SaulAlexanderALTALv053FCompleteBundle (1) (5) There is sufficient evidence to justify a prosecution.

Bundle prepared at uk.caselines.com

Index

A: Coroner's Documents

Page Document Date

A1 - A7 Dr R Chapman - PM Report 07

September

2020

A8 - A11 S Turner - Toxicology Report 07

September

2020

A12 - A21 SECAmb - Electronic Patient Records 07

September

2020

B: HMP Downview

C: CNWL

Page Document Date

C1 - C216 SystmOne Records 08

September

2020

D: PPO

Page Document Date

D1 - D21 PPO Report - Clincial Review 07

September

2020

D22 - D38 PPO Report - Report 07

September

2020

D39 - D46 Transcript of Interview - Gary Stevens 07

September

2020

D47 - D54 Transcript of Interview - Jason Willis 07

September

2020

D55 - D56 Note of Interview - Francois Victoire 07

September

2020

D57 - D58 Note of Interview - Kerry Martin 07

September

2020

D59 Note of Interview - Jack Ripley 08

September

2020

D60 - D61 Note of Interview - Tommy Gurney 07

September

2020

E: Surrey Police

Page Document Date

E1 - E2 Statement - Anna Bakht 07

September

2020

E3 - E5 Statement - Helen Bedford 07

September

2020

E6 - E8 Statement - Sarah Henderson 07

September

2020

E9 Statement - Christopher Sailes 07

September

2020

E10 - E11 Statement - Claire Franklin 07

September

2020

E12 - E13 Statement - Dorian Rodger 07

September

2020

E14 - E17 Statement - Gary Stevens 07

September

2020

E18 - E20 Statement - Jason Willis 07

September

2020

E21 - E23 Statement - Jessica Gardener 07

September

2020

E24 - E27 Statement - Ross Rigby 07

September

2020

E28 - E29 Statement - Simon Triptree 07

September

2020

E30 - E31 Statement - Sophie Marshall 07

September

2020

E32 - E39 SPR PHOTO 01 – photos of cell and deceased 07

September

2020

E40 - E64 Surrey Police - ICAD 07

September

2020

E65 Turner medical notes 1 07

September

2020


September

2020


September

2020

E68 - E92 Turner medical Patient Summary 07

September

2020

5ef82dece5334fb699030dea72a857d45ef82dece5334fb699030dea72a857d4-1

A1

Dr. R.C. Chapman MB ChB FRCPath DMJ(Path) FFFLM

Statement of

STATEMENT OF WITNESS

(Section 9 Criminal Justice Act 1967 and Rule 16.2 Criminal Procedure Rules)

Age of Witness Over 18

Occupation of Witness

Address

Robert Charles Chapman

MB ChB ,FRCPath, DMJPath, FFFLM

Consultant Forensic Pathologist

Forensic Pathology Services

Aspect House, Grove Business Park,

Wantage, Oxfordshire OX12 9FA

FPS

Forensic Pathology Services

Aspect House

Grove Business Park

Wantage

Oxfordshire

OX12 9FA

Tel: 01235 773332

Fax: 01235 773330

O Biedrzycki

N R B Cary

R C Chapman

A W Fegan-Earl

A J Kolar

S M Poole

B Swift

Consultant: M P Cieka

Consultant: V Fitzpatrick-Swallow

Consultant: B Lockyer

Consultant: M S Lyall

Consultant: C Randall

This statement, consisting of 7 pages signed by me, is true to the best of my knowledge

and belief and I make it knowing that, if it is tendered in evidence, I shall be liable to

prosecution if I have wilfully stated in it anything which I know to be false or do not believe

to be true.

Qualifications and Experience

Dated: 4 th June 2020

Signed …………………………..

Signature witnessed by ………………………………

I hold the degrees of Bachelor of Medicine and Bachelor of Surgery. I am a Fellow of the

Royal College of Pathologists and I hold the qualification of Diploma in Medical

Jurisprudence in Pathology. I am a Fellow of the Faculty of Legal and Forensic Medicine.

I have been a Forensic Pathologist since 1988, previously holding Senior Lecturer and

Consultant posts in teaching hospitals within London. I currently practise as a full-time

Consultant Forensic Pathologist within a practice of 7 partners. My ongoing experience

includes the full range of general forensic pathology and the investigation of sudden and

suspicious deaths on behalf of the Coroners and Police Services of the London and Home

Counties regions. I teach both senior and junior police officers and forensic scientists

regarding scene examination and about forensic pathology in broad terms. I participate

in seminars associated with my specialty. I maintain membership of various learned

societies including the British Association in Forensic Medicine, the Forensic Science

Society and the Royal Society of Medicine.

A1

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A2

20-S-0082 Saul Alexander Altal (Prev TURNER Saul)

Page 2 of 7

Declaration

I understand that I owe an overriding duty to the Court to provide independent assistance,

to the Court, by way of unbiased opinion in relation to the matters within my expertise and

that such advice must be uninfluenced by the exigencies of the case. I have complied

with, and will continue to comply with, my duty to the Court.

I confirm that I have read guidance contained in a booklet known as Disclosure: Expert's

evidence and unused material which details my role and documents my responsibilities,

in relation to revelation as an expert witness. I have followed the guidance and recognise

the continuing nature of my responsibilities of revelation. In accordance with my duties of

revelation, as documented in the guidance booklet, I:-

a. confirm that I have complied with my duties to record, retain and reveal material

in accordance with the Criminal Procedure and Investigations Act 1996, as

amended;

b. have compiled an Index of all material. I will ensure that the Index is updated

in the event I am provided with or generate additional material;

c. that in the event my opinion changes on any material issue, I will inform the

investigating officer, as soon as reasonably practicable and give reasons.

POST MORTEM REPORT

20-S-0082/RC.jf 4 th June 2020

On 11 th February 2020 I attended the Mortuary of the Royal Surrey County Hospital,

Guildford, where I was briefed concerning the death of:

Saul Alexander ALTAL (Prev. TURNER Saul) – Age 36 years

Date of Birth: 08/12/1983

CIRCUMSTANCES

Prior to my examination I received a Coroner’s Officer’s history and a briefing from

Officers present. This was preliminary information and may therefore be incomplete or

contain errors.

It is understood this man died on 6 th February 2020 at 09.35 hours. He was a prisoner at

High Down Prison. It is understood that he had been found in the top bunk of a shared

cell. The covers were up around his body and head and his head had been turned to the

Signature………………………………………Signature of Witness………………………….

A2

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Page 3 of 7

right. He had been in the cell for approximately 16 hours with a new cell mate. According

to the cell mate he had been retching. There was no disturbance of the cell to suggest a

fight. A PC observed apparent discoloration around the neck a burst blood vessel in the

eye. SOCO attended and his neck, face and finger nails were swabbed at the scene and

his clothing obtained.

It is believed he had been at the prison since 8 th January. He had been in healthcare for

the previous two weeks for assessment and poor mood. He had been transferred out of

healthcare on 5 th February 2020 and moved to the current cell house block. He had been

in the cell overnight until being found unresponsive by prisoners and staff. He had been

discharged from the healthcare with no issues raised.

POST MORTEM EXAMINATION

Those present at the examination included:

Darren Kirby

DS Holly Say

Rachel Graham

Gemma Rance

Keeley Harvey

Coroner’s Officer

Senior SOCO

SOCO

SOCO

My examination commenced at 11.20 hours.

Receipt of body:

EXTERNAL EXAMINATION

The body was received within a body bag, sealed with a tag RA/13 and label reading,

‘BELIEVED SAUL TURNER 8/12/83’.

There were the following further external observations:

The body was that of an adult male, 170cm (approximately 5ft 7in) in height and 71kg

(approximately 11st 3lb) in weight. He was clad only in boxer shorts. The body surface

appeared clean with no signs of contamination.

There were defibrillator pads on the trunk, in the right upper chest and left lateral chest

positions. There were ECG pads on his shins x 2.

The head hair was brown with areas of greying, approximately 4cm in length. The eyes

were unremarkable and no petechiae or other haemorrhages were seen within the

conjunctivae of the eye lids or sclerae. There were no petechiae in the face or neck.


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Page 4 of 7

There was a tattoo reading ‘MOTHER’ on the left upper chest and of ‘ELLA’ on the right

forearm.

The finger nails had been recently trimmed and were approximately 1mm in length at their

free margins. They appeared clean.

The anus appeared slightly dilated but there was no evidence of injury and no drugs or

packages were concealed.

There were the following post mortem changes:

There was hypostasis on the back of the body. The body was in full rigor mortis. There

was early decomposition with greening discoloration of the abdominal wall.

There were the following marks of injury:

There were no external marks of injury.

There were the following older features:

There was an old linear scar to the back of the left calf.

Head & Neck

INTERNAL EXAMINATION

Reflection of the scalp revealed no evidence of bruising or other injury. The skull was

intact. The brain coverings were healthy. The brain was of normal external appearances.

No evidence of intracranial bleeding was seen. Serial coronal sections of the brain

showed no evidence of focal natural disease or injury. Cerebral blood vessels were of

normal distribution and appeared healthy.

The facial soft tissues were dissected. There was no deep bruising or bony injury.

The lips were healthy. The dentition was natural and undamaged. There was no bruising

to the tongue.

The neck structures were dissected in layers following removal of cranial and thoracic

contents. The soft tissues showed no evidence of bruising or other injury. The hyoid

bone and laryngeal cartilages were intact. The vessels of the neck were healthy.

Trunk

There was no bruising to the anterior or lateral chest walls. The ribs and sternum were

intact. The pleural linings of the chest were unremarkable. The lungs appeared


A4

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Page 5 of 7

congested and oedematous. Some froth material was present in the trachea and bronchi.

The coronary vessels were clear.

The pericardium was healthy. The heart was of normal overall size and weight. Left

ventricular wall thickness measured 1.1cm; the right ventricular wall thickness 0.4cm.

The atria and ventricles were of normal configuration. The heart valves were of normal

size and appearance. The coronary arteries were of normal anatomical course. The

proximal part of the left anterior descending branch of the left coronary artery showed pinpoint

occlusion by firm atheroma. There was a possible thrombus (histology) within the

remaining lumen of this vessel. The circumflex branch of the left coronary artery and the

right coronary artery were fully patent throughout. The myocardium of the left and right

ventricles appeared healthy. The aorta was healthy and free of atheroma.

Abdomen

The oesophageal lining was normal. The stomach contained a quantity of rice and fluid

material. The small and large bowels were unremarkable. The peritoneal cavity was

moist.

The liver was of normal size and appearance. The gall bladder was healthy. The

pancreas was unremarkable.

The spleen was large and firm. There was no lymphadenopathy.

The kidneys were of normal size. Capsules stripped readily. Good cortical width present.

Ureters healthy. The bladder contained approximately 30ml of clear urine.

The prostate gland appeared normal. The testes showed no evidence of injury or natural

disease.

The adrenal glands appeared healthy.

The following organ weights were obtained:

Brain: 1325g Liver: 1831g

Heart : 323g Spleen: 329g

Right Lung: 897g Right Kidney: 185g

Left Lung: 789g Left Kidney: 162g

Exhibits:

My examination was completed at 12.20 hours when the following exhibits were handed

to the exhibits officer:


A5

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Page 6 of 7

RCC/1

RCC/2

RCC/3

RCC/4

RCC/5

RCC/6

RCC/7

RCC/8

RCC/9

Blue boxer shorts

Head hair toxicology

Vitreous humour

Blood for toxicology

Blood for toxicology

Urine

Stomach contents

Histology

Deep muscle tissue

Further investigations:

Toxicology:

I have seen a streamlined forensic toxicology report by Andrew Christopher Love. Post

mortem blood was analysed, and the substances 5F-MDMB-PICA and 5F-MDMB-PICArelated

substance were detected. Mirtazapine was also detected. There were no other

significant findings. In the urine, alcohol was detected at a concentration of 13mg per

100ml.

The toxicologist indicated that:

“The results showed that Mr ALTAL had used the synthetic cannabinoid 5F-MDMB-PICA

which belongs to a group of substances more commonly referred to as ‘Spice’ or ‘Mamba’.

It was not possible to say how much of the drug had been used or precisely when, but

the results could reflect relatively recent use and he may have been experiencing the

effects associated with this drug at the time of his death.” There is limited published

scientific information on the effects of this drug. Synthetic cannabinoids may be more

potent than herbal cannabis and effects include increased heart rate, vomiting,

breathlessness, agitation, convulsions, hallucinations and, in some instances, death. The

substance has become one of the more frequently reported synthetic cannabinoids and

has featured in clinical hospital admissions and in fatalities. The substance related to it

was probably a metabolite also detected in the blood. The drug Mirtazapine is an antidepressant

drug. Its concentration was not accurately measured but it appeared broadly

consistent with therapeutic use. Mr ALTAL was not under the influence of alcohol at the

time of his death. The alcohol in the urine may be residue of alcohol consumed at an

earlier time or it may have been produced post mortem.

Histology:

Eleven blocks of the major organs were retained for histological study. A section from

the proximal segment of the left anterior descending branch of the left coronary artery

shows an eccentric atheromatous plaque with virtual complete obliteration of the

remaining lumen by a recent thrombus. Sections of the myocardium showed no evidence

of established myocardial infarction or other pathology. Sections of lung showed marked

pigmented macrophages and patchy oedema. Sections of kidney and liver appeared

normal.


A6

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Page 7 of 7

CONCLUSIONS

1. Saul ALTAL was a 36-year-old man who was suffering with significant natural

disease. He had suffered a recent coronary artery thrombosis in one of the three

major epicardial vessels of his heart and this appeared to be the probable

mechanism of his death.

2. Toxicology analysis revealed the presence of the drug 5F-MDMB-PICA (“Spice”),

a synthetic cannabinoid, which has been associated with hospital admissions and

fatalities. Whilst there is limited information on the toxic effects of this drug, related

synthetic cannabinoids are associated with cardiac toxicity, hypertension,

arrhythmias and myocardial infarction. It appears likely that in this case, the

presence of the Spice had played a part in death by increasing heart rate and

myocardial ischaemia in a man with underlying coronary heart disease, and

increasing the risk of the development of a fatal arrhythmia in the presence of a

coronary artery thrombus.

3. I give as the cause of death:

1a

1b

Coronary Artery Thrombosis

Coronary Atheroma

2 5F-MDMB-PICA (Spice) Toxicity

Dr R C Chapman MB ChB, FRCPath, DMJ(Path), FFFLM

Home Office Registered Consultant Forensic Pathologist


A7

OFFICIAL (when complete)

fb1440975a9c4c76abd6525fbca67cb9fb1440975a9c4c76abd6525fbca67cb9-1

Streamlined Forensic Toxicology Report

SFR Stage 1 Forensic Result

Barcode

Relates to Saul TURNER Ref No:

Location / Venue

Date of Offence Found dead on 06/02/2020

Crime No: 45200014974

Custody / URN

Forensic Case

Ref:

Forensic Lab

Ref:

Scientist Andrew Christopher Love Report No: 01 Other Ref:

Case management - To the court and to the defence:

MG22 (b) SFR1

Page 1 of 4

20/01361/1

EFS-20043321-

CTOX-01

The prosecution propose to rely on the forensic evidence contained in this SFR and if there is a trial, to adduce it by way of a s10

CJA 1967 admission to the general effect that the exhibit(s) listed were forensically examined and the examination produced the

result(s) described. Therefore should there be a real issue in relation to the forensic evidence below, such that the admission cannot

be made, the prosecution ask that the defence identify the issue (Crim.PR.3.3 and Crim.PR 19.3(2)).

If this report contains expert evidence, then, in accordance with CPR 19.3(2), the defence is required to serve a response to this

report as soon as practicable, and in any event not more than 14 days after service of the report setting out which, if any of the

conclusions in this report are admitted as fact, and where a conclusion is not admitted what are the disputed issues concerning that

conclusion.

This SFR is not a witness statement to which the provisions of s9 CJA 1967 and Crim.PR 16 apply, nor is it an expert's report to

which the provisions of Crim. PR 19.4 apply, its purpose being to introduce any expert evidence contained therein as admitted fact. If

this SFR contains expert opinion, it is a summary of that opinion served pursuant to Crim. PR 19.3(1)

SFRs assist courts to fulfil their duty to actively manage the case (Crim.PR 3.1) by ensuring that evidence is presented in the shortest

and clearest way and by facilitating the early identification of the real issues. (Crim.PR 3.2). Each party must actively assist the court

in fulfilling its duty (Crim.PR 3.3).

