Prevention of Future Deaths reports · 2021
Regulation 28 report to prevent future deaths, reference 2021-0315, written 17 Sep 2021. A coroner writes one of these when an inquest reveals a risk that could cause further deaths unless something changes.
| Date of report | 17 Sep 2021 |
|---|---|
| Reference | 2021-0315 |
| Deceased | Frankie Macritchie |
| Coroner | Andrew Cox |
| Coroner area | Cornwall and Isles of Scilly |
| Category | Child Death (from 2015) · Other related deaths · Police related deaths |
| Source | judiciary.uk record · original PDF |
| Responses published | 1 |
Text extracted from the PDF text layer. Reproduced verbatim, including the scan's own layout.
Information Classification: CONTROLLED REGULATION 28: REPORT TO PREVENT FUTURE DEATHS REGULATION 28 REPORT TO PREVENT FUTURE DEATHS THIS REPORT IS BEING SENT TO: The Dog Legislation Office, Devon and Cornwall Police Constabulary 1 CORONER I am Andrew Cox, HM Senior Coroner for the coroner area of Cornwall and the Isles of Scilly. 2 CORONER’S LEGAL POWERS 3 4 I 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 17/9/21, I concluded an inquest into the death of Frankie Gray Macritchie, who died at Caravan 72, Tencreek Holiday Park in West Looe on 13/4/19. Frankie was 9 years old. . The medical cause of death was recorded as: 1a) Exsanguination 1b) Multiple dog bites. I recorded a Narrative Conclusion that Frankie died from injuries inflicted in a dog attack. . , on holiday. They owned a 5-year-old male CIRCUMSTANCES OF THE DEATH Frankie had gone to the caravan park with his mother, had joined a lady called American bulldog crossed with a Staffordshire bull terrier kilogrammes. Frankie was left unsupervised with the dog in the early hours of 13 April by his mother. He was attacked by the dog and died from the injuries he suffered. Subsequent investigations by the police have revealed the dog was involved in two incidents in October 2016 and a further incident in August 2018 when a child was bitten. While both incidents in 2016 were reported to police, it is believed that the incident in 2018 was not. The obvious concern that came out of the inquest was that, had the incidents in 2016 being investigated differently, this tragic outcome could have been avoided. . it weighed 45 5 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. – - That reports of dog attacks are fully investigated and, where appropriate, a dog is euthanised to try and reduce the risks of further and more serious incidents. 1 Information Classification: CONTROLLED 6 ACTION SHOULD BE TAKEN In my opinion action should be taken to prevent future deaths and I believe you [AND/OR your organisation] have the power to take such action. You may wish to consider the extent to which the reported dog attacks in 2016 were investigated. You may wish to take steps to ensure there is now a robust process in place that means all reported dog attacks are appropriately investigated and dealt with. 7 YOUR RESPONSE You are under a duty to respond to this report within 56 days of the date of this report, namely by 14/11/21. I, 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. 8 COPIES and PUBLICATION I have sent a copy of my report to the Chief Coroner and to the following Interested Persons: [and to the LOCAL and SAFEGUARDING BOARD (as the deceased was under 18). , 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. 9 [DATE] 17/9/21 [SIGNED BY CORONER] 2
1 response published against this report on judiciary.uk. A response is a body's written reply to the coroner's concerns; publication is at the discretion of the Chief Coroner's office, so an absent response does not mean nobody replied.
Chief Constable
Police Headquarters, Middlemoor, Exeter, Devon , EX2 ?HQ
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Mr A Cox
Senior Coroner
Cornwall Coroners' Service
The New Lodge
Newq uay Road
Penmount
Truro
TR4 9AA
22 November 2021
Dear Mr Cox
INQUEST INTO THE DEATH OF FRANKIE MACRITCHIE: REPORT UNDER
REGULATION 28 OF THE CORONERS (INVESTIGATIONS) REGULATIONS 2013
I write in respect of the above-mentioned report of 17 September 2021 ("the
Regulation 28 report") that I have received from you .
Although the Regulation 28 report was addressed to our Dog Legislation Office
("DLO"), I have decided to respond to it myself given the nature of the concerns that
you have raised, notwithstanding that this response has been compiled in consultation
with the DLO .
Firstly, I would like to express condolences on behalf of myself and Devon and
Cornwall Police to the family and friends of Frankie.
