Published in Police Magazine
© The Police Federation of England & Wales
July, 2000 issue.
The Home Office Police Research Group paper Deaths in Police Custody Learning the Lessons defines three causative groups self-harm, illness and/or injury, and deaths where the action of others may have been contributory. Of 275 deaths occurring between January 1990 and December 1996, 172 were due to the deceased's own actions, suicides and alcohol abuse being prominent; 81 were due to the deceased's medical condition, but in 22 cases actions by the police, medical services or others may have been associated.
Self-harm may be minimized by use of forms that help police identify vulnerable prisoners; by the removal of objects in cells that could be used as hooks for self-suspension and by closed-circuit TV. A trial is in progress of a built-in microwave-powered device which alerts custodians to the absence of respiratory movement by cell occupants in 12 seconds. Prison doctors are trained to recognize suicidal tendencies. A safe defibrillator, designed for non-medical personnel, is available for use in custody suites and prisons.
Alcohol and substance abuse accounted for 69 deaths. In 1979 the Association of Police Surgeons recommended to the Home Affairs Committee investigating deaths in custody that non-violent drunks should be diverted into drying out centers, staffed by personnel trained to care for those with impaired consciousness and equipped to carry out full-scale resuscitation. This recommendation was accepted and subsequently endorsed by the BMA and others, but nothing was done. At a conference organized in November 1998 by the Police Complaints Authority, the call for such centers was renewed, as it was at a Royal Society of Medicine symposium on 21-22 September, but drunks and addicts continue to die in police cells, and police are blamed. The fault is the failure of governments to implement a recommendation which could reduce deaths in custody by some 25%.
At the RSM meeting Dr John Gosnold suggested secure wards in district hospitals and a more active forensic role for accident and emergency doctors. This proposal has intrinsic value and might well be a source of additional income for the NHS.
Customs and Excise have difficulties with couriers who swallow or stuff themselves with illicit drugs. A urine test which is able to detect even minute osmosis from the packets could save lives, but they have no powers to conduct the test without the courier's consent. Gross leakage from the packets is likely to be fatal. Karch and Stephens have shown that even small amounts of cocaine may induce the condition of 'excited delirium'. In this condition individuals become overheated and psychotic, typically stripping off clothes, becoming violent and requiring restraint, after which they succumb. The blame falls on police who apply the restraint. Recovery, even before restraint, is virtually unknown, and this fact must be widely disseminated to all involved in the investigation of these deaths.
Some deaths due to illness in custody are unavoidable. Police need to be trained to recognize early warning signs indicating the need for urgent professional help. The Audit Commission recommended joint training with police surgeons, which is being developed. Standards of care delivered by police surgeons have been improved by the imposition of mandatory ongoing training; the Metropolitan Police requires its doctors to acquire the DMJ(Clin). Custodial medical care is expensive so there is a tendency to outsource this function to commercial organizations. It will be a tragedy if this lowers standards of care and increases mortality and morbidity; the figures must be closely monitored. Most sensitive is the Police Research Group's third category, where police action may be causative of the death. Certain methods of restraint have been discredited, particularly neck holds and prone restraint resulting in 'positional asphyxia'. The dangers of CS gas and various baton injuries are emphasized in training.
Where a death in custody has occurred, the investigation must be transparent, the family of the deceased being privy to the results. Their anxiety and distress must be acknowledged, for failure to respect this leads to bitterness, suspicion and destructive hostility. Deaths of black people have had a high profile, especially when preceded by a violent struggle or physical restraint by police. In the years 1995-1998m 14% of people dying in police custody were from ethnic minorities, made up of 8% black, 3% Asian and 3% other. Of the 65 deaths in police custody in 1998-1999, a 41% rise in fatalities over the last four years, 12 were from ethnic minorities, 18.5% of the total, a cause for increasing concern. All the disciplines involved in the criminal justice system must be concentrated to reverse these upward trends.
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