Summary of Forensic Evidence: This report relates to the analysis of the submitted items for the presence of alcohol,

certain medication and a range of commonly abused drugs, including New Psychoactive Substances (NPS) and

synthetic cannabinoids, in order to determine whether or not any such substance played a role in the death of

Mr TURNER.

A8

Exhibit(s) Examined

RCC/4

PRESERVED BLOOD (taken at the postmortem

examination on 11/02/2020)

Results / Findings

The following substances were detected in the blood:

5F-MDMB-PICA

Detected

5F-MDMB-PICA-related substance Detected

Mirtazapine

Detected

No alcohol and none of the other substances listed under ‘Evidence Type /

Supporting Technical Information’ were detected in the blood.

RCC/6

URINE (taken at the post-mortem

examination on 11/02/2020)

Alcohol was detected in the urine at a concentration of 13 milligrams per

100 millilitres (mg%)

CONCLUSIONS:

1. The results show Mr TURNER had used the synthetic cannabinoid, 5F-MDMB-PICA which belongs to a group

of substances more commonly referred to as ‘Spice’ or ‘MAMBA’. I am unable to say how much of this drug

had been used, or precisely when it was used, but the results could reflect relatively recent use and if this were

the case he may have been experiencing effects associated with 5F-MDMB-PICA at the time of his death.

There is limited published scientific information on the effects of 5F-MDMB-PICA but it has generally been

reported that synthetic cannabinoids may be more potent than herbal cannabis and effects include increased

heart rate, vomiting, breathlessness, agitation, convulsions, hallucinations and in some instances death.

5F-MDMB-PICA is one of the more frequently reported synthetic cannabinoids to have more recently emerged

12/2015 OFFICIAL (when complete)

A8

fb1440975a9c4c76abd6525fbca67cb9-2



MG22 (b) SFR1

Page 2 of 4

and has featured in fatalities and clinical admissions. A substance related to 5F-MDMB-PICA, most likely a

metabolite, was also detected in the blood.

2. Mirtazapine is an antidepressant drug prescribed in the treatment of major depression. Reported side effects

include dry mouth, drowsiness and dizziness. Although the concentration of mirtazapine was not accurately

measured it appeared broadly consistent with therapeutic use and I am informed that Mr TURNER was

prescribed this medicine.

3. No alcohol was detected in the blood and therefore Mr TURNER was not under the influence of alcohol at the

time of his death. A very low concentration of alcohol was detected in the urine and may be the residue of

alcohol consumed at an earlier time. Alternatively alcohol may also be produced post-mortem by

microbiological action and this could be the source for the alcohol detected.

4. None of the other substances listed under ‘Evidence Type / Supporting Technical Information’ were detected

and their involvement in the death of Mr TURNER can be ruled out.

The above conclusions are a summary of the findings and a brief interpretation. Further details and/or

interpretation can be provided upon request.

Evidence Type / Supporting Technical Information:

These results are assumed to reflect the situation at the time Mr TURNER died, notwithstanding any post-mortem

changes.

The preserved blood and the urine were both analysed for the presence of alcohol (this test may also detect other

volatile substances).

The preserved blood was analysed for the presence of the following range of drugs of abuse and medicines:

Amphetamine and methylamphetamine related substances (amphetamine, ephedrine/pseudoephedrine,

methylamphetamine, methylenedioxyamphetamine (MDA), methylenedioxymethamphetamine (MDMA, "Ecstasy"),

para-methoxyamphetamine (PMA), para-methoxymethamphetamine (PMMA)); piperazines (benzylpiperazine (BZP),

chlorophenylpiperazine (CPP), trifluoromethylphenylpiperazine (TFMPP)); cathinone and related substances (butylone,

mephedrone, methylenedioxypyrovalerone (MDPV), methylethcathinone, methylone, naphyrone, pentylone); cocaine;

cannabis (herbal/resin); ketamine; opiate/opioid analgesics (buprenorphine, codeine, dextropropoxyphene,

dihydrocodeine, fentanyl, heroin, methadone, morphine, oxycodone, oxymorphone, pethidine, pholcodine, tramadol);

benzodiazepine drugs (alprazolam, chlordiazepoxide, clonazepam, diazepam, flunitrazepam, lorazepam, midazolam,

nitrazepam, oxazepam, phenazepam, temazepam); sedative hypnotics (zaleplon, zolpidem, zopiclone);

antidepressants (amitriptyline, citalopram, desipramine, dosulepin, duloxetine, fluoxetine, fluvoxamine, imipramine,

mirtazapine, nortriptyline, paroxetine, sertraline, trazodone, venlafaxine); antipsychotics (chlorpromazine, clozapine,

olanzapine, quetiapine); antihistamines (chlorphenamine, cyclizine, diphenhydramine, hydroxyzine, promethazine);

antihypertensives (atenolol, propranolol); anticonvulsant (lamotrigine); procyclidine. The preserved blood was also

screened for the following chemically ‘acidic’ drugs (diclofenac, furosemide, ibuprofen, naproxen, paracetamol, salicylic

acid (the major metabolite of aspirin), and warfarin).

An aliquot of the preserved blood sample was sent to LGC Limited and analysed using liquid chromatography-high

resolution accurate mass spectrometry (LC-HRAM) which can detect several hundred substances and many new

psychoactive substances (NPS), including fentanyl derivatives and synthetic cannabinoids.

The analysis includes those substances listed in the relevant panels within the Police Contracts. This is not exhaustive

and tests for other substances can be undertaken if required.

General toxicology technical information is available from the Forensic Service Provider

Report provided

by

Role/Registration

No:

Andrew Christopher Love Provider/Force/Unit Eurofins Forensic Services

Toxicologist

Important CPS:

Where real issue(s) are identified and if additional forensic

work is necessary, please notify the agreed Force contact

in writing, listing the issue(s) to be further addressed.

Date of

Report

Forensic

Contact

Details

02/04/2020

The Police Criminal Justice Unit

A9

A9



Police / Courts

Further work will normally take 28 working days to produce from receipt of request.

MG22 (b) SFR1

A10

Page 3 of 4


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MG22 (b) SFR1

A11

Page 4 of 4

Streamlined Forensic Toxicology Report

SFR Stage 1 Forensic Result

Barcode

STATUS OF TOXICOLOGY RELATED EXHIBITS

Relates to Saul TURNER Ref No:

Location / Venue

Date of Offence Found dead on 06/02/2020

Crime No: 45200014974

Scientist

Andrew Christopher Love

Report

No:

Custody / URN

Forensic Case

Ref:

Forensic Lab

Ref:

01 Other Ref:

20/01361/1

EFS-20043321-

CTOX-01

Additional information / Evidence Type Technical Information:

NB: No further examinations will be carried out unless specifically required.

Please note that items received as part of this submission will be destroyed, retained or returned as stipulated by the

submitting force protocol.

Please note these exhibits relate only to other Toxicology exhibits submitted for analysis at the same time as those

shown in the SFR results and findings set out on Page 1

The prosecution will not ordinarily undertake further forensic analysis unless and until the exact issue that such

analysis needs to address has been identified; and only if, in light of that issue, it is appropriate that the next stage of

analysis should be undertaken by a prosecution rather than a defence expert. If appropriate a direction under CrimPR

3.5(2)(h) as to the order in which the expert issues should be determined may be sought.

Exhibits

RCC/3 VITREOUS HUMOUR

Status

Not analysed

NB: - The scientist does not accept responsibility for the sensitivity or otherwise of this material.


A11

2/10/2020 ePCR Full Case Summary

479a5dbb2c39468eacd7a67103f4d0bf479a5dbb2c39468eacd7a67103f4d0bf-1

ePCR Full Case Summary

Included In Case Data

Consent and

Capacity Primary Survey Observations

Incidentd

one Patient Event History

come

Clinical

Outcome

Secondary

Drugs

Impressions

Survey

Interventions Administered

Indicators Disposition/Out

Incident

Crew

Clinician 1 Clinician 2 Clinician 3 Clinician 4

Name H. Bedford

S. Henderson

ID 24112536 27268565 - -

- -

Emergency Care Support

Worker

Role Paramedic

Incident Details

Hmp Highdown

Prison

Vehicle ID 255 Location

K6AK34NR1097

(1097)

Male/36 YEARS

Case Label

Case Reference K6AK34NR1097 CAD Call Sign 255 Road Highdown Lane

CAD Daily ID 1097 Alerts - District -

- Town Sutton

Post-Dispatch

Instructions

CAD ID 34341771

Handover PIN 2691 Priority C1 Postcode SM2 5PJ

A12

02086427702

Scene Contact

Number

Type - Reported Condition Cardiac Arrest

A12

https://epcronline.secamb.nhs.uk/frmCaseSummaryFull.aspx?id=191225&guid=CF52DB32-26FA-4268-82E2-9B6E5681D99C&ro=-1&vehicletimings=0 1/10


479a5dbb2c39468eacd7a67103f4d0bf-2

Incident Timings

-

Verbal

Handover

Leave Scene -

At Scene

09:10:00 06-

FEBRUARY-

Call Time

-

Hospital

Handover

At Destination -

2020

09:27:00 06-

FEBRUARY-

2020

At Patient

09:22:56 6-

FEBRUARY-

2020

09:10:23 6-

FEBRUARY-

2020

09:10:32 6-

FEBRUARY-

2020

Assigned

13:20:08 6-

FEBRUARY-

2020

- End Treatment - Clear

Start

Treatment

Mobile

Incident Notes

Onsite paramedic

Patient Details

ALLERGIES

NO KNOWN DRUG ALLERGIES

(NKDA)

Patient Details

Hmp Highdown

Prison

Title - Gender Identity Male Location

Forename Saul Telephone Number - Road Highdown Lane

Surname Turner Date of Birth 08-DECEMBER-1983 Town Sutton

NHS Number - Age 36 YEARS Postcode SM2 5PJ

A13

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Medical History

Risk Factors

ALCOHOL, DRUGS,

SMOKING

Family History

-

Medical Conditions/PMHx

Alcohol dependence

Chronic depression

Suicidal thoughts

Deliberate self harm

Recreational drug use

Medication

MIRTAZAPINE

PARACETAMOL

Allergies

NO KNOWN DRUG

ALLERGIES

(NKDA)

Social History

Home Circumstances - Mobility - Religious A iation -

Needs - Employment - Ethnicity WHITE BRITISH

Support - Marital Status - Interpreter Required -

Package of Care/Level

of Support

- Sexual Orientation - Language -

Disability -

Persons With Patient

Building Road District Town Postcode Phone Language Interpreter

Relationshi

p

Title Forename Surname

020 8642

7702

Staff At

Location

MOJ

Anna Bakht

Next of Kin

Building Road District Town Postcode Phone Language Interpreter

Relationshi

p

Title Forename Surname

Cheryl PARTNER

Patient Details Notes

A14

Pt under GP's covering HMP highdown, no other NOK details known or given. Pt did have an 'act' in situ, providing mental health support, was

discharged from act 1/52 ago, by psychiatric doctor.

A14




Event History

Symptom Onset

Approximate

Time - Onset Time -

Cardiac arrest

Presenting

Complaint

Last Oral Intake -

pt found in bed on top bunk Under blanket, holding

blanket with both hands arms over torso, hands by

neck,lying supine. Cell mate left cell between 8.00 and

09.00, 08.55 2 x other prisoners, went in to cell and

found pt, noti ed o cers, code blue put out on prison

site at 09.09, prison guards moved pt on mattress from

top bunk to oor beside bunk beds in cell, nurse arrived

09.12, CPR started, and de b attached, on site

paramedic arrived at 09.15, decision to stop CPR made,

due to presence of hypostasis and rigor mortis, decision

con rmed with Highdown GP on site @ 09.18.

History of

Presenting

Complaint

Consent and Capacity

Consent

Yes

Share

Functional

Information - Impairment

Given No Treatment -

Mental Capacity

Patient given su cient appropriate information No Reasoning Patient deceased

Patient able to understand given information No Reasoning -

Patient able to have rational conversation including

No the pros and cons

Reasoning -

Patient able to retain information long enough to

No make a decision

Reasoning -

Patient is able to explain their decision using their

No own words

Reasoning -

Advanced statement present No

Advanced decision present No

Legal power of attorney in health/deputy present No

Safe to wait for capacity to return No Reasoning -

A15

A15




Primary Survey

Catastrophic Haemorrhage Not Present -

-

Cervical Spine Normal -

Airway Normal -

Breathing Abnormal APNOEA

Circulation Abnormal ABSENT

Disability Abnormal UNRESPONSIVE

-

Exposure/Environment Normal -

Observations

NEWS

2

Pain

GCS

(E/V/

M)

AcVP

U

Pupils (mm)

BM

(mmol

/L)

Temp

o

( C)

BP

(mmH

g)

Pulse

Rhyth

m

HR

(/min)

PEFR

(l/min)

EtCO2

(kPA)

SpO2

(%)

Date/Time RR

(/min)

3

(1/1/

1)

0 0 L5 R5 U

10:03:00 06-FEBRUARY-

2020

Observation Notes

Full set of obs not recorded as pt deceased

Secondary Survey

Secondary survey notes

On crew arrival pt found on mattress (on cell oor), lying supine, clothed, under sheet. On site nurse and paramedic in cell with pt. On arrival

paramedic (Anna) explained they had made a decision to cease resuscitation attempt due to conditions unequivically associated with death.

Crew uncovered pt, completed 3 lead rhythm striP con rming asystole. rigor mortis Felt and witnessed by crew. no drug paraphernalia found in

cell, no apparent injuries or obvious wounds seen.

A16

A16




Cardiac

Respiratory

11:02:00 06-FEBRUARY-2020

Details

SRNI True Clubbing - Oedema -

Lymph

nodes -

Jaundice - Cyanosis -

Anaemia -

Details

SRNI - ECG Rhythm ASYSTOLE

Oedema - Pulses RUL -

Bruits - RLL -

LUL -

LLL -

ECG Photo

Gastrointestinal

For Cardiac Assessment Recorded At: 11:02:00 06-FEBRUARY-2020

Details

SRNI True

Bowel

Sounds -

Pregnant -

A17

A17




Urinary

Micturition Pain SRNI

Blood / Visual

haematuria

Frequency Colour Smell

- - - - - True

Obstetric and gynaecology

SRNI

True

Musculoskeletal/Injury assessment

Neurological

Details

Details

SRNI True Type - Burns % -

SRNI True

Tone -

Power -

Sensation -

Cranial

-

Nerve

Assessment

Impressions

Name Ordinal

Cardiac arrest

Interventions

Resuscitation

De brillation

A18

Date/Time Rhythm Shock (J) By

09:35:00 06-

ASYSTOLE 24112536 - H. Bedford

FEBRUARY-2020

A18




Clinical Outcome Indicators

Cardiac arrest details

COI EXCEPTIONS - Time of arrest unknown

Aetiology Arrest location

Precordial thump

administered

Time of arrest Time of arrest exceptions

TIME UNKNOWN UNKNOWN 97 OTHER

Bystander Crew Other HCP Other 999 None Details

Witnessed by None

09:12:00 06-

FEBRUARY-2020

CPR by Yes

Shock by None

Pre-arrival de b by Yes

ROSC by None

Disposition/Outcome

Conveyed

Handover

Verbal Handover Hospital handover Late reason Receiving name Handover PIN

2691

Non-conveyed

Reason

Recognition of life extinct (ROLE)

A19

A19




ROLE

Date/Time By

09:35:00 06-FEBRUARY-

2020

24112536 - Helen Bedford

Resuscitation inappropriate

DNACPR/ReSPECT Advanced directive Terminal illness Condition incompatible with life

HYPOSTASIS, RIGOR MORTIS

Cessation of resuscitation

Other reason

20mins asystole despite

ALS

Asystolic Remained asystolic 30secs asystole

True True True False

Codes

Outcome disposition code Crew condition code Crew condition code 2

Z02 – Deceased - Handover to Police

(expected or unexpected death)

A00 - CARDIAC ARREST

Clinician sign off

Clinician Signature

Clinician Signature

27268565 - S.

Henderson

24112536 - H.

Bedford

A20

A20




Disposition/outcome notes

Police o cer based at highdown concerned there may be suspicious circumstances, police requested, crew requested to stay on scene to

complete statements. Crew liased with CID on scene, case ref card and rythm stip given to o cers, statement taken from crew.