Secondly, I thank you for sending a copy of the Regulation 28 report that was made
during the inquest into Frankie's death. As you would expect, I welcome any such
opportunities for Devon and Cornwall Police to consider whether there are any
improvements that can be made to how we work.
In the Regulation 28 report, you confirm that the matter of concern that you wish to
raise is one of whether dog attacks are fully investigated and , where appropriate, a
dog is euthanised to try and reduce the risks of further and more serious incidents
such as the tragic death of Frankie. You also suggest that consideration should be
given to:
• The extent to which reports of previous attacks by the dog
that
attacked Frankie were investigated.
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• Taking steps to ensure that there is now a robust process in place that means
all reported dog attacks are appropriately investigated and dealt with.
By way of context, in the first instance I will outline our general position in respect of
the investigation of reports to the police of an incident involving a potentially dangerous
dog .
Devon & Cornwall Police's investigation of dangerous dog matters
Reports to the police of an incident involving a potentially dangerous dog commonly
fall into the following categories:
• Dog attacks on people;
• Dog attacks on livestock;
• Dog attacks on other animals (for example: dog on dog fights, dogs chasing
cats etc); and
• Offences involving prohibited breeds.
The police response will typically vary depending on the type of report.
I only intend to give attention to the first category of allegation above in this response
as the others do not appear to be relevant for the purposes of the Regulation 28 report,
in that I am not aware that the police have ever received a report in relation to the dog
that attacked Frankie that would fall within the scope of the other three categories.
Where dog attacks on people are concerned, a dog causing an injury to a person while
dangerously out of control represents an offence under s.3 Dangerous Dogs Act 1991
("ODA").
The police response to an allegation of such an offence depends on the circumstances
of the individual matter; for example, the seriousness of the injury caused and any
previous offending history involving the dog in question .
Where an allegation is less serious in nature, and / or is the first allegation of a minor
s.3 ODA offence, a Dog Control Order ("DCO") can be given to the owner of the dog
in question by the police. A DCO is an agreement entered into by the owner of the dog
on a voluntary basis that is not legally-binding whereby they agree to keep the dog in
accordance with various requirements. Common examples of such requirements are
requiring the owner to ensure that the dog is muzzled and kept on a lead when in a
public place.
In the event of either a breach of a DCO, or more serious suspected s.3 ODA offences,
the following options are potentially available :
• An order that is similar to the DCO can be made by a court following a complaint
by the police under s.2 Dogs Act 1871 ("the 1871 Act") . A breach of such order
t Devon & Cornwall
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Chief Constable
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is not in itself a criminal offence; however, a breach of an order can be treated
as a contempt of court which is potentially punishable by a fine and / or prison
sentence. The order can also be made as a contingent destruction order
("COO"), i.e. the court can order that the dog be destroyed if the order is not
complied with. A prosecution does not need to have taken place for the court
to grant such an order.
• The court can also make an order for the destruction of the dog under s.2 of
the 1871 Act. Again, a prosecution does not need to have taken place for the
court to grant such an order. When making an order for destruction under the
1871 Act, the court can also potentially make an order banning the owner from
owning dogs in the future under supplementary provisions of the Dangerous
Dogs Act 1989 (rather than the similarly-named 1991 ODA) .
• The owner can be prosecuted under the ODA. This will typically be pursued
where the allegations of s.3 ODA offences are particularly serious and are
accompanied by evidence that makes out the offence to the criminal standard
of proof. In other cases, pursuing an order under the 1871 Act may well be more
appropriate as the court can make such an order on the basis of the civil
standard of proof. A prosecution under the ODA can result in one or more of a
fine, imprisonment, COO and / or destruction order being ordered by the court
as a part of their sentencing powers.
It is our experience that the court will only make an order for destruction in the most
serious of cases, and typically only where there is evidence of both significantly
irresponsible ownership and the dog itself posing a risk of harm .
The police do have powers under which a dog can be seized, and any decision to
seize is also made by reference to the individual circumstances of the matter in
question. An incident that is assessed as being more serious and / or one where the
public are believed to remain at a risk of harm from the dog is more likely to result in
a seizure. The welfare of the dog is also a potentially relevant factor.
A dog that is believed to be unregistered, i.e. not registered in accordance with the
appropriate government dangerous dogs regime and a prohibited breed, will be seized
regardless.
