Prevention of Future Deaths reports · 2017
Regulation 28 report to prevent future deaths, reference 2017-0092, written 23 Mar 2017. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.
| Date of report | 23 Mar 2017 |
|---|---|
| Reference | 2017-0092 |
| Deceased | Antony Abbott |
| Coroner | Jennifer Leeming |
| Coroner area | Manchester (West) |
| Category | Other related deaths |
| Source | judiciary.uk record · original PDF |
| Responses published | none published |
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 (1)
NOTE: This form is to be used after an Inquest.
REGULATION 28 REPORT TO PREVENT FUTURE DEATHS
THIS REPORT IS BEING SENT TO:
1. The Right Honourable Boris Johnson P.C. M.P., Secretary of State for
Foreign and Commonwealth Affairs, House of Commons, London SW1A OAA
CORONER
I am M Jennifer Leeming, Senior Coroner for the Coroner Area of Manchester
West.
CORONER'S LEGAL POWERS
T 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 the 9" November 2015 I commenced an investigation into the death of
Antony Miles Abbott, aged 36 years born the 25” September 1979. The
investigation concluded at the end of the Inquest on the 16" March 2017.
The conclusion of the Jury at the Inquest was that Antony Miles Abbott had died
of:-
la Hanging
The Jury further recorded the following conclusion:-
Misadventure
Antony's death was contributed to by neglect. The failure to implement the
recommendations of the May 2015 report on the Benidorm Police Station
Custody Office was a significant factor in Antony’s death.
CIRCUMSTANCES OF THE DEATH
The jury found that Antony was arrested on the 23” October 2015 and taken to
Benidorm Police Station, Benidorm, Spain where he was placed in a cell. Antony
was observed following being placed in the cell for a period of 18 minutes.
Antony was found with a soft loose ligature around his neck which was tied to
the cell door. There was no CCTV Surveillance either directly within the cell or
to the end of the corridor where the cell was located. There was also no
audible means of attracting attention for example a buzzer within the cell.
There was no observed officer presence for a period of 18 minutes as verified
by the CCTV footage.
COPIES and PUBLICATION
I have sent a copy of my report to the Chief Coroner and to the following
Interested Persons:-
2. (Antony's Father), [ii
Fe
I 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.
| Dated Signed
{7 a’
23" March, 2017 M Jennifef Leeming, HM Senior Coro
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