A21

A21


Printed

409af26bccb2448dabacd1cf3d115e4f409af26bccb2448dabacd1cf3d115e4f-1

by TURNER, Steven (Mr) (Clerical Access Role)HMP Highdown 1 of 216

TURNER, Saul (Mr)

Client ID: A2425AM

Patient Record

TURNER, Saul (Mr) NHS Number: 719 122 2247

Date of Birth 08 Dec 1982 00:00 (37 y) Gender Male

Place of Birth UNKNOWN

Marital Status Single person Ethnic Origin White British

Language Main spoken language English English Speaker Unknown

(XaG5t)

Deceased 06 Feb 2020 09:35

Contact Details

Current Home Address HMP Highdown Highdown Highdown Lane Sutton

C1

16 Jan 2020 -

SM2 5PJ

Previous Home Address Hmp Yoi Grove Road Portland Dorset DT5 1DL 17 Sep 2018 - 12 Feb 2020

Current Temporary Address HMP Highdown Highdown Highdown Lane Sutton 16 Jan 2020 -

SM2 5PJ

Registration Details

Registration Date 08 Jan 2020 Date of Removal 06 Feb 2020

PDS Registered

Usual Branch HMP Highdown (02071476300)

Practice

Dispensing N Pharmacy None

Attendance Record

Last 12 Months (Total)

Appointments 34 (51) Attendance 33 (50) 97% (98%)

Visits 0 (0) 0% (0%) DNAs 1 (1) 2% (1%)

Journal

08 Dec 1982 Surgery: MIKOLAJCZUK, Beata (Healthcare Assistant) Entered at:

HMP Swaleside

Entered: 08 Oct 2015 05:34

Prescription or Medication details to Unknown

1996 Surgery: SKINNER, Margaret (Assistant Practitioner) Entered at:

HMYOI Portland

Entered: 25 Apr 2018 11:18

Tuberculosis (BCG) vaccination (653..) - While at school had BCG vaccine

2010 Surgery: FORSHAW, Karen (Administrator) Entered at: HMP

Elmley

Entered: 19 May 2011 09:16

Prescription or Medication details to unknown recipient

02 Feb 2010 Surgery: FORSHAW, Karen (Administrator) Entered at: HMP

Swaleside

Entered: 25 Jan 2017 11:29


25 Feb 2010 Surgery: FORSHAW, Karen (Administrator) Entered at: HMP

Swaleside

Entered: 25 Jan 2017 11:31


23 Mar 2010 Surgery: FORSHAW, Karen (Administrator) Entered at: HMP

Swaleside

Entered: 25 Jan 2017 11:18


05 May 2010 17:14 Surgery: OLADIMEJI, Bola (Systems Support Access Role) Entered at: HMP Swaleside

Current Home Address: ZZ99 3VZ

Sentence: No sentence date set - 25 Apr 2011

Stay: 05 Jun 2012 17:14 - 01 Jun 2010

12 May 2010 15:50 Surgery: PAIN, John (Manager) Entered at: HMP Swaleside

Referral In to HMP Highdown for Healthcare: Ended on 16 Jun 2010 00:00

Status Update for Healthcare Referral In: Receiving Care

13 May 2010 15:51 Health Centre: OLADIMEJI, Bola (Systems Support Access Role) Entered at: HMP Swaleside

PNG Image: Photo.PNG

14 May 2010 10:52

30 May 2010 13:55

Health Centre: OLADIMEJI, Bola (Systems Support Access Role) Entered at: HMP Swaleside

Health Centre: MEAKINS, Phillipa (Pharmacy Technician) Entered at: HMP Swaleside

Other note (XaIgC) - seen in seg by Nurse Derek Wallis. Algorithm completed.

Thu 23 Apr 2020 15:02

Mr Saul Turner "Saul Altel" (A2425AM)

Confidential: Personal Data 719 122 2247, 08 Dec 1982

C1

C2

Printed

409af26bccb2448dabacd1cf3d115e4f-2


31 May 2010 10:33 Health Centre: COOPER, Sharon (Officer) Entered at: HMP Swaleside

Other note (XaIgC) - Seen on seg rounds, no problems.

01 Jun 2010 10:49 Health Centre: PETERS, Jo (Practice Nurse) Entered at: HMP Swaleside

Other note (XaIgC) - Seen in seg, no complaints.

01 Jun 2010 16:36 Health Centre: GROVE, Kerrie (Administrator) Entered at: HMP Swaleside

Stay: 01 Jun 2010 16:36 - 16 Jun 2010

02 Jun 2010 10:55 Health Centre: WILSON, Linda (Practice Nurse) Entered at: HMP Swaleside

Other note (XaIgC) - seen in seg,no concerns raised.

03 Jun 2010 13:01 Health Centre: GHAFFAR, Ali (Dr) (General Medical Practitioner) Entered at: HMP Swaleside

Other note (XaIgC) - seen in seg.no complaints

05 Jun 2010 10:22 Surgery: OTA, Mercy (Practice Nurse) Entered at: HMP Swaleside

Other note (XaIgC) - Seg round, no complaints.








Other note (XaIgC) - seen iin seg. no complaints

08 Jun 2010 19:52 Surgery: PIRIE, Stephen (Other Medical Officer) Entered at: HMP Swaleside

Other note (XaIgC) - Seen in Seg following DSH. 2 x lacerations to torso and 1 to right shoulder all claeaned,

sprayed with Betadine and dressed with Melolin. Razor blade removed from cell. States no further SH thoughts. For

review tomorrow. F213SH to follow.

09 Jun 2010 09:56 Surgery: MATHEW, Seena (Mrs) (Practice Nurse) Entered at: HMP Swaleside

Other note (XaIgC) - Seen in seg . Algorithm completed . No concerns raised.


Other note (XaIgC) - seen in seg no complaint

11 Jun 2010 10:59 Health Centre: WALLIS, Derek (Nurse Manager) Entered at: HMP Swaleside

Other note (XaIgC) - SEG ROUND - No problems.

12 Jun 2010 10:46 Health Centre: JORDAN, Dave (Practice Nurse) Entered at: HMP Swaleside

Other note (XaIgC) - Seen in seg no issues.

13 Jun 2010 10:52 Health Centre: WALLIS, Derek (Nurse Manager) Entered at: HMP Swaleside

Other note (XaIgC) - seg round no problrms


Other note (XaIgC) - seen in seg no complaints

17 Jun 2010 08:24 Health Centre: STANLEY, Dermot (Mr) (Practice Manager) Entered at: HMP Swaleside

26 Jun 2010 21:58 Health Centre: STANLEY, Dermot (Mr) (Practice Manager) Entered: 26 Jun 2010 22:01

Entered at: HMP Swaleside

F213 to unknown recipient

02 Jul 2010 13:29 Surgery: WOODS, Steve (Manager) Entered at: HMP Elmley

Current Home Address: ZZ99 3VZ

Sentence: No sentence date set - 25 Apr 2011

Stay: 02 Jul 2010 13:29 - 02 Aug 2010

05 Jul 2010 09:31 Health Centre: CRIPPS, Janet (Administrator) Entered at: HMP Elmley

Referral In to HMP Highdown for Healthcare: Ended on 25 Apr 2011 00:00


05 Jul 2010 09:56 Surgery: WOODS, Steve (Manager) Entered at: HMP Elmley

Self Harm Care Plan Created

Low in Mood Care Plan Created

Self Harm Instruction: Ensure that all staff are aware of the potential for self harm.

Self Harm Instruction: Initiate a therapeutic relationship with key worker.

Self Harm Instruction: Demonstrate acceptance and non judgmental responses.

Self Harm Instruction: Ensure all potentially harmful substances and implements are removed whilst encouraging to

retain and use personal belongings.

Self Harm Instruction: Provide clear and understandable instructions about care and treatment.

Self Harm Instruction: Identify factors which appear to trigger self harm thoughts.

Thu 23 Apr 2020 15:02



C2

C3

Printed



Self Harm Instruction: Identify potential factors which appear to reduce suicidal preoccupation.

Self Harm Instruction: Encourage diversional or recreational activities.

Self Harm Instruction: Record all notes and observations in this template

Low in Mood Instruction: Encourage awareness of positive responses from others (Deleted 18 Aug 2010 18:12)

Low in Mood Instruction: Encourage to keep an emotional log throughout the day (Deleted 18 Aug 2010 18:12)

Low in Mood Instruction: Ensure basic physical needs are met (Deleted 18 Aug 2010 18:12)

Low in Mood Instruction: Initiate a therapeutic relationship (Deleted 18 Aug 2010 18:12)

Low in Mood Instruction: Demonstrate acceptance ensuring non-judgemental responses (Deleted 18 Aug 2010

18:12)

Low in Mood Instruction: Enhance feelings of safety (Deleted 18 Aug 2010 18:12)

Low in Mood Instruction: Identify activities, thoughts and times of day that raise the mood (Deleted 18 Aug 2010

18:12)

Low in Mood Instruction: Record all notes and observations in this template (Deleted 18 Aug 2010 18:12)

Low in Mood Instruction: If applicable, maintain Prison Service documentation (Deleted 18 Aug 2010 18:12)

Low in Mood Instruction: Give medications as prescribed and observe for side effects (Deleted 18 Aug 2010 18:12)

Self Harm Visiting Frequency: Visit every day, Ended 28 Jul 2010 17:05

Low in Mood Visiting Frequency: Visit every day, Ended 01 Sep 2010 18:22

Self Harm Review next due on 12 Jul 2010 09:57

Low in Mood Review next due on 12 Jul 2010 09:58

05 Jul 2010 10:17 Surgery: OSUAGWU, Ferdinand (Dr) (General Medical Practitioner) Entered at: HMP Elmley

History: Hx -----rt inner asopect of his forearm...Noticed 3d ago

Exam----Typical ring like lesion with central clearance

Impression===Ringworm---Tinea

Rx----Terbinafine cream 1% apply bd for 4w

05 Jul 2010 14:28 Surgery: ADIGUN, Omolara (Practice Nurse) Entered at: HMP Elmley

Activity: Self Harm (Care Plan) (30 minutes) with Patient

Activity: Low in Mood (Care Plan) (30 minutes) with Patient

Self Harm Notes: Staff aware, no issues reported

Self Harm Notes: 1-1 time spent with Mr Altel, stated he felt better in himself, no self harm toughts expressed.

Engaged with activities.

Self Harm Notes: No triggers to self harm reported or noted.

Self Harm Notes: Unlock to attend to personal hygiene and tidied up his cell.

Low in Mood Notes: Managed according to ACCT protocol, no self harm thoughts expressed.

Low in Mood Notes: Seen by GP, clo ringworms, anti-fungi cream prescribed.

Low in Mood Notes: Appeared settled and bright in mood. Interacted well with staff and peers.

Low in Mood Notes: Attended to personal hygiene, no issues raised

Low in Mood Notes: Compliant with medication as prescribed.

Self Harm performed (8 out of 9)

Low in Mood performed (10 out of 13)

Patient Contact: 60 minutes

Total Contact: 60 minutes

05 Jul 2010 14:46 Surgery: ADIGUN, Omolara (Mental Health Nurse) Entered at: HMP Elmley

06 Jul 2010 13:23 Health Centre: DENSHAM, Ronald (Mr) (Officer) Entered at: HMP Elmley

History: Mr Altel has been positive in mood, he is interacting well with other inmates and staff. He will be moved

next week to the house block next week after seeing the Doctor.

07 Jul 2010 16:27 Surgery: RYLES, Alison (Mrs) ('Other' Community Health Service) Entered at: HMP Elmley


Self Harm Notes: Saul engaged in a short conversation during rounds for requests this morning.

Self Harm Notes: During conversations with staff Saul responded appropriatley.

Self Harm Notes: Saul today has been out of his cell for meals and also for association in the compound. There are

no concerns with Saul.




08 Jul 2010 17:42 Surgery: BUWU, Godfrey (Practice Nurse) Entered at: HMP Elmley

History: CP 1 - Saul remains in a quiet and settled presentation, mood appears flat, interactions with peers and staff

were minimal and only where necessary. CP 2 - no evidence of response to stimuli, or Depressed mood (XE0re).

09 Jul 2010 06:14 Surgery: NABAFU, Barbara (Miss) (Practice Nurse) Entered at: HMP Elmley

History: nocte cp1- mood dificult to assess as client was already asleep at he start of the nocte shift, cp2 Nursed on

an OPEN ACCT as per acct recommentations all night no at risk behaviuors noted

09 Jul 2010 12:02 Surgery: REVELL, Sharon (Practice Nurse) Entered at: HMP Elmley


Low in Mood Notes: Presented as bright in mood, says that he was fine and had nothing to talk about when offered

Thu 23 Apr 2020 15:02



C3

Printed



1:1. Utilised the exercise yard interacting appropriately with staff and other inmates. No untoward behaviour noted.






Self Harm Notes: Did not express any thoughts of self harm, interacted well with others. No triggers to self harm

identified or reported.





History: Nocte: CP1 complied with his prescribed medication. cp2 Remains on open ACCT document. He remains

subdued in mood and quiet unpredictable No evidence of risk behaviour observed. slept throughout the night.




Self Harm Notes: No self harm thoughts expressed, no triggers to self harm. Fairly settled day interacting well with

others. Utilised exercise and association time.

Low in Mood Notes: Offered 1:1 and he stated that he had nothing to talk about.

Low in Mood Notes: No physical complaints, attended to his personal hygiene this morning and cleaned his cell.

Low in Mood Notes: Presented as settled in mood and behaviour interacting appropriately with staff and other

inmates during exercise and association.

Low in Mood Notes: Managed on ACCT protocol, documentation maintained on ACCT






History: Nocte. cp1 was resting on bed during commencement of the night shift. complied with his morning

prescribed medication. cp2 continues to be nursed on open ACCT document. No evidence of risk behaviour noted.

He slept well throughout the night no concerns to report.

11 Jul 2010 11:29 Surgery: MAIBVISIRA, Francis (Mr) (Health Professional Access Role) Entered at: HMP Elmley

History: Entry by Dr.A.Ghaffar: seen in inpatient still on citalopram and venlafaxine He says he feels better since

started Venlafaxine Not suicidal No thoughts of DSH Has been eating , keeping his personal Hygiene , associating

with ohter prisoners Having ACCT review on 13-07-2010 Contintue observations

11 Jul 2010 11:50 Surgery: NGARIZE, Tendai (Mr) (Practice Nurse) Entered at: HMP Elmley



Self Harm Notes: CP1-Had 1.1 session denied suicidal or self harm intent.Interctive with peers .

Low in Mood Notes: States that his mood has improved, apetite is better and is sleeping better at night.Has been

commenced on new antidepressant is aware that this will take 4-6 weeks to check efficacy.Compliant with

medication regime.

Self Harm fully performed





History: Nocte 11:07:10- CP1: He was resting / watching football match in cell at the start of the shift. He complied

with his medications,

CP2: Remains on acct, no concerns about mood and behaviour (brighter in mood). He appears to have slept

throughout the night.

12 Jul 2010 14:19 Surgery: COLTON, Paul (Practice Nurse) Entered at: HMP Elmley



Self Harm Notes: settled morning self caring no mention of any self harm no problems apparent has eaten well

mixing with fellow patients





13 Jul 2010 05:35 Surgery: BHEBHE, Sifiso (Practice Nurse) Entered at: HMP Elmley

History: nocte; cp1 continues to be nursed on an OPEN ACCT due to risk of self harm no evidence of same noted,

cp2- mood appered slightly lifted observed to be reading books in his room -good concentration. slept

13 Jul 2010 12:15 Health Centre: MHLANGA, Nelly (Mrs) (Practice Nurse) Entered at: HMP Elmley

C4

Thu 23 Apr 2020 15:02



C4

Printed





Self Harm Notes: 1.1 session facilitated, stated that he feels more positive and is going out for exercise and

interacting well with other peers. No self harm or suicidal ideation expressed.





14 Jul 2010 20:08 Surgery: MUCHAZIWEPI, Osmond (Practice Nurse) Entered at: HMP Elmley



Self Harm Notes: Mr Altel refused to have a one to one when it was offered

Low in Mood Notes: He had a good food and fluid intake.

Low in Mood Notes: Mr Altel has had minimal interractions with staff and peers.






History: noct:e predominantly settled night continues to be nursed on an OPEn ACCT as and checks done as per

protocol

15 Jul 2010 11:26 Health Centre: CRIPPS, Janet (Administrator) Entered at: HMP Entered: 15 Jul 2010 11:30

Elmley

Blood Results to unknown recipient

Notes: printed 05/07/2010

15 Jul 2010 18:57 Surgery: ADIGUN, Omolara (Practice Nurse) Entered at: HMP Elmley



Self Harm Notes: No self harm issues, remains on an open ACCT. Managed according to ACCT protocol.

