 9 Jan 2015. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.

Date of report9 Jan 2015
Reference2015-0006
DeceasedJason Lawson
CoronerRobert Chapman
Coroner areaRutland & North Leicestershire
CategoryHospital Death (Clinical Procedures and medical management) related deaths · State Custody related deaths
Organisation namedNottinghamshire Healthcare NHS Foundation Trust · Northamptonshire Healthcare NHS Foundation Trust
Sourcejudiciary.uk record · original PDF
Responses publishednone published

The report

Text recovered by OCR from a scanned PDF. OCR is imperfect: check anything you rely on against the source PDF. Reproduced verbatim, including the scan's own layout.

REGULATION 28 REPORT TO PREVENT FUTURE DEATHS
THIS REPORT IS BEING SENT TO:

NHS England
The Prison Service

CORONER

| am Robert Chapman, Assistant Coroner, for the Coroner Area of Rutland & North
Leicestershire

CORONER’S LEGAL POWERS

| make this report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009
and regulations 28 and 29 of the Coroners (Investigations) Regulations 2013.

INVESTIGATION and INQUEST

On 19™ March 2013 | commenced an investigation into the death of Jason Edward
Lawson, aged 38. The investigation concluded at the end of the Inquest without a jury
on 20" November 2014. The conclusion of the inquest was:

The Cause of death was:
1.a. Sudden Unexpected Death in Epilepsy

The Conclusion was:
Narrative Conclusion

Mr Lawson had been diagnosed as suffering from epilepsy and schizophrenia. He had
received treatment and medication in both the community and more recently through the
healthcare provisions in the various prisons where he had served sentences of
imprisonment.

On the morning of the 17” March 2013, whilst at HMP Stocken, Mr Lawson was found
dead in his prison cell. His death was certified by a paramedic at 1.19pm on the 17"
March 2013. He died from natural causes.

CIRCUMSTANCES OF THE DEATH:

Mr Lawson suffered from epilepsy and schizophrenia and had received treatment and
medication in both the community and through the healthcare provisions in the various
prisons where he had served sentences of imprisonment. He was imprisoned at HMP
Stocken at the time of his death.

On the afternoon of 16 March 2013 he had received a visit from relatives. He appeared
to be well. He was locked in his cell at 4.30 that afternoon, was checked by prison
officers at around 9pm, and checked again through the hight, at around 7.30 on the
morning of the 17 March and again at 8.20am when his cell door was unlocked. He was
found dead in his cell at about 12.00 noon on the 17" March when he had not attended
to collect his lunch.

The time of death is uncertain, but is likely to have been late in the evening of the 16"
March or in the early hours of the 17" March. He was certainly dead when the checks
were carried out on the 17™ March at 7.30am and 8.20am

Subsequent to Mr Lawson’s death a Governors Order has been issued requiring welfare
checks to ascertain whether the prisoner was breathing or moving. The officers who
| gave evidence were uncertain about the details of the Order and its application on a

weekend.

Whilst in HMP Stocken Mr Lawson had had a number of epileptic attacks. On one
occasion in November 2012 the medical team had suggested he receive 24 hours of
constant watch. There had been no medically trained staff available to undertake this
during the night and it was done by prison staff. There was no policy in place to cover
this eventuality and no provision for an agency nurse or other medical staff to be brought
in on a one off basis.

Mr Lawson had received medical and mental health care whilst in HMP Stocken. The
difficulties faced by the medical and mental health staff arose out of Mr Lawson’s limited
intellectual ability, and that he was very variable as to whether he would take his
prescribed medication, particularly because he felt it was not helping him and had
undesirable side effects. It appears likely that he last took his anti-epileptic medication
on the Friday before his death on Sunday. His risk of having an epileptic attack and
death as a result was increased by his failure to take the medication regularly.

It was clear from the evidence that a number of members of the healthcare and mental
health staff had encouraged him to take his medication, and had taken individual steps
to persuade him: However despite the awareness of his frequent failure to take his
medication there was no plan, no focus on his compliance and what should be done
about it, and no cross team approach between the healthcare and mental health teams.

The distance from some of the wings in the prison to the healthcare centre varies but
some wings are 5 minutes’ walk away and the prisoners have to wait up to an hour.
Some prisoners cannot be bothered to wait. There has been some improvement since
Mr Lawson's death in that “healthcare hatches’ for the dispensing of medication have
been established on some but not all wings.

There were shortfalls in the prescription process where repeat prescriptions ended and
were not renewed, and prescriptions lapsed and no plan for review was in place to
consider whether the medication should be repeated, especially for antipsychotic
medication. There was no system in place either to identify when a prescription had
lapsed, or to take action following a prisoner’s regular non-attendance.

Changes to the systems have been made following Mr Lawson’s death. His non-
compliance with medication would now be recognised and escalated to a “Three
Pathways Meeting” which would consider ways to tackle non-compliance. However the
system still relies on staff recognising that a prisoner has not attended, and there was no
computer generated system to alert staff to continuous non-attendance. Similarly the
system still relies on staff seeing that prescriptions have lapsed, and that a review was
appropriate.

Mills & Reeve are solicitors to Nottinghamshire Healthcare NHS Trust. A letter from Mills
& Reeve dated 24 November 2014 is attached, which deals with the ability of the
computer system to flag up non-attendance and the imminent expiration of prescriptions.

CORONER’S CONCERNS

During the course of the inquest the evidence revealed matters giving rise to concern. In
my opinion there is a risk that future deaths will occur unless action is taken. In the
circumstances it is my statutory duty to report to you.

The MATTERS OF CONCERN are as follows:

1. The welfare check did not ascertain that he had died. He was certainly dead at
the time of the check at 7.30am and 8.20am on the 17'" March.

2. On some wings there is still some distance to walk to the medical centre and the
time to wait mitigates against prisoners bothering to do attend.

3. The current system relies on healthcare staff/pharmacy staff recognising that
prisoners have not attended to collect their prescription, without having a
computer driven system to flag up non-attendance.

4. The current system relies on healthcare staff/pharmacy staff recognising that
prescriptions have lapsed without having a computer driven system to flag it up.

5. There is no specific policy to deal with the situation where a prisoner needs 24
hour observation from medical staff where the prison is not equipped for
constant medical supervision.

ACTION SHOULD BE TAKEN

In my opinion action should be taken to prevent future deaths and | believe that the NHS
England and the Prison Service has the resources and power to:
1. Prepare the necessary policies and guidelines referred to, and ensure that they
are complied with, and
2. Consider alterations to the computer system that would flag up regular non-
attendance by prisoners and also the imminent expiration of prescriptions.

YOUR RESPONSE

You are under a duty to respond to this report within 56 days of the date of this report,
namely by 9" March 2015. |, the coroner, may extend the period.

Your response must contain details of action taken or proposed to be taken, setting out
the timetable for action. Otherwise you must explain why no action is proposed.

COPIES and PUBLICATION
| have sent a copy of my report to the Chief Coroner and to the following Interested

land her solicitors
Nottinghamshire Healthcare NHS Trust, and their solicitors
Northamptonshire Healthcare NHS Foundation Trust and their solicitors
The Treasury Solicitors on behalf of The Prison Service

| am also under a duty to send the Chief Coroner a copy of your response.

The Chief Coroner may publish either or both in a complete or redacted or summary
form. He may send a copy of this report to any person who he believes may find it useful
or of interest. You may make representations to me, the coroner, at the time of your
response, about the release or the publication of your response by the Chief Coroner.

9” January 2015 [SIGNED BY CORO Dp

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