It is my experience that there is a perception that the police are readily able to seize a
dog that is believed to be dangerous and have it destroyed . In reality this is not the
case, as I have hopefully illustrated.
Previous incidents involving
As outlined above , the Regulation 28 report invites me to consider the extent to which
reports of previous attacks by the dog that attacked Frankie were investigated.
I have been made aware of two reports to the police that are believed to be in relation
to
, both having been received in October 2016 . These are as follows:
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Devon & Cornwall
Chief Constable
Police Headquarters, Middlemoor, Exeter, Devon , EX2 7HQ
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• A report of a dog that attempted to bite a member of the public. The subsequent
enquiries by the police also revealed further suggestions that the dog had been
intimidating residents local to where the dog lived, having not been kept under
control by its owner. The complainant in this matter also alleged that the dog
had previously barked and growled at her as she tried to leave her vehicle.
• A further report of a dog running loose in the road , in and out of traffic, and after
another dog .
Both reports are believed to be in relation to
indicates, we do not appear to have received any other reports in relation to
. As the Regulation 28 report
.
In relation to both incidents, enquiries were undertaken but ultimately the police were
had acted in a way that represented
unable to identify definitive evidence that
was given words of advice by the police
an offence; therefore, the owner of
about keeping the dog secure.
These incidents were concerning, notwithstanding that no physical injury to a person
or animal was alleged, with police taking action . I am nevertheless confident that,
between the seriousness of these allegations and the lack of evidence available to the
police, that a prosecution for a s.3 ODA would not have been possible, nor would have
an application for a destruction order (whether following a conviction for a s.3 ODA
offence or by complaint to the court under the 1871 Act) . In short, I am confident that
destroyed would have been unsuccessful.
any attempt by the police to have
It is arguable that the dog could have been seized by the officers dealing with these
incidents, but on the basis of the limited evidence available and that these incidents
(even considered collectively) were not among the more serious such reports that we
receive where dangerous dogs are concerned, I believe the decision to not seize
was legitimate.
It is also arguable that a DCO could have been made, or a similar order applied for
under s.2 of the 1871 Act, in response to these incidents, with a requirement that
be kept under proper control. I accept that these were options available to the
police to explore at the time.
I am however confident that the contents of any such order would not be able to extend
to requiring that
be kept in accordance with any requirements in a private
place. It is our experience that such an order will only be lawful if it is proportionate,
i.e., no more than is necessary to ensure that the dog in question is kept under control,
particularly where to go further could represent an interference with the owner's Article
8 rights under the Human Rights Act 1998. Notwithstanding that there was no definitive
posed a serious risk of injury to anyone available to the police,
evidence that
there was no evidence at all that he was out of control in a private place, i.e., where
he lived or was kept.
1/9:;.-: Devon & Cornwall
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Conclusion
Chief Constable
Pol ice Head quarters, Middlemoor, Exeter, Devon , EX2 ?HQ
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I understand fully why you have raised this matter under a Regulation 28 report based
upon the information available to you at that time, along with the terrible tragedy that
resulted in the death of Frankie.
In responding to your direction, undertakings by
operational and senior leaders including discussions with front line colleagues assures
me that Devon and Cornwall Police are dealing with reports appropriately where a dog
poses a risk of serious harm. On the basis of these enquiries, I am of the view that
we deal with such reports robustly. This includes having to defend our position through
the courts and the media.
The police can only successfully apply for the destruction of a dog in the most serious
of cases. Where Frankie's tragic death is concerned, I do not believe that the police
could realistically have taken any steps that would have had the direct result of
being destroyed or otherwise kept under proper control, while in a public
place.
As you would expect, correspondence from yourself is taken most seriously by me.
Whilst I am assured in regard to the specific questions you raise , I have nevertheless
taken this opportunity to give further consideration to how Devon and Cornwall Police
can improve our approach to the policing of dangerous dogs and potentially dangerous
dogs with the public. Whilst I am satisfied as to our procedures, I do perceive that the
public do not always contact us and we are not always consistent in making clear why
and how our decision making has taken place. I will explore with the Police and Crime
Commissioner the opportunities for enhanced public communication, potentially with
our farming community and Local Authority partners in respect of dangerous dogs.
Thank you again for your consideration and questioning of the force through the
Regulation 28 procedure and copying the report to me. I trust this response provides
you with the further information that you require . Please do contact me should you
wish for further clarification or information.
Chief Constable
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