Self Harm Notes: 1-1 facilitated, stated he si still feeling low but denied self harm thoughts or siucidal intents.

Self Harm Notes: Participated in exercise and association.

Self Harm Notes: Good interaction with peers and observed to be watching TV in cell at times.

Low in Mood Notes: 1-1 facilitated with him, verbalised feeling low in mood, but denied self harm thoughts.

Low in Mood Notes: Remains on ACCT.

Low in Mood Notes: Compliant wiyh his medication, stated he found new medication effective.

Low in Mood Notes: Good personal hygiene maintained.





C5


History: Nocte: nurse on an OPEN ACCT PLAN all though the night checks done as per ACCt protocol,- mood

remains some what subdued continues to comply with the prescribed meds



Self Harm Notes: Generally settled, 1.1 facilitated stated that his motivation has improved,apetite is good and is

sleeping better.States has no suicidal or self harm intent.






Self Harm Notes: Mr Altel was out for association in the exercise yard noted to be chatting with peers.Presented with

flat affect but motivation has improved.





History: nocte: Cp1- mood appeared slightly improved- no self - harm behaviours noted slept undisturbed all night

17 Jul 2010 14:51 Surgery: MATSIKA, Clemence (Mental Health Nurse) Entered at: HMP Elmley



Low in Mood Notes: Saul came out for exercise and association he interacted appropriately with staff and peers. He

has played pool with staff and peers. Mood appears bright. He had a good dietary intake. No challenging behaviour

reported.

Thu 23 Apr 2020 15:02



C5

Printed



Low in Mood Notes: Saul has been observed according to AACT protocol. He apperas free to express himself, as he

has been interacting with many of his peers and staff.








Self Harm Notes: No at risk behaviours noted

Self Harm Notes: He refused to have 1:1 when it was offered

Low in Mood Notes: He was concordant with his medication

Low in Mood Notes: His mood was euthymic and he was monosyllabic in response to attempts to engage him in

conversation





19 Jul 2010 04:57 Surgery: MACARTHUR, Kevin (Mr) (Practice Nurse) Entered at: HMP Elmley

History: settled night no concerns expressed


History: Nocte Settled night, no complains voiced. Ropo Zvouno RGN



Self Harm Notes: Saul remains on open acct nil untoward behaviour noted.






Self Harm Notes: Spoken to denied suicidal or self harm intent.Much better in terms of motivation self caring and

associated with peers,






Low in Mood Notes: Brighter in mood and interactive with peers and staff.Out for exercise and association.Diet and

fluids atken at mealtimes.






Low in Mood Notes: Saul remains compliant with medication regime.





History: Settled night, no complains voiced.

21 Jul 2010 10:10 Surgery: TAGLIAVINI, Beatrice (Dr) Entered at: HMP Elmley Entered: 21 Jul 2010 17:55

Did not attend for GP Reception Clinic appointment with Dr Beatrice Tagliavini

Did not attend (Xa1kG)



Self Harm Notes: Had 1.1 session much calmer in presentation, stated that apetite and sleep pattern are

good.Reported that is awaiting therapeutic benefits frm his new antidepressant he was commenced last

weekReassured that this will take up to 4-6 weeks.






Self Harm Notes: Remains on open ACCT spoken to states has no suicidal or self harm intent.Associated with peers

in the exercise yard,Self caring.


C6

Thu 23 Apr 2020 15:02



C6

Printed







Self Harm Notes: Mr Altel c/o itchy red spots on both feet not seen today due to non-availability of GP.




22 Jul 2010 09:39 Health Centre: REED, Andrew (General Medical Practitioner) Entered at: HMP Elmley

History: new rash on left foot and right forefoot

Examination: well circumscrimbed eryhtrematous patches with centralised dry skin, fairly typical if tinea

Plan: continue to use the same cream that he has been using on the right forearm

Advice to return (Ua03I) - Pt has been advised to return to healthcare should his symptoms get worse or he

deteriorates etc. he has been made aware of the ability to report Special sick if need be

Tinea pedis (Xa97k)




Low in Mood Notes: Saul was spoken presented with good eye contact, mood remains somewhat subdued ,out for

association with peers and played pool.

Low in Mood Notes: Self caring, had shower and cleaned his cell.Diet and fluids taken at mealtimes.






Low in Mood Notes: Saul remains compliant with medication regime.






Self Harm Notes: Saul remains on open ACCT states has no suicidal or self harm thoughts.During 1.1 session stated

that his motivation has improved and feels better about himself.




23 Jul 2010 03:31 Surgery: ZVOUNO, Ropofadzai (Miss) (Practice Nurse) Entered at: HMP Elmley

History: Nocte CP1 Settled night, no complains voiced.

23 Jul 2010 17:44 Surgery: MABHEDHLA, Nyasha (Mental Health Nurse) Entered at: HMP Elmley




Self Harm Notes: Mr Altel has remained subdued in his mood with minimum conversation with staff, he interacted

well with his peers during exercise and Association time. he did not verbalise any suicidal ideations or self harm

intent , he verbalised to staff that he was ok.

Low in Mood Notes: Mr Altel, complied with all his medication as prescribed. he attended to his ADL. though his

mood appeared to be subdued he did not isolate himself iin his cell instead he came out during association time and

exercise time. Saul attended the library and took out three books.








Self Harm Notes: No self harm issues raised.

Self Harm Notes: Remains on open ACCT observations done as required.




24 Jul 2010 18:36 Surgery: ADIGUN, Omolara (Mental Health Nurse) Entered at: HMP Elmley



Self Harm Notes: Mr Altel attended to his personal hygiene. He participated in all activities, in good spirit. Out for

exercise and association, interacted well with peers and staff. No untowards behaviour exhibited, stated he gets

along with peers.

C7

Thu 23 Apr 2020 15:02



C7

Printed



Low in Mood Notes: Mr Altel presented as settled and slightly bright in mood. Stated he has bad and good days, on

bad days he slept over his negativity thoughts and on good days he intertacted with others. Advised to speak to staff

on bad. fenied self harm thoughts or suicidal intent. Stated his new anti-depressant seems to be working as he

noticed a change in his mood. ACCT maintained according to protocol. Compliant with his medication.








Self Harm Notes: No self harm issues raised during the night

Low in Mood Notes: Appeared settled in mood and slept throughout the night. No complains voiced.







Self Harm Notes: Remains on open acct no risky behaviours exhibited.1.1 session facilitated stated that has no

thoughts of suicide or self harm.Reported that he keeps in touch with his family by phone or letters as they live

outside kent.Out for association played pool and engaged well with staff.Self caring, diet and fluids taken at

mealtimes.






Low in Mood Notes: States that his mood is improving and also his motivation.He acknowledges that has just been

commenced on an antidepressant and needs time to obtain therapeutic benefits.Played pool and associated with

peers.






Self Harm Notes: No self harm issues raised. Appeared settled in mood. Remains on open ACCT, observations

done as requested.




26 Jul 2010 15:10 Health Centre: MHLANGA, Nelly (Mrs) (Practice Nurse) Entered at: HMP Elmley



Self Harm Notes: No self harm issues noted or reported.

Low in Mood Notes: Mr Altel remains on open Acct document and has been nursed according to Acct protocol.

Complied with his medication regime, 1.1 offered and declined, he stated that he was fine, denied any thoughts to

self harm. Exercise facilitated this afternoon.







Self Harm Notes: client was taken over awake self occupied by reading books for most of the night- settled to sleep

by midnight- continues to be nursed on an ACCT- plan due to risk of self harm- no sings of DSH overnight checks

mantained as per protocol







Self Harm Notes: Mr Altel has remained in a settled mood there where no issues raised in regards to self harm or

suicidal ideations.

Low in Mood Notes: Mr Altel has attended to his personal hygiene and cleaned his room. He appeared subdued in

his mood with minimum interaction with both staff and other patients. He went out during exercise time he

C8

Thu 23 Apr 2020 15:02



C8

C9

Printed



verbalised that he was feeling ok and he appeared to be amicable with his peers during this time as there were no

issues raised.







Self Harm Notes: client was asleep at the start of the shift no at risk behaviours noted. nursed on an open acct plan

checks done as per acct protocol





History: Violence between parents (13HP6)Mr Altel was overheard threatening a fellow patient with violence and

was locked behind his door SIR submitted and entered in the unit observation book




Low in Mood Notes: Mr Altel was reminded of appropriate behaviour after he was overhead threatening a fellow

prisoner

Low in Mood Notes: Mr Altel presented as pleasant and appropriate he apologised for his previous behaviour. He

presented with good eye contact and rapport. His mood was euthymic

Low in Mood Notes: Mr Altel has been concordant with his medication





Self Harm Visiting Frequency: Visit every week on Monday, Tuesday, Wednesday, Thursday, Friday, Saturday,

Sunday, Ended 28 Jul 2010 17:24




Low in Mood Notes: remained quiet and appearing somewhat subdued, no concerns verbalised, nursed on an open

acct plan no self harm issues noted




29 Jul 2010 10:52 Health Centre: MUSTAPHA, Ahmed (General Medical Practitioner) Entered at: HMP Elmley

History: Says he has no physical health problems;

Plan: Returned to continue his Mental Health care.



Low in Mood Notes: Mood remains subdued but complied with medication regime.






Low in Mood Notes: Mr Altel was out for a shower and cleaned his cell.Diet and fluids taken at mealtimes.





Activity: Self Harm (Care Plan) with Patient

Self Harm Notes: Remains on open acct stated that has thoughts of self harm but has not acted on them.





30 Jul 2010 05:47 Surgery: MACARTHUR, Kevin (Mr) (Practice Nurse) Entered at: HMP Elmley


Self Harm Notes: settled over night no thoughts of self harm expressed, remains on open acct obs carried out as per

care plan.


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Self Harm Notes: Mr Altel, requested for a razor in the morning when returning it it was observed that he had

removed a blade, a room search was completed and the razor blade was retrieved from under his clothes. He

declined to talk to staff despite all effrts to engage him.

Low in Mood Notes: Mr Altel has remained subdued in mood, he has intercted minimally with both staff and patients.







Low in Mood Notes: client appaered sullen in mood not keen on talking to staff when spoken complied with his meds

this am no evidence of self harm noted




31 Jul 2010 16:58 Surgery: ABIODUN, Babatunde (Mr) (Nurse Practitioner) Entered at: HMP Elmley



Low in Mood Notes: He appears subdued in mood at the start of the shift, later he became positive. He attended to

his personal care and cleans his room; he communicated his needs to staff in appropriate manner .Sill on basic,

concordant with medication and no aggressive behavior displayed during the shift. Adequate diet and fluid taken




01 Aug 2010 13:39 Surgery: NGARIZE, Tendai (Mr) (Practice Nurse) Entered at: HMP Elmley


Low in Mood Notes: Mr Altel presented as irritable in mood.Observed opening another inmate's hatch spoken to

about his behaviour.1.1 facilitated reluctant to engage upset that he is allowed out for an hour.Rationale explained to

him that he made threats against another inmate.






Self Harm Notes: Remains on open acct did not verbalise suicidal or self harm thoughts.


02 Aug 2010 07:08 Surgery: BHEBHE, Sifiso (Practice Nurse) Entered at: HMP Elmley


Low in Mood Notes: mood remains low, denied any thoughts of self harm at the time of making contact, nursed in a

safe cell and continues to be nursed on an open acct paln




02 Aug 2010 08:48 Surgery: THOMAS, Hayley (Administrator) Entered at: HMP Elmley

Stay: 02 Aug 2010 08:48 - 04 Aug 2010

02 Aug 2010 17:42 Surgery: MAIBVISIRA, Francis (Mr) (Clinical Team Manager) Entered at: HMP Elmley



Self Harm Notes: He denied suicidal thoughts/actual dsh issues.

Low in Mood Notes: Saul spoke to staff about coming out of his cell more, he was informed that there is a review

meeting tomorrow to re-evaluate the risk of coming out normally after he made threats to assault another service

user. He was let out for his hour for association and exercise.

Low in Mood Notes: Came out for exercise and association and shower facilitated.

Low in Mood Notes: He took his medication as prescribed.





03 Aug 2010 06:17 Surgery: ZVOUNO, Ropofadzai (Miss) (Practice Nurse) Entered at: HMP Elmley



Self Harm Notes: No self harm issues raised

Low in Mood Notes: Settled night. Complied with morning medication as prescribed.

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Low in Mood Notes: Concordant with medication regime.






Low in Mood Notes: Spoken to regarding threats he made to another inmate.Informed that has been risk assesed

and is allowed to mix with other inmates.Spoken to about his future conduct.






Low in Mood Notes: Self caring, had shower and exercise facilitated.Diet and fluids taken at mealtimes.,






Self Harm Notes: Remains on open acct but nil untoward behaviour noted.




Self Harm Notes: Supervised shaving only did not request any razors today.




Self Harm Notes: Mr Altel associated with peers in the exercise yard noted to be appropriate in his intearctions.




Self Harm Notes: Spoken to presented with good eye contact stated that is happy to mix with the rest of inmates

after being risk assessed.Denied suicidal or self harm intent.States that has fleeting thoughts of self harm but has not

acted on them.




Low in Mood Notes: Appeared settled in mood, no concerns voiced.




04 Aug 2010 08:54 Surgery: THOMAS, Hayley (Administrator) Entered at: HMP Elmley

Stay: 04 Aug 2010 08:54 - 24 Aug 2010

04 Aug 2010 15:04 Surgery: MATSIKA, Clemence (Mental Health Nurse) Entered at: HMP Elmley



Self Harm Notes: No self harm ideation expressed.

Low in Mood Notes: Saul came out for exercise and he interacted with staff and peers appropriately. No challenging

behaviour or self harm reported.








Self Harm Notes: No self harm issues raised.

Low in Mood Notes: Compliant with medication and settled.



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05 Aug 2010 17:11 Surgery: WHITEHEAD, Katie (Officer) Entered at: HMP Elmley



Self Harm Notes: Mr Altel remains on an open acct, all staff are aware of the acct document.

Self Harm Notes: Mr Altel has not self harmed today, i have no concerns of self harm.

Self Harm Notes: No triggers points raised.

Self Harm Notes: Mr Altel has been out of his cell most of the day. He has been out on the exercise yard with

minimal interaction with others. He said he is waiting for an assessment from the inreach team. Collected his meals.

Low in Mood Notes: Mr Altel has been out for a shower and to clean his cell today.

Low in Mood Notes: Complied with medications. No side effects reported or noted.








Self Harm Notes: no self harm thoughts voiced.

Low in Mood Notes: Compliant with medication, no concerns voiced.





06 Aug 2010 18:14 Surgery: MABHEDHLA, Nyasha (Mental Health Nurse) Entered at: HMP Elmley



Self Harm Notes: no risk behaviour was reported by staff.

Self Harm Notes: verbalised that he was ok, and had no concerns to discuss.

Self Harm Notes: Used all his belongings appropriately.

Self Harm Notes: Adhered to his care plans.

Self Harm Notes: Saul did not verbalise any suicidal ideations.

Low in Mood Notes: complied with all his medication.

Low in Mood Notes: read a book that he took out from the library.

Low in Mood Notes: all needs were met.

Low in Mood Notes: Saul attended exercise session, he interacted well with his peers.

Low in Mood Notes: no agression was exhibited towards him from other inmates.








Self Harm Notes: posed no concerns in this regard as he did not verbalise any suicidal or self harm intents.

Self Harm Notes: verbalised that he was ok and settled.

Self Harm Notes: no concerns were raised in this regard.

Self Harm Notes: non were identified.

Self Harm Notes: Non were identified.

Self Harm Notes: played pool with his peers.

Low in Mood Notes: played some pool with his peers appears to have enjoyed himself.

Low in Mood Notes: all needs were met.

Low in Mood Notes: complied with all his medication as prescribed.

Low in Mood Notes: Mr Altel verbalised that he was feeling ok within himself.

Low in Mood Notes: no concerns were raised.








Self Harm Notes: All staff are aware that Mr Altel is on an open acct document.

Self Harm Notes: Mr Altel has no sharp objects in his cell to harm himself with. He has a supervised shave when

required.

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Self Harm Notes: Mr Altel has been out of his cell for a shower to clean his cell and shower. Whilst he is keeping

busy and interacting he appears settled in mood.

Self Harm Notes: Mr Altel participates in exercise and association.

Low in Mood Notes: Complied with medications.

Low in Mood Notes: All needs are met. No issues raised today.

Low in Mood Notes: Mr Altel does not fully communicate with staff. Minimal interaction when spoken to, little eye

contact.








Self Harm Notes: No concerns of self harm today. He is happy as his property from houseblock 5 has been found

and is now located in inpatients.

Self Harm Notes: No harmful objects in his cell. He is still having supervised shaves.

Self Harm Notes: No triggers of self harm mentioned.

Low in Mood Notes: medications complied with.





09 Aug 2010 12:32 Surgery: FEENEY, Sean (Dr) (Psychiatrist) Entered at: HMP Elmley

History: Seen in IPD; he is now in a safer cell after staff saw an attempt to make a ligature last week. Still has 8.5

months of sentence to do. Still depressed and severe easy fatiguability, though has put on some weight it appears.

PLAN -increase venlafaxine to 75 bd; remain in IPD.

10 Aug 2010 06:07 Surgery: MACARTHUR, Kevin (Mr) (Practice Nurse) Entered at: HMP Elmley

History: nocte settled night remains on acct obs carried out as per instructins no thoughts of self harm expressed

10 Aug 2010 17:27 Surgery: REVELL, Sharon (Practice Nurse) Entered at: HMP Elmley



Self Harm Notes: no self harm feelings or thoughts expressed

Self Harm Notes: Says he is fine when spoken to, minimal interaction and not engaging in conversation with staff

when spoken to

Self Harm Notes: no issues

Self Harm Notes: no concerns

Self Harm Notes: complied with his treatment plan

Self Harm Notes: no triggers mentioned

Self Harm Notes: no concerns

Self Harm Notes: utilised the exercise yard during exercise time

Low in Mood Notes: managed on ACCT procedure

Low in Mood Notes: Little interaction with staff only on needs basis. Says he is fine and does not wish to engange in

conversation with staff. Poor eye contact when spoken to.

Low in Mood Notes: Presented as low in mood, minimal interaction with ithers

Low in Mood Notes: complied with his medication

Low in Mood Notes: no issues

Low in Mood Notes: no safety issues








Self Harm Notes: remains on acct obs carried out as per instructions no thoughts of self harm expressed






Low in Mood Notes: Mood remains unpredictable, but pleasant on approach. He came out for exercise and

association. He had a good dietary intake. No self harm ideation or challenging behaviour reported. He has been

avoiding eye contact on interaction. He has been interacting with peers. He took his prescribed medications.


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History: settled overnight.



Self Harm Notes: no thoughts of self harm expressed








Self Harm Notes: Mr Altel remains on an open acct document.

Self Harm Notes: Mr Altel was given some of his personal belongings yesterday which he was happy with. He is

hoping to move to a cell with power so he can have a tv.

Self Harm Notes: No triggers raised. He said he is ok.

Self Harm Notes: He has spent most of the day in his cell talking to people at his door. He has minimal interactions

and mostly talks when he is approached.

Low in Mood Notes: Mr Altel has been settled in mood today. He has minimal interaction with others and staff.







History: Mood stable (Ua1r8) overnight remains on acct obs carried out as per instructions No thoughts of deliberate

self harm (XaIuw) expressed.



13 Aug 2010 10:15 Health Centre: SHAH, Rajiv (Dr) (General Medical Practitioner) Entered at: HMP Elmley

History: spots on face

Diagnosis: Acne vulgaris (XE1BO)

Plan: no known allergy, take doxycycline od, see us if any concern

Doxycycline 100mg capsules - 30 capsules - Noon: 1.0 capsules




Self Harm Notes: Saul has not attempted any self harm. he is quite settled in mood.

Self Harm Notes: Saul has his own property in his cell, he is much happier now it has all been found.

Self Harm Notes: Saul went out for exercise this morning and has been interacting well.

Low in Mood Notes: I have been talking to Saul this morning. He approached me for a chat. We was talking about

his family and his child. He was talking very positivley about them.







History: Mood stable (Ua1r8). No thoughts of deliberate self harm (XaIuw)expressed, remains on acct obs carried out

as per instructions








Low in Mood Notes: Saul appeared settled in mood, he said he is feeling fine. He came out for exercise and

association. He played pool with staff and peers. He has been interacting with appropriately. No challenging

behaviour reported. no self harm ideation expressed. Given 1;1 session by named nurse.





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Self Harm Notes: remains on acct obs carried out as per instructions no thoughts of self harm expressed






Low in Mood Notes: He came out to have exercise and association cleaned up his cell and interacted appropriately.

Low in Mood Notes: He presented as calm and settled in mood and behaviour.

Low in Mood Notes: No triggers identified today.

Low in Mood Notes: Medication was given as prescribed and no side effects observed or reported.

Low in Mood Notes: Saul presented as fairly sesttled and interacted well with fellow inmates amd staff alike.

Low in Mood Notes: He remains on an open Acct and denied suicidal thoughts.





History: Mood stable (Ua1r8) overnight remains on acct obs carried out as per instructions No thoughts of deliberate

self harm (XaIuw) expressed










Self Harm Notes: No self harm issues reported or noted. Saul is settled and states he has no current self harm

thoughts.

Self Harm Notes: Saul interacts well with others. He has been out for exercise.

Low in Mood Notes: Saul approches me he likes to talk. He has no issues today to discuss.





17 Aug 2010 11:10 Health Centre: MHLANGA, Nelly (Mrs) (Practice Nurse) Entered at: HMP Elmley


Low in Mood Notes: Complied with his medication regime, no side effects reported.

Low in Mood Notes: Exercise offered and accepted.

Low in Mood Notes: Remains on Acct document and has been nursed according to acct protocol. Denied any

suicidal ideation.

Low in Mood Notes: 1.1 facilitated, stated that he has ocassional thoughts of self harm, but has not acted upon his

thoughts. He also reported to be responding well to his treatment.







Self Harm Notes: No self harm thoughts expressed or noted, Mr Altel has been moved from a safer cell into a normal

cell after his acct review.

Self Harm Notes: No self harm triggers mentioned.


18 Aug 2010 18:09 Surgery: MAIBVISIRA, Francis (Mr) (Health Professional Access Role) Entered at: HMP Elmley

18 Aug 2010 18:13 Surgery: MAIBVISIRA, Francis (Mr) (Health Professional Access Role) Entered at: HMP Elmley

Dsh and depression. Care Plan Created

Low in Mood Instruction: Saul is to be managed as per careplan.

Low in Mood Instruction: Allocated/treatment nurse to ensure that he is compliant with his treatment plan.

Low in Mood Instruction: Allocated nurse to ensure that Saul has a 1.1 session facilitated per every shift, outcome to

be documented on system 1.

Dsh and depression. Visiting Frequency: Visit every week on Monday, Tuesday, Wednesday, Thursday, Friday,

Saturday, Sunday, Ended 19 Aug 2010 17:48

Dsh and depression. Review next due on 23 Aug 2010 18:14


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Low in Mood Notes: Saul denied suicidal thoughts and presented as calm and settled in mood and behaviour. He

appears more settled in a normal cell with a tv.

Low in Mood Notes: He was concordant with his treatment plan and denied thoughts of harming himself. He came

out for exercise and association.

Low in Mood Notes: Saul's 1.1 session was facilitated and presented as calm and settled in mood and behaviour

Low in Mood fully performed





Dsh and depression. Visiting Frequency: Visit every minute, Ended 19 Aug 2010 18:26


Saturday, Sunday, Ended 19 Aug 2010 17:49

Low in Mood Notes: Mr Saul was nursed as per careplan.

Low in Mood Notes: Complied with his medication regime.

Low in Mood Notes: 1.1 offered, did not verbalise any suicidal ideation or self harm thoughts. He stated that he was

fine.





Activity: Dsh and depression. (Care Plan) (30 minutes) with Patient

Dsh and depression. Instruction: Monitor and document, Mr Altel's mood and behaviour.

Dsh and depression. Instruction: To explore areas/activities of interest and encourage participation

Dsh and depression. Instruction: Observe how Mr Altel interacts with other peers (Deleted 19 Aug 2010 18:42)

Dsh and depression. Instruction: Observe how Mr Altel interacts with peers

Dsh and depression. Instruction: Provide Mr Altel with opportunity to express his thoughts, feelings and anxities.


Saturday, Sunday, Ended 04 Sep 2010 18:54

Dsh and depression. Notes: Presented as being calm and settled in mood and behaviour.

Dsh and depression. Notes: Came out for association and has been palying pool with other peers.

Dsh and depression. Notes: Has been interacting well with peers.

Dsh and depression. Notes: 1.1 session facilitated by named nurse, stated that he was feeling 'alright'. did not

express any self harm issues.

Dsh and depression. performed (4 out of 5)



20 Aug 2010 13:13 Surgery: REVELL, Sharon (Practice Nurse) Entered at: HMP Elmley




Dsh and depression. Notes: Calm and settled in mood and behaviour, no untoward behaviour noted

Dsh and depression. Notes: Came out for exercise and associated with others

Dsh and depression. Notes: Good interaction with peers, laughing and jocking during association

Dsh and depression. Notes: Offered time to express his feelings and anxities, verbalised that he was fine and had no

issues to discuss

Self Harm Notes: No self harm issues expressed

Self Harm Notes: Stated that he was fine and had no issues to discuss about

Self Harm Notes: No triggers to self harm identified or verbalised

Self Harm Notes: Exercise and associated with others in the exercise yard

Low in Mood Notes: Settled in mood and behaviour, no self harm thoughts verbalised

Low in Mood Notes: :Complied with his treatment plan

Low in Mood Notes: Came out for exercise interacting with other patients. Offered him 1:1 time to express how he

was feeling and he stated that he was fine and had no issues to discuss


Dsh and depression. fully performed









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Dsh and depression. Notes: Mr Altel's mood appeared to be calm and subdued with no apparent issues to report.

Dsh and depression. Notes: Mr Altel came out during exercise time and sat in the garden where he interacted well

with his peers, he played some pool during association time.

Dsh and depression. Notes: Saul intercated amicably with his peers.

Dsh and depression. Notes: Mr Altel did not verbalise any concerns.

Self Harm Notes: Saul denied any suicidal or self harm ideations.

Self Harm Notes: care plan was adhered to.

Self Harm Notes: no issues were raised in this regard.

Self Harm Notes: no triggers were identified.

Self Harm Notes: Mr Altel appears to enjoy playing pool, he was encouraged to play pool during association time.

Self Harm Notes: Mr Altel played pool during association time.

Low in Mood Notes: Saul was managed as per care plan. he denied any self harm or suicidal ideations.

Low in Mood Notes: Mr Altel complied with all his treatment plan.

Low in Mood Notes: Mr Altel appeared to be settled in in his presentation, his mood appeared calm and subdued, he

verbalised that he was feeling ok, he denied any self harm or suicidal ideation.











Dsh and depression. Notes: Mr Altel's was calm and settled in his mood and behaviour.

Dsh and depression. Notes: He came out during exercise time and interacted well with his peers, he appears to have

a good rapport with three other patients and appears to spend ampule time with them.

Dsh and depression. Notes: Mr Altel has interacted amicably with his peer.

Dsh and depression. Notes: care plan was adhered to.

Self Harm Notes: all staff are aware of his potential to self harm as he contiues to be managed on an open ACCt

docuement

Self Harm Notes: relationship was intiatated as per care plan.

Self Harm Notes: care plan adhered to.

Self Harm Notes: no concernss were raised inthis regard.

Self Harm Notes: complied with his treatment plan.

Self Harm Notes: no factors were identified, as he did not make any attempt to self harm.

Self Harm Notes: |M|r altel did not verbalise any suicidal ideations nor were they any factors identified

Self Harm Notes: Mr Altel came out during exercise time and interacted well with his peers.

Low in Mood Notes: Care plan adhered to.

Low in Mood Notes: Mr Altel complied to his treatment plan with no apparent concerns.

Low in Mood Notes: Mr altel verbalised that he was ok and feeling fine, he appeared to be calm in mood and settled

in his presentation.






23 Aug 2010 09:23 Surgery: LONG, Hayley (Mrs) (Administrator) Entered at: HMP Elmley



Low in Mood Notes: Concordant with medication regime.Did not report any side effects.






Low in Mood Notes: 1.1 session facilitated made good eye contact.Presented with flat affect, but denied suicidal or

self harm intent.Reported that has ups and downs but maintained positive outlook.




23 Aug 2010 12:00 Surgery: NGARIZE, Tendai (Mr) (Nurse Access Role) Entered at: HMP Elmley


Dsh and depression. Notes: Presented with a flat affect but associated with peers and staff.

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Dsh and depression. Notes: Mr altel associated with peers in the exercise yard and was appropriate in his

interactions.






Dsh and depression. Notes: 1.1 facilitated denied suicidal or self harm intent.






Low in Mood Notes: Concordant with medication regime.Did not report any side effects.












Low in Mood Notes: Concordant with medication regime.Did not report any side-effects.






Low in Mood Notes: Concordant with medication regime.No side effects reported,











History: settled night no concerns expressed, remqains on open acct no thoughts of self harm expressed










24 Aug 2010 08:45 Surgery: LONG, Hayley (Mrs) (Administrator) Entered at: HMP Elmley

Stay: 24 Aug 2010 08:45 - 02 Sep 2010




Dsh and depression. Notes: Mr Altel, appeared calm and settled in his mood and behaviour, no issues were raised.

Dsh and depression. Notes: Mr Altel came out during exercise,and interacted well with his peers.

Dsh and depression. Notes: Mr Altel interacted well with his peers warmly and amicable.

Dsh and depression. Notes: care plan was adhered to.

Low in Mood Notes: Mr Altel attended to his personal hygiene and cleaned his cell.

Low in Mood Notes: Mr Altel complied with his medication and attended exercise session in the garden.

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Low in Mood Notes: Mr Altel, verbalised that he was feeling fine and denied any suicidal or self harm ideations.






History: Mood stable (Ua1r8) overnight, acct now closed, no concerns raised.











History: Mood stable (Ua1r8) overnight, medication given as charted no concerns raised.








26 Aug 2010 14:12 Surgery: ADIGUN, Omolara (Mental Health Nurse) Entered at: HMP Elmley




Dsh and depression. Notes: Appeared settled and brighter in mood.

Dsh and depression. Notes: Out for exercise and association with peers, no concerns reported.

Dsh and depression. Notes: Good rapport and interaction observed with peers.

Dsh and depression. Notes: 1-1 facilitated, He stated that he is fine, no anxieties expressed.

Self Harm Notes: No triggers reported.

Self Harm Notes: Mr Altel occupied himself with reading and watching TV. No self harm behaviour displayed.

Self Harm Notes: Mr Altel was off ACCT on 24/8/10, for closure review next week. Denied deliberate self harm

thoughts or intent.

Low in Mood Notes: Saul is compliant with his medication, no side effects reported.

Low in Mood Notes: 1-1 facilitated, Saul stated he is fine and denied self harm or suicidal intent or thoughts.







History: Mood stable (Ua1r8) overnight No thoughts of deliberate self harm (XaIuw) expressed no concerns raised,












Dsh and depression. Notes: Generally settled in mood and behaviour.

Dsh and depression. Notes: Mr Altel requested to play chess during association time, which was facilitated.

Dsh and depression. Notes: Noted to be interacting appropriately with peers, no concerns raised.

Dsh and depression. Notes: 1.1 offered and accepted, stated that he was fine, did not verbalise any self harm or

suicidal ideation.

Low in Mood Notes: Careplan adhered to.

Low in Mood Notes: Complied with his medication regime, no side effects reported or noted.

Low in Mood Notes: 1.1 facilitated, presented with good eye contact, stated that he was fine, no issues of self harm

verbalised.

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History: Mood stable (Ua1r8)overnight no concerns raised.










Dsh and depression. Notes: No DSH issues.

Low in Mood Notes: Saul was facilitated a 1;1 session . He appeared settled in mood and pleasant on approach

today. No self harm issues.






History: Mood stable (Ua1r8) overnight no concerns raised












Dsh and depression. Notes: Presented as settled and brighter in mood and behaviour.

Dsh and depression. Notes: He was out for exercise this morning and association.

Dsh and depression. Notes: Good rapport with peers observed.

Dsh and depression. Notes: Denied self harm thoughts or suicidal intent on spoken, appeared to be in good spirit.

Low in Mood Notes: Care plan adhered to.

Low in Mood Notes: Mr Altel is compliant with his medication and treatment plan, no concerns expressed.

Low in Mood Notes: Mr Altel stated that he is fine, no self harm thoughts verbalised.





30 Aug 2010 06:37 Surgery: BHEBHE, Sifiso (Practice Nurse) Entered at: HMP Elmley


Low in Mood Notes: saul reported he was ok at the start of the night shift no thoughts of self-harm reported complied

with his meds this am







Dsh and depression. Notes: Presented as bright and cheerful in mood and behaviour.

Dsh and depression. Notes: He socialised with peers and participated in all activities.

Dsh and depression. Notes: Good rapport observed with peers.

Dsh and depression. Notes: Mr Altel stated he is fine on spoken to, no deliberate self harm thoughts or suicidal intent

expressed.

Low in Mood Notes: He is compliant with his medication, no side effects reported.

Low in Mood Notes: Mr Altel was seen by Dr Feeney, he is fit for discharge from IPD and to apply for rule 45. He

ststed he is fine with this decision.



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01 Sep 2010 12:03 Surgery: NGARIZE, Tendai (Mr) (Practice Nurse) Entered at: HMP Elmley


Low in Mood Notes: 1.1 session facilitated amenable and pleasant on approach.




01 Sep 2010 12:05 Surgery: NGARIZE, Tendai (Mr) (Practice Nurse) Entered at: HMP Elmley


Low in Mood Notes: Presented as euthymic in mood and remains concordant with medication regime.




01 Sep 2010 12:06 Surgery: NGARIZE, Tendai (Mr) (Nurse Access Role) Entered at: HMP Elmley


Dsh and depression. Notes: Interactive with peers played pool.




01 Sep 2010 12:39 Surgery: NGARIZE, Tendai (Mr) (Nurse Access Role) Entered at: HMP Elmley


Dsh and depression. Notes: diet and fluids taken at mealtimes.




01 Sep 2010 18:22 Surgery: MAIBVISIRA, Francis (Mr) (Health Professional Access Role) Entered at: HMP Elmley


Status Update for Healthcare Referral In: Discharged From Care

02 Sep 2010 08:41 Surgery: LONG, Hayley (Mrs) (Administrator) Entered at: HMP Elmley

Stay: 02 Sep 2010 08:41 - 03 Sep 2010

03 Sep 2010 08:38 Surgery: LONG, Hayley (Mrs) (Administrator) Entered at: HMP Elmley

Stay: 03 Sep 2010 08:38 - 17 Dec 2010




Status Update for Healthcare Referral In: Discharged From Care

06 Sep 2010 10:36 Health Centre: SHAH, Rajiv (Dr) (General Medical Practitioner) Entered at: HMP Elmley

Medication review done (XaF8d)

(R) Doxycycline 100mg capsules - 30 capsules - Noon: 1.0 capsules

Doxycycline 100mg capsules - 30 capsules - Noon: 1.0 capsules

Ended 01 Nov 2010 Patient Preference (patient has stopped colecting for long time) by SHAH, Rajiv (Dr)

10 Sep 2010 09:27 Surgery: FEENEY, Sean (Dr) (Psychiatrist) Entered at: HMP Elmley

History: Dr Feeney; seen in IPD on 31st August. Feeling much better, up and down rather than down; Able to talk

more and more engaged. Optimistic on good days; is hoping to go to HB6. States that he has had periods of high

energy, overactivity, and sleeplessness over several days on a number of occasions in the past, so the question of

future need for mood stabiliser arises. Says 'thank you very much for your help ... your'e a thorough Gent'. PLAN -

discharge next week to single cell; FU by me 1 week; check literature re mood stabilizer.

13 Sep 2010 11:23 Health Centre: SHAH, Rajiv (Dr) (General Medical Practitioner) Entered at: HMP Elmley


13 Sep 2010 12:25 Surgery: FEENEY, Sean (Dr) (Psychiatrist) Entered at: HMP Elmley

History: Seen OPD on 10th. States is well - 'perfect!' - and is looking forward with enthusiasm to going to the gym wvt

regaining weight.

23 Sep 2010 10:06 Health Centre: PARKS, Claire (Miss) (Administrator) Entered at: HMP Elmley

24 Sep 2010 08:48 Surgery: WISEMAN, Samantha ('Other' Community Health Service) Entered at: HMP Elmley

04 Oct 2010 11:00 Health Centre: SANDS, Rebecca (Miss) (Pharmacy Technician) Entered at: HMP Elmley


04 Oct 2010 11:19 Health Centre: SHAH, Rajiv (Dr) (General Medical Practitioner) Entered at: HMP Elmley

Medication review done (XaF8d)

(R) Venlafaxine 150mg modified-release tablets - 28 tablets - AM: 1.0 tablets

Venlafaxine 150mg modified-release tablets - 28 tablets - AM: 1.0 tablets

Ended 01 Nov 2010 Patient Preference (patient has DNA for medicine) by SHAH, Rajiv (Dr)

05 Oct 2010 09:55 Health Centre: PARKS, Claire (Miss) (Administrator) Entered at: HMP Elmley

06 Oct 2010 09:04 Surgery: WISEMAN, Samantha ('Other' Community Health Service) Entered at: HMP Elmley

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01 Nov 2010 11:08 Health Centre: SHAH, Rajiv (Dr) (General Medical Practitioner) Entered at: HMP Elmley

10 Nov 2010 13:36 Surgery: ROBINSON, Dee (Medical Secretary) Entered at: HMP Elmley

History: Seen by Dr Feeney

He stated he is completely well at present and has not had any medication at all for over a month. He said his

appetite and sleep are good and he has gained weight, up to about 60kg, though he still looks quite thin. When his

mother came to see him recently she was surprised to see how much weight he has lost. However, he is essentially

euthymic and is going to the gym every day. He has now been told he will have full access to his daughter when he

is released from custody and he is looking forward greatly to getting out.

I will review him should the need arise in 6 weeks time.

01 Dec 2010 09:46 Health Centre: PARKS, Claire (Miss) (Administrator) Entered at: HMP Elmley

04 Dec 2010 09:32 Surgery: WOODS, Steve (Manager) Entered at: HMP Elmley

17 Dec 2010 09:12 Surgery: WISEMAN, Samantha ('Other' Community Health Service) Entered at: HMP Elmley

Stay: 17 Dec 2010 09:12 - 25 Apr 2011

11 Jan 2011 06:49 Surgery: BHEBHE, Sifiso (Practice Nurse) Entered at: HMP Elmley

History: Headache (XE0rh)

Examination: requested and received parcetamol 1 gram given by night osg Julie

11 Jan 2011 12:47 Surgery: ROBINSON, Dee (Medical Secretary) Entered at: HMP Elmley

History: Seen by Dr Feeney 10.01.11 - OPD

Seen by Dr Feeney in industrial cleaning. He has been given a job as a cleaner and is in the process of training to

do this. He has been well, no depression. He has been active and going to the gym regularly. He is on no

medication. I will him again in about two month's time.

12 Jan 2011 14:41 Health Centre: SANDS, Rebecca (Miss) (Pharmacy Technician) Entered at: HMP Elmley

History: 2 paracetamol issued by officer fairclough on the HB

13 Jan 2011 09:47 Health Centre: SANDS, Rebecca (Miss) (Pharmacy Technician) Entered at: HMP Elmley

History: 2 paracetamol issued by officer haywood on HB at 9.50am

07 Feb 2011 10:48 Health Centre: DENSHAM, Ronald (Mr) (Officer) Entered at: HMP Elmley

History: Special Sick

Examination: Swelling and redness to left side of face, painful to touch.

Diagnosis: He stated that he has no allergys and has had the medicatoin before. Medication explained and issued

Amoxicillin250mg and Ibuprofen 200mg x16

09 Feb 2011 09:47 Health Centre: PARKS, Claire (Miss) (Administrator) Entered at: HMP Elmley

10 Feb 2011 09:29 Surgery: WISEMAN, Samantha ('Other' Community Health Service) Entered at: HMP Elmley

07 Mar 2011 01:14 Surgery: BOYLE, Hugh (Healthcare Assistant) Entered at: HMP Elmley

History: Paracetamol 500mg soluble tablet (di22.) - 2 Paracetamol authorised to be issued by officer on the HB at

01.15hrs

Examination: c/o a headache

26 Apr 2011 08:56 Surgery: TUCKER, John (Clerical Access Role) Entered at: HMP Elmley

02 Nov 2011 14:22 H, Health Centre: PARKS, Claire (Miss) (Administrator) Entered at: HMP Elmley

Paper record held here (Y1800)

02 Feb 2012 20:32 Surgery: Unknown Staff Member Entered at: Hmp Rochester Entered: 11 Apr 2013 14:32

Previous Home Address: ZZ99 3VZ

02 Feb 2012 20:32 HCC, Surgery: LASKEY, Christine (Ms) (Sister/Charge Nurse) Entered at: HMP Lewes

Date Of Birth Changed From '01 Jan 1900', Address Entered


Sentence: 02 Feb 2012 - 21 Feb 2013

Stay: 02 Feb 2012 20:32 - 03 Feb 2012

02 Feb 2012 20:32 Surgery: Unknown Staff Member Entered at: HMP Winchester Entered: 14 Jan 2015 16:52


02 Feb 2012 20:32 Surgery: Unknown Staff Member Entered at: Hmp Camp Hill Entered: 07 Oct 2013 21:22


02 Feb 2012 20:32 Surgery: Unknown Staff Member Entered at: HMP Wormwood Entered: 16 Feb 2016 02:32

Scrubs



History: Seen by nurse (XaATp)No thoughts of deliberate self harm (XaIuw) and No suicidal thoughts (XaIJ7).

Cheerful mood (Ua1X9) although c/o feeling hungry and tired. No problems identified. Completed Hep B.

Tuberculosis: no (Y093d)

Asthma: no (Y0944)

Sickle cell carrier: no (Y09fe)

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Prisoners alcohol intake week before custody (YX013) 0 Units / Week

Has not stayed in a psychiatric hospital (Y08e2)

Prisoner does not take drug intravenously (Y08f9)

Prisoner has not used drugs in the last month (Y08f7)

Diabetes mellitus: no (Y093f)

Has not seen Doctor in previous few months (Y08d6)

Has no outstanding hospital/ Doctors appointments (Y07f8)

Health information not received from outside source: no (Y09cc)

Is not receiving prescribed medication (Y08d7)

Epilepsy: no (Y0941)

Chest pain: none (Y092a)

Has not received physical injuries recently (Y08d8)

First Reception Screening (Positive Response) (Y0801)

Has not been homeless in the past year (Y08db)

No medical/ psychiatric report required (Y08d9)

Has not been in prison before (Y08dc)

Prisoner does not feel like Self Harming or Suicide (Y0903)

Prisoner has a psychiatric nurse or care worker in the community : no (Y09d1)

Prisoner has not received treatment from a psychiatrist outside prison: no (Y09ce)

Prisoner has not tried to harm themselves (outside prison) (Y09fa)

No immediate action required (YX027)

Fit for normal location, work and any cell occupancy (YX035)

Prisoner has tried to harm themselves (in prison) (YX020)

Health care services information leaflet given (XaLMh)

03 Feb 2012 09:53 HCC, Surgery: MORLEY, Lynn (Clerical Worker) Entered at: HMP Lewes

Stay: 03 Feb 2012 09:54 - 15 Mar 2012

06 Feb 2012 07:55 Surgery: STEVENS, Helen (Community Psychiatric Nurse) Entered at: HMP Lewes

Reason for referral (XaIpS)

Phone call from Donna Beard informing us that Saul has returned to prison and for us to be aware.

Saul has a history of depression.

Referral In to HMP Highdown for In Reach: Ended on 14 Feb 2012 14:45

With the Following Intervention(s)

Referral back to GP

Status Update for In Reach Referral In: Receiving Care


Saul has been in HMP Lewes previously and spent time on HCC for depression. He was previously known as Saul

Altel.

Seen today on F wing, Saul was pleased to see me and informed me that he is very well and does not even take

antidepressants any longer. Reports being back on recall which he is not happy about but showed no evidence of

being depressed. Denied having any issues that would warrant Inreach/Mental health involvement and confirmed

that he knows how to access support if he requires it. Denies any current thoughts/urges to self harm or current

suicidal ideation.

According to eCPA document saved in record attachments from court Liaison Saul took an OD July 2011 due to

crisis regarding housing and relationship.

To discuss with Dr Gibbs in MDT meeting.

Acrobat Document: sa.pdf - Court Liaison report



Notes summary on computer (9344.)

History of depressive episodes in past

Reactive depression.

History of Borderline PD

Referral declined (XaPBy)

Notes summary on computer (9344.)

Has been known to Lewes prison, Saul is currently well and aware of how to access support if required.

Took OD in July 2011.

Diagnosis of Borderline PD

Yes (Y0427)

Notes summary on computer (9344.) - Call from Court Liaison Donna Beard

No (Y0428)

Yes (Y0427)

No (Y0428)

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Plan (XaIVg) - To be managed in Primary care.

Yes (Y0427) - Paula Message

Yes (Y0427)


Status Update for In Reach Referral In: Discharged From Care

15 Mar 2012 10:52 HCC, Surgery: MORLEY, Lynn (Clerical Worker) Entered at: HMP Lewes

Stay: 15 Mar 2012 10:52 - 27 Mar 2012

23 Mar 2012 02:59 Surgery: MACDONALD, Mary (Mental Health Nurse) Entered at: HMP Lewes

not on a detox and no outstanding appointments and therefore appears fit for transfer

23 Mar 2012 10:15 HCC, Surgery: MORLEY, Lynn (Clerical Worker) Entered at: HMP Lewes

27 Mar 2012 Surgery: DELL, Lindsay (Miss) (Administrator) Entered at: Hmp Entered: 28 Mar 2012 11:03

Camp Hill

Clinic Letter to Hmp Camp Hill

27 Mar 2012 Surgery: DELL, Lindsay (Miss) (Administrator) Entered at: Hmp Entered: 28 Mar 2012 11:04

Camp Hill

Second Reception Screening (Y0da6) (New Episode)

27 Mar 2012 13:54 Surgery: PACKER, Julie (Staff Nurse) Entered at: Hmp Camp Hill


Stay: 27 Mar 2012 13:54 - 30 Mar 2012


No thoughts of deliberate self harm (XaIuw)

No current indication/evidence of risk, suitable for multi-cell location (Y4579)

O/E - height (229..) 1.75 m (5 ' 9 ")

Pulse rate (X773s) 77 bpm

Past medical history (14...) - nil of note

Prisoner has been in prison before (YX004) - come from Lewis. Also has been at Camphill before.

Adult male (Y3072)


Prisoner has received medication for mental health problems (YX019) - was on anti depressents a few years ago. Nu

current issues

Emotional state observations (Ua16B) - no concerns

O/E - weight (22A..) 62.4 Kg (9 st 12 lb)

Unknown (X90UG)

Unknown (X90UG)

Unknown (X90UG)

Hepatitis B immunisation (X74VC)

New patient screening (68R..) - Fit and well. No concerns. Already had Hep B vaccinations.

Learning disabilities health action plan declined (XaJW9)

Hep B Vacc - immunised already (Y075d)

Expected peak expiratory flow rate (XaEFL) 631 L/min

Ideal body weight (66CB.) 76.26 Kg (12 st)

Body mass index - observation (22K..) 20.38 Kg/m²

Smoker (137R.)

Tuberculosis (BCG) vaccination (653..)

Prisoner has concerns over their physical health (YX009) - fit 1a

Not disabled (Y3416)

124 / 57 mmHg

30 Mar 2012 14:34 Surgery: DELL, Lindsay (Miss) (Administrator) Entered at: Hmp Camp Hill

Stay: 30 Mar 2012 14:34 - 16 Apr 2012

30 Mar 2012 15:15 Surgery: DENHAM, Susan (Staff Nurse) Entered at: Hmp Camp Hill


Paracetamol 500mg tablets - 16.0 tablets - take 1 or 2 4 times/day

31 Mar 2012 07:04 Surgery: Unknown Staff Member Entered at: Hmp Camp Hill

Diagnosis Summary Marked in Error:

27 Mar 2012 14:31 New patient screening (68R..) was in summary



02 Feb 2012 20:32 First Reception Screening (Positive Response) (Y0801) was in summary

04 Apr 2012 09:32 HMP Prison: STRYDOM, Adriaan (Dr) (Doctor) Entered at: Hmp Camp Hill

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History: seen on segregation unit

Examination: npr

05 Apr 2012 09:51 Surgery: HARRIS, Mike (Staff Nurse) Entered at: Hmp Camp Hill

Seen by nurse (XaATp) - in segregation unit. Nothing to report but has asked for Aqueous cream.

