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Report points to prison care lapses

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Lapses in clinical care may have led to at least four prisoners’ deaths from heart disease in the last four years, a watchdog has said.

Prison staff could respond better to almost one in two medical emergencies that lead to inmates dying from heart disease in jails, the Prisons and Probation Ombudsman said.

Delays in entering cells to provide treatment, further delays in calling ambulances and a shortage of staff with emergency first aid training contributed to the problem.

A greater focus on deaths from natural causes in prisons, more training for staff and a review of existing protocols between primary care trusts, prisons, and ambulance services were all needed, the watchdog said.

Acting prisons and probation ombudsman Jane Webb said: “A greater emphasis on medical emergencies and deaths from natural causes more broadly would be beneficial.”

The watchdog looked at 115 investigations into prisoner deaths from heart-related conditions between January 2007 and December last year.

Serious concerns over the clinical care provided to those diagnosed with heart disease or risk of its development were found in one in five cases, the report found.

Lapses in care may have led to death in at least two of these cases.

On one occasion there was a missed opportunity for a referral and in another case the emergency response was poor, the report found.

And of those who went undiagnosed, serious concerns were raised in more than one in four cases, with lapses in care in at least two cases that may have led to death.

Transfer to an outside hospital was not swift enough in these two cases.

In both groups “emergency response has emerged as a key issue, with serious concerns in this area being identified in seven cases in total”, the report said.

It acknowledged problems providing emergency care to those behind bars, including a prisoner’s reliance on staff to call an ambulance, security concerns over entering cells and “numerous locked gates” delaying healthcare staff and paramedics reaching a prisoner.

The report found almost half of those prisoners who died due to coronary heart disease or heart attacks had no diagnosis before their death.

The average age of inmates who died from heart-related conditions was 53, with three in 10 younger than 45, the report said.

Between 2007 and 2009, more than four in 10 deaths in prisons from natural causes were from circulatory diseases.

Nearly half of the 115 deaths (44%) occurred in category B or C training prisons for sentenced prisoners, 36% in local category B prisons that serve the courts and 12% in high-security prisons.

But almost 3 per cent of the deaths occurred in young offender institutions, with 5 per cent in category D prisons with open conditions.

A government spokesman said: “The Ministry of Justice and Department of Health welcome this report.

“In response to the report, we will reissue joint guidance to ensure that access to prisons for ambulances is not unnecessarily delayed.”

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