06 Apr 2012 09:18 Surgery: WILLIAMS, Mark (Dr) (Doctor) Entered at: Hmp Camp Hill

History: Seen in segregation unit (Y0ce3) CO Rt upper chest/shoulder pain, releived by holding arm to side, no h/o

cough, temp etc.

Ibuprofen 200mg tablets - 24 tablets - take one or two 3 times/day


05 Apr 2012 09:51 Seen by nurse (XaATp) was in summary

07 Apr 2012 10:54 Surgery: DENHAM, Susan (Staff Nurse) Entered at: Hmp Camp Hill

History: Seen by Nurse on Seg Round - NPR

Examination: Fit and well (Xa96k)

Plan: Review of admission to segregation unit (XaPmi)





09 Apr 2012 09:17 Surgery: WILLIAMS, Mark (Dr) (Doctor) Entered at: Hmp Camp Hill

History: Seen in segregation unit (Y0ce3) NPR

10 Apr 2012 10:34 Surgery: WINZAR, Jacqueline (Staff Nurse) Entered at: Hmp Camp Hill




11 Apr 2012 09:23 HMP Prison: MANNING, Victoria (Dr) (Doctor) Entered at: Hmp Camp Hill

History: Seen by general practitioner (9N21.)

Seen in segregation. No medical complaints. Appears to be coping well.






16 Apr 2012 08:55 Surgery: DELL, Lindsay (Miss) (Administrator) Entered at: Hmp Camp Hill

Stay: 16 Apr 2012 08:55 - 10 Oct 2012

20 Apr 2012 16:27 Surgery: BROWNING, Tanya (Staff Nurse) Entered at: Hmp Camp Hill


Paracetamol 500mg tablets - 16.0 tablets - take 1 or 2 4 times/day

10 Jul 2012 09:29 Surgery: PACKER, Julie (Staff Nurse) Entered at: Hmp Camp Hill

History: c/o acne and wanting oral ABx.

Examination: Mild acne to forehead. Back appears a little more severe. States previous GP px oral ABx. No record

on S1.

Plan: Ref to GP. Appt booked for Friday.

13 Jul 2012 11:05 HMP Prison: WILLIAMS, Mark (Dr) (Doctor) Entered at: Hmp Camp Hill

History: Acne - ongoing problems, used Minicin Outside.

Examination: Acne spots at various stages, face & shoulders affected.


Plan: Re-instate Tx.

Minocycline 100mg modified-release capsules - 56 capsules - take one daily

QUINODERM ANTIBACTERIAL wash [QUINODERM] - 100 millilitres - bd

17 Jul 2012 11:52 Surgery: DENHAM, Susan (Staff Nurse) Entered at: Hmp Camp Hill

24 Sep 2012 10:17 HMP Prison: WILLIAMS, Mark (Dr) (Doctor) Entered at: Hmp Camp Hill

History: acne - settled on Tx but has recurred


History: Seb cyst on forehead - present several months

Examination: mobile cyst on forehead

Diagnosis: Sebaceous cyst (XaIP9)

Medication review done (XaF8d) - Acne Rx -> repeat.

Referral for minor surgery (XaJub)

(R) Minocycline 100mg modified-release capsules - 56 capsules - take one daily

(R) QUINODERM ANTIBACTERIAL wash [QUINODERM] - 100 millilitres - bd

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Hospital Referral for minor surgery


Ended 22 Feb 2013 Patient Deducted (Hmp Camp Hill) by PACKER, Julie

QUINODERM ANTIBACTERIAL wash [QUINODERM] - 100 millilitres - bd

Ended 22 Feb 2013 Patient Deducted (Hmp Camp Hill) by PACKER, Julie

24 Sep 2012 12:23 Surgery: DELL, Lindsay (Miss) (Administrator) Entered at: Hmp Camp Hill

Hospital Referral for minor surgery updated: Waiting For Information

27 Sep 2012 12:19 Surgery: PICKERING, Sarah (Miss) (Staff Nurse) Entered at: Hmp Camp Hill

10 Oct 2012 12:31 Surgery: BRADLEY, Sarah (Mrs) (Administrator) Entered at: Hmp Camp Hill

Stay: 10 Oct 2012 12:31 - 22 Feb 2013

20 Oct 2012 16:17 Surgery: PICKERING, Sarah (Miss) (Staff Nurse) Entered at: Hmp Camp Hill

History: Medication given (8B311)

Examination: 28 x Minocycline given as precribed, unable to click off on S1

(R) QUINODERM ANTIBACTERIAL wash [QUINODERM] - 100 millilitres - bd

26 Oct 2012 14:47 Surgery: PEACEY-WILCOX, Saffron (Administrator) Entered at: Hmp Camp Hill

Angiography Report to Mr Saul Turner

Hospital Referral for minor surgery updated: Appointment Booked

12 Nov 2012 11:20 Surgery: HULL, Susan (Mrs) (Pharmacy Technician) Entered at: Hmp Camp Hill

(R) Minocycline 100mg modified-release capsules - 56 capsules - take one daily

19 Nov 2012 11:50 Surgery: SKELDON, Maria (Ms) (Clinical Team Manager) Entered at: Hmp Camp Hill

(R) Minocycline 100mg modified-release capsules - 56 capsules - take one daily (Future dated medication 07 Jan

2013)

02 Dec 2012 15:11 Surgery: WINZAR, Jacqueline (Staff Nurse) Entered at: Hmp Camp Hill

History: Transfer of care (XaBPq)


Plan: per completed - for pt to attend SMH - for Maxillofacial appoint 12/12/12 - 14.15

02 Dec 2012 15:23 Surgery: WINZAR, Jacqueline (Staff Nurse) Entered at: Hmp Camp Hill

12 Dec 2012 Surgery: BRADLEY, Sarah (Mrs) (Administrator) Entered at: Hmp Entered: 07 Jan 2013 11:37

Camp Hill

Clinic Letter to Dr Victoria Manning

12 Dec 2012 Surgery: MANNING, Victoria (Dr) (Doctor) Entered at: Hmp Camp Entered: 10 Jan 2013 09:59

Hill


Camp Hill

Letter from consultant (XM1Tt) (New Episode)


Camp Hill

Letter from consultant (XM1Tt) (New Episode)

12 Dec 2012 Surgery: MANNING, Victoria (Dr) (Doctor) Entered at: Hmp Camp Entered: 10 Jan 2013 09:59

Hill

28 Dec 2012 09:45 Surgery: DELL, Lindsay (Miss) (Administrator) Entered at: Hmp Camp Hill

Letter to Patients to Mr Saul Turner

Hospital Referral for minor surgery updated: Appointment Booked

13 Jan 2013 11:51 Surgery: PICKERING, Sarah (Miss) (Staff Nurse) Entered at: Hmp Camp Hill

History: Transfer of care (XaBPq)


Plan: For hospital appointment 21/1/13

21 Jan 2013 Surgery: STRYDOM, Adriaan (Dr) (Doctor) Entered at: Hmp Camp Entered: 08 Feb 2013 10:39

Hill

HISTOLOGY: CLINICAL INFORMATION:-

Skin. epidermoid cyst, forehead excision.

MACRO:-

Ellipse of skin 10x3mm with underlying whitish nodule 11x7x7mm.

MICRO:-

Skin shows an epidermal inclusion cyst ('sebaceous cyst'). No atypi

a

and no features of malignancy are seen.

LESION, CYST FOREHEAD - EPIDERMAL CYST.

Dr Kamarul Jamil, MBChB, FRCPath, Consultant Histopathologist

29.01.13.

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Reports are authorised electronically.

HISTOLOGY Report, Normal, Communicate Patient

28 Jan 2013 09:01 Surgery: WINZAR, Jacqueline (Staff Nurse) Entered at: Hmp Camp Hill

Removal of skin sutures (Y8880) - 4 sutures removed from forhead , no sign of infection, wound cleaned and small

dressing applied for one -two days just to allow the skin to heal completley . informed pt to return if he gets any sign

of infection or any other problems.

08 Feb 2013 10:38 Surgery: STRYDOM, Adriaan (Dr) (Doctor) Entered at: Hmp Camp Hill

Angiography Report to Mr Saul Turner

16 Feb 2013 13:59 Surgery: VERLANDER, Lesley (Staff Nurse) Entered at: Hmp Camp Hill

Medically fit for prison transfer (XaQfN)

22 Feb 2013 09:17 Surgery: PACKER, Julie (Staff Nurse) Entered at: Hmp Camp Hill

Stay: 22 Feb 2013 09:17 - 21 Feb 2013

22 Feb 2013 09:17 Surgery: Unknown Staff Member Entered at: HMP Lewes Entered: 03 Jun 2013 04:22

22 Feb 2013 10:39 Surgery: JAMES, Denise (Business Manager) Entered at: HMP Lewes




Prisoner has not tried to harm themselves (in prison) (Y09f9)





No known allergies (1151.)






Has not received medication for mental health problems (Y08e6)



Prisoner has been in prison before (YX004)




Has no concerns over their physical health (Y08dd)


Asthma: no (Y0944)


Prisoner seen doctor in previous few months (YX005)



Other Consent Given (Y9959)


Prisoner receiving prescribed medication (YX007) - medication for achne

Sentence: 22 Feb 2013 - 02 Nov 2013

Stay: 22 Feb 2013 15:17 - 25 Feb 2013



History: Seen by nurse (XaATp)No thoughts of deliberate self harm (XaIuw)and No suicidal thoughts (XaIJ7)at time

of writing. No other problems identified. For prescribed medication for acne. Completed hep b vaccinations.

Hepatitis B immunisation (X74VC) - completed

25 Feb 2013 10:23 Surgery: JAMES, Denise (Business Manager) Entered at: HMP Lewes

Stay: 25 Feb 2013 10:23 - 12 Mar 2013

11 Mar 2013 15:28 Surgery: SKELDON, Maria (Ms) (Clinical Team Manager) Entered at: Hmp Camp Hill

Hospital Referral for minor surgery ended: Transferred Out Of Area

12 Mar 2013 10:16 Surgery: BARDEN, Anne (Clerical Access Role) Entered at: HMP Lewes

Stay: 12 Mar 2013 10:16 - 15 Mar 2013

13 Mar 2013 10:07 Surgery: KELLY, Steve (Mental Health Nurse) Entered at: HMP Lewes

Not on detox, no outstanding hospital apptmnts, fit for transfer.

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13 Mar 2013 17:15 Surgery: FULLER, Jane (Nurse Access Role) Entered at: HMP Lewes

History: Seen in segregation unit for completion of algortihm. Saul has brought a debt with him from another prison,

this has resulted in him being moved from a wing. Saul refused to relocate and was subsequently relocated to the

segregation unit where he most likely has a razor blade in his possession. Seen in cell, states he is fit and well

though believes his canteen of over one hundred pounds has been witheld/missing/taken. Saul demands his money

back immediatly and has made a threat to DSH if the canteen or money is not given to him, though he does state he

is not suicidal and this is a direct reaction to him not getting what he feels is his. Algorithm completed, fit for seg,

stated on form that if Saul does DSH then this will be reassessed.

15 Mar 2013 10:13 HCC, Surgery: CREAN, Ernest (General Medical Practitioner) Entered at: HMP Lewes

Patient reviewed (6A...) - seen in seg , no concerns

15 Mar 2013 11:37 Surgery: BARDEN, Anne (Clerical Access Role) Entered at: HMP Lewes

Stay: 15 Mar 2013 11:37 - 11 Apr 2013

15 Mar 2013 12:43 Surgery: STEVENS, Helen (Community Psychiatric Nurse) Entered at: HMP Lewes

Seen in segregation this morning - is currently located there as refuses to move any where. Has been known to

HCC in the past and Inreach for depression. Currently denies having any self harming thoughts or suicidal ideation

and is keen to have his property and monies sorted so he can settle. Reports that a lot of social circumstances

have changed since I saw him last. Fit to remain in the segregation unit currently.

17 Mar 2013 10:49 Surgery: HALLIWELL, Vanessa (Staff Nurse) Entered at: HMP Lewes

History: Seen in Seg. Chart and cream over on F wing so, will take them over PM. No other issues raised for HC


History: Seen in Seg. No issues raised for HC

19 Mar 2013 12:55 Surgery: STEVENS, Helen (Community Psychiatric Nurse) Entered at: HMP Lewes

Seen in segregation unit this morning for an algorithm prior to adjudication, no current mental or physical health

issues so has been fitted for cellular confinement if required.

Seen by member of prison inreach mental health team (XaP7x)

20 Mar 2013 11:15 Surgery: LASKEY, Christine (Ms) (Sister/Charge Nurse) Entered at: HMP Lewes

History: Segregation unit referral (XaPmc)no problems identified.

20 Mar 2013 15:03 Prison: CARTER, Elizabeth (General Medical Practitioner) Entered at: HMP Lewes

Patient reviewed (6A...) - In seg, well

21 Mar 2013 08:27 Surgery: CONLEY, Christopher (Mr) (Staff Nurse) Entered at: HMP Lewes

History: Seen in segregation unit (Y0ce3)

No issues

Ongoing review (XaIpj)

21 Mar 2013 15:45 Surgery: CONLEY, Christopher (Mr) (Staff Nurse) Entered at: HMP Lewes

History: Segregation unit referral for good order and discipline (XaPmf)

Good review. in segregation for refusing to return to ordinary location in protest to canteen money being 'stolen'

Complaint is being dealt with at senior level following appear process. Saul is requesting legal advice regarding

taking things further and potential criminal proceedings.

5 days CC ended at the beginning of the week.

No current problems regarding healthcare. Seen daily by staff and is aware of how to access support.

For review in 2 weeks.


History: Seen in segregation unit (Y0ce3)no problems identified.

22 Mar 2013 10:04 Surgery: CREAN, Ernest (General Medical Practitioner) Entered at: HMP Lewes

Patient reviewed (6A...) - seen in seg, no concerns today

23 Mar 2013 12:26 Surgery: JUTSON, Stacy (Staff Nurse) Entered at: HMP Lewes

Seen in segregation unit (Y0ce3) - no conerns raised to HCC.



25 Mar 2013 12:38 Surgery: CARTER, Elizabeth (Clinical Practitioner Access Role) Entered at: HMP Lewes

Seen in seg well.

27 Mar 2013 12:26 Surgery: CARTER, Elizabeth (Clinical Practitioner Access Role) Entered at: HMP Lewes

seen in seg fine


History: Seen in Seg Unit. No issues raised for HC


History: Seen in Seg. No issues raised for HC

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02 Apr 2013 08:53 Surgery: HURN, Richard (Nurse Access Role) Entered at: HMP Lewes

Seen in segregation no healthcare issues raised.

Seen in segregation unit (Y0ce3)

02 Apr 2013 10:37 Surgery: CREAN, Ernest (General Medical Practitioner) Entered at: HMP Lewes


03 Apr 2013 09:20 Surgery: LASKEY, Christine (Ms) (Sister/Charge Nurse) Entered at: HMP Lewes

History: Seen in segregation unit (Y0ce3)no problems identiifed.

03 Apr 2013 10:17 Surgery: CARTER, Elizabeth (Clinical Practitioner Access Role) Entered at: HMP Lewes

Seen in seg well

03 Apr 2013 14:41 Surgery: KELLY, Steve (Mental Health Nurse) Entered at: HMP Lewes

Seen at GOOD review, no DSH or healthcare issues, to remain in seg.

04 Apr 2013 09:18 Surgery: MOYO, Sithembile (Mrs) (Nurse Access Role) Entered at: HMP Lewes

Declined to be seen by the nurse

Told the officers that he was well, no health-care issues were reported

04 Apr 2013 09:39 Surgery: JONES, Stacy (Sister/Charge Nurse) Entered at: HMP Lewes

fitted for transfer




05 Apr 2013 12:40 Surgery: HURN, Richard (Nurse Access Role) Entered at: HMP Lewes

Seen in segregation no healthcare issues raised.



History: Seen in segregation unit (Y0ce3)c/o headache over last few days. for review by g.p. tomorrow. Given

analgesia for relieve of headache. No other problems identified.




Patient reviewed (6A...) - seen in seg , no concerns today

10 Apr 2013 08:34 Surgery: LITTLE, Alastair (Mr) (Sister/Charge Nurse) Entered at: HMP Lewes

History: No issues raised.


10 Apr 2013 10:06 Surgery: CARTER, Elizabeth (Clinical Practitioner Access Role) Entered at: HMP Lewes

Seen in Seg says well.

11 Apr 2013 Prison: BELL, Sarah (Medical Secretary) Entered at: Hmp Entered: 13 Apr 2013 10:58

Rochester

Document to Hmp Rochester

11 Apr 2013 Surgery: BELL, Sarah (Medical Secretary) Entered at: Hmp Entered: 13 Apr 2013 10:58

Rochester

medication compact and consent to transfer of information



11 Apr 2013 14:32 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at: Hmp Rochester

Stay: 11 Apr 2013 14:32 - 12 Apr 2013



Prisoner has received physical injuries over the past few days (YX008)

O/E appearance (XM09b) - Is taking Minocilline for his acne and needs to continue treatment.


Smoker (137R.) - 25grams of tobacco a week

Asthma: no (Y0944)

Able to write (XaAzO)


Does not have a psychiatric nurse or care worker (Y08e4)

Normal vision (668A.)

No hearing problems (Y1103)

Able to read (XaBme)


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Prisoner receiving prescribed medication (YX007) - Minocilline

Patient registered - GPR (XE2y4)




Reads English (XaIMM)

English language (Xa6ev)


White British (XaFwD)

Country of birth (XaG2A) - UK

Not religious (135D.)

Paper record held here (Y1800) - paper record signed

At risk state (Xa1qc) 11 - Presentation: Orientated,Cheerful,Communicative

Previous Mental Health Problems: Seen a psychiatrist, antidepressants given

Previous in Possession: yes

History of Self Harm: N/A

History of overdose: Once 1-2 years ago

Cell Sharing (refer to cell sharing risk assessment): Single

Type of Medication: N/A

Age: 19 or above

Orientated (X75yi)

Health Information the prisoner thinks is important (YX024) - On antibiotics for his acne that he needs to continue.

Fit to attend gym (XaKkp)

Consent given to share patient data with specified 3rd party (XaNwR)

Consent obtained (Y001d) - paper record signed

Agitation or aggression (Y4573) - He states he gets agitated with someone around with him in the cell

Clear indication of high level of risk that prisoner might assault cell mate (Y4577) - He states he gets agitated if there

is anothe person sharing in his cell

Psychiatric monitoring (8A2..)

Prisoner assessment for in-possession medication completed (XaPim)

Drug overdose (Xa4eX)

Fit for work (13JW.)

No thoughts of deliberate self harm (XaIuw) - He said that he feels alright at the moment. No thoughts of self harm or

suicide.

Prisoner has not tried to harm themselves (outside prison) (Y09fa) - suicide attempt in 2011, tried to overdose.

Prisoner has tried to harm themselves (in prison) (YX020) - has self harmed few times, cut himself when he was

depressed

Prisoner has received treatment from a psychiatrist outside prison (YX016) - 2007 & 2011 re: Depression. No longer

on medications



Teetotaller (1361.)

None used (X90cT)

Did not attend substance misuse clinic (XaJsy)

At risk of DSH - deliberate self harm: no (Y09a3)

Moderate suicide risk (XaIeW)

H/O: deliberate self harm (XaF9U)

12 Apr 2013 08:52 Old Healthcare, Surgery: NOWICKA, Katarzyna (Medical Secretary) Entered at: Hmp Rochester

Stay: 12 Apr 2013 08:52

12 Apr 2013 12:06 Surgery: BELL, Sarah (Admin/Clinical Support Access Role) Entered at: Hmp Rochester

PNG Image: Photo.PNG

Reminder/Alert: CSRA - HIGH - SINGLE - Priority: High

Reminder/Alert: MEDICATION SCORE - 11 - Priority: High

16 Apr 2013 10:29 New Healthcare, Surgery: WICKENS, Angela Entered at: Hmp Entered: 17 Apr 2013 01:45

Rochester

Did not attend for Nurse Clinic appointment with Angela Wickens


19 Apr 2013 09:52 Surgery: SHAH, Rajiv (Dr) ('Other' Community Health Service) Entered at: Hmp Rochester


19 Apr 2013 15:29 Surgery: MOREEA, Yacoob (Mr) (Nurse Access Role) Entered at: Hmp Rochester

Thu 23 Apr 2020 15:02



C30

C31

Printed



15 May 2013 10:19 Surgery: OSUAGWU, Ferdinand (Dr) (GP Partner) Entered at: Hmp Rochester


15 May 2013 16:54 Surgery: VALINO, Maria (Mrs) (Nurse Access Role) Entered at: Hmp Rochester

23 May 2013 13:35 Surgery: CARTER, Ellen (Ms) (Admin/Clinical Support Access Role) Entered at: Hmp Rochester

Seen by smoking cessation advisor (XaIye) - co read 10 nrt 25mg patches 16hr and x 1 box 15mg uinhalator booklet

issued and treatment explained.

30 May 2013 13:26 Surgery: CLIFTON, Hannah (Miss) (Admin/Clinical Support Access Role) Entered at: Hmp

Rochester

Seen by smoking cessation advisor (XaIye) - Attended appt. CO reading 3, issued with 25mg nicorette patches

(16hr) and 15mg nicorette inhalator (1x20pk). Praise given for good reduction in Carbon monoxide reading.

06 Jun 2013 14:11 Surgery: CLIFTON, Hannah (Miss) (Admin/Clinical Support Access Role) Entered at: Hmp

Rochester

Seen by smoking cessation advisor (XaIye) - Attended appt. CO reading 4. Issued with 25mg nicorette patches

(16hr).

13 Jun 2013 09:47 Surgery: ADIGWE, Amechi (Dr) ('Other' Community Health Service) Entered at: Hmp Rochester


13 Jun 2013 15:32 Surgery: CLIFTON, Hannah (Miss) (Admin/Clinical Support Access Role) Entered at: Hmp

Rochester

Seen by smoking cessation advisor (XaIye) - Attended appt. CO reading 5, issued with 25mg nicorette patches.

18 Jun 2013 11:39 Surgery: VALINO, Maria (Mrs) (Nurse Access Role) Entered at: Hmp Rochester

20 Jun 2013 13:12 Surgery: CARTER, Ellen (Ms) (Admin/Clinical Support Access Role) Entered at: Hmp Rochester

Seen by smoking cessation advisor (XaIye) - C.O. 0.3 15mg nrt patches

27 Jun 2013 11:15 New Healthcare, Surgery: CARTER, Ellen (Ms) Entered at: Hmp Entered: 27 Jun 2013 21:12

Rochester

Did not attend for Smoking Cessation appointment with Ellen Carter


28 Jun 2013 09:25 Old Healthcare, Surgery: NOWICKA, Katarzyna (Medical Secretary) Entered at: Hmp Rochester

04 Jul 2013 11:15 New Healthcare, Surgery: CARTER, Ellen (Ms) Entered at: Hmp Entered: 04 Jul 2013 13:33

Rochester

Did not attend for Smoking Cessation appointment with Ellen Carter


04 Jul 2013 15:11 Surgery: CARTER, Ellen (Ms) (Admin/Clinical Support Access Role) Entered at: Hmp Rochester

Did not attend smoking cessation clinic (XaIpo) - DNA

22 Jul 2013 07:53 Old Healthcare, Surgery: WELLS, Nancy ('Other' Community Health Service) Entered at: Hmp

Rochester

22 Jan 2014 14:54 Old Healthcare, Surgery: WELLS, Nancy ('Other' Community Health Service) Entered at: Hmp

Rochester

22 Jan 2014 14:54 Old Healthcare, Surgery: WELLS, Nancy ('Other' Community Health Service) Entered at: Hmp

Rochester

SystmOne Outgoing Record Sharing consent changed to: No

14 Jan 2015 16:52 Surgery: CHIMBWANDA, Chenai (Miss) (Staff Nurse) Entered at: HMP Winchester




White British - ethnic category 2001 census (XaQEa)




Teetotaller (1361.)

Cannabis drug dependence NOS (E243z)



Overview Notes (Y0028)

29 Newcome

Newcomb Road

Portsmouth


Hastings

East Sussex

Thu 23 Apr 2020 15:02



C31

C32

Printed



Overview Notes (Y0028) - Saul Turner

Overview Notes (Y0028) - 08/12/82

General practitioner (YX039) - Dr Seal


History of cannabis misuse (XaMf9)

Fit for normal location, work and any cell occupancy - Referred to doctor (Y09d6)




Practice leaflet sent (8CE5.)

Date (Xa0ck)

Yes (Y0427)

Patient consented to sharing of information (Y3358)

H/O: mental health problem (YA741) - None raised






Has not tried to harm themselves (In prison) (Y08de)

Additional note (XaIg3) - Patient seemed fine, was stable, engaged well with staff, no concerns at time of

assessment


127 / 62 mmHg

15 Jan 2015 Surgery: STOODLEY, Sam (Mr) (Administrator) Entered at: HMP Entered: 15 Jul 2015 11:15

Winchester

Consent Form to The Station Practice, Hastings

15 Jan 2015 09:15 Surgery: HOLBROOK, Nicola (Mrs) (Administrator) Entered at: HMP Winchester

Previous general practitioner clinical record requested (XaXPl) - Dr Seal & partners fax 01424 464757

15 Jan 2015 09:51 Surgery: COX, Louise (Miss) (Administrator) Entered at: HMP Winchester

16 Jan 2015 09:20 Surgery: SCREENING, Secondary Entered at: HMP Winchester Entered: 17 Jan 2015 01:55

Did not attend for Secondary Screening appointment with Secondary Screening


17 Jan 2015 09:05 Surgery: MCCARTHY, Tanya (Mrs) (Health Care Support Worker) Entered at: HMP Winchester

Cigarette consumption (Ub1tI) 10 cigarettes / day

Smoker (137R.)

Impressions of the prisoners behaviour and mental state (YX023) - no thoughts of self harm at this present time

No relevant family history (122..)



O/E - weight (22A..) 65 Kg (10 st 3 lb)

O/E - height (229..) 1.75 m (5 ' 9 ")

Ideal body weight (66CB.) 76.26 Kg (12 st)


Hepatitis C status - Unknown (Y0971)

Hepatitis B status - Unknown (Y096c)

Not known if had MMR Vaccination (Y08ec)

Second Reception Screening (Y0da6)

Chlamydia screening declined (XaJdS)

Unknown (X90UG)

Hep B Vacc - offered and refused (Y075b)

Fully mobile (13C1.)


Hearing normal (1C11.)

Requires a course of hepatitis B (65W5.)

Learning disability screening questionnaire (XaXwn)

Other Disabilities Score (Y0cb3) 3 - Can you tell the time?: Yes

Can you read?: Yes

Can you write?: Yes

Do you live independent i.e. don't have daily help?: Yes

Do you have a job?: No

Thu 23 Apr 2020 15:02



C32

C33

Printed



Have you had previous contact with learning disability services?: No

Have you had any special schooling?: No

127 / 62 mmHg



19 Feb 2015 15:24 Surgery: MCCARTHY, Tanya (Mrs) (Health Care Support Worker) Entered at: HMP Winchester

Registered GP (XaIjE)

Dr Seal

hasting

east sussex

Registered GP (XaIjE)


Discharge report (XaIgD)

03 Mar 2015 09:07 Surgery: COX, Louise (Miss) (Administrator) Entered at: HMP Winchester

26 Mar 2015 16:35 Surgery: MAHUMAPELO, Samuel (Mr) (Nurse Access Role) Entered at: HMP Winchester



Has not had BCG Vaccination (Y0800)



History of three hepatitis B vaccinations (XaN20)


Treatment given (8BC..) - no

Persistent cough (Xa2kc) - no

Prisoner receiving prescribed medication (YX007)



White British - ethnic category 2001 census (XaQEa)

Current health problems (Y3536) - none



Teetotaller (1361.)



Has not tried to harm themselves (In prison) (Y08de)

H/O: mental health problem (YA741) - none

Fit for normal location, work and any cell occupancy - Referred to doctor (Y09d6)

Date (Xa0ck)

Overview Notes (Y0028) - not registered

Yes (Y0427)

Practice leaflet sent (8CE5.)



Cannabis drug dependence NOS (E243z)






Additional note (XaIg3) - calm

101 / 59 mmHg

Friend: Mr John Williams




30 Mar 2015 Surgery: COX, Louise (Miss) (Administrator) Entered at: HMP Entered: 04 Mar 2016 10:55

Winchester

Document to HMP Winchester


30 Mar 2015 15:09 Surgery: CAVANAGH, Ruaidhri (Mr) (Health Care Support Worker) Entered at: HMP Winchester

Thu 23 Apr 2020 15:02



C33

Printed



SystmOne Incoming Record Sharing consent changed to: Yes

30 Mar 2015 15:09 Surgery: CAVANAGH, Ruaidhri (Mr) (Health Care Support Worker) Entered at: HMP Winchester


Smoker (137R.)

FH: Ischaemic heart disease at less than 60 years (XE0oG)

Sister has diabetes

Mother had stent put in after heart attack

FH: Diabetes mellitus (1252.)

Sister has diabetes





O/E - height (229..) 1.73 m (5 ' 8 ")

Ideal body weight (66CB.) 74.52 Kg (11 st 10 lb)


Unknown (X90UG)


Hepatitis B status - Unknown (Y096c)

Chlamydia test offered (XaLHg)



History of measles, mumps and rubella vaccination (XaQe5)



Impressions of the prisoners behaviour and mental state (YX023) - States that he self harmed in the past and two

suicide attempts (one in 2012 and one about three months ago) using pills. States no thoughts of suicide or self

harm presently. States that he's just looking 'for a bit of peace and quiet'. Appears quite anxious but together and

coperative and chatty.


Other Disabilities Score (Y0cb3) 4 - Can you tell the time?: Yes

Can you read?: Yes

Can you write?: Yes

Do you live independent i.e. don't have daily help?: Yes

Do you have a job?: Yes

Have you had previous contact with learning disability services?: No

Have you had any special schooling?: No

Fully mobile (13C1.)

107 / 51 mmHg

05 Apr 2015 15:03 Surgery: NDEBELE, Norma (Ms) (Staff Nurse) Entered at: HMP Winchester

Medically fit for prison transfer (XaQfN) - To Westhill at the time of completing this form

06 May 2015 22:53 Surgery: NDLOVU, Penelope (Ms) (Nurse Access Role) Entered at: HMP Winchester

11 May 2015 08:16 Surgery: HOLBROOK, Nicola (Mrs) (Administrator) Entered at: HMP Winchester

08 Oct 2015 05:34 Surgery: MIKOLAJCZUK, Beata (Healthcare Assistant) Entered at: HMP Swaleside


08 Oct 2015 05:34 Surgery: MIKOLAJCZUK, Beata (Healthcare Assistant) Entered at: HMP Swaleside

16 Feb 2016 02:32 Surgery: JAIMON, Nikhila (Mrs) (Staff Nurse) Entered at: HMP Wormwood Scrubs






16 Feb 2016 06:47 Surgery: DIAS, Leela (Mrs) (Nurse Manager) Entered at: HMP Wormwood Scrubs


Surname Changed From 'Turner', Middle Name(s) Entered, Former Surname Entered


16 Feb 2016 10:43 Surgery: XABANISA, Robert (Mr) (Staff Nurse) Entered at: HMP Wormwood Scrubs

No (Y0428)

No (Y0428)

C34

Thu 23 Apr 2020 15:02



C34

C35

Printed



No (Y0428)

No (Y0428)

No (Y0428)


First Reception Screening (Unknown) (Y0803)


Smoking cessation advice (Ua1Nz)

No (Y0428)

No (Y0428)

Smoker (137R.)


No (Y0428)

Asthma: no (Y0944)

No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)

Unknown (X90UG)


O/E - pulse rhythm regular (2431.)

No (Y0428)

No (Y0428)

No (Y0428)


Referral for mental health assessment (XaLNF) - History of Nervous breakdown in 2007.



Asthma: no (Y0944)


Health related observations about the prisoners physical appearance (YX010) - Appears well, personal hygiene

satisfactory, vital signs done and recorded.



Health information received from outside source (YX002) - Last time seen a Dr was at HMP Winchester in 2015 for

routine check up.


Has a prison record (XE0pD) - HMP Winchester in 2015, states he was in prison for 45 days.




Waist circumference (Xa041) 85 cm (33 ")

Prisoner has tried to harm themselves (outside prison) (YX021) - States he had thoughts of selfharming, but he did

nothing. States the reason for the thoughts was due to family problems. States he will not selfharm whilst in prison.

Impressions of the prisoners behaviour and mental state (YX023) - Appears stable in mood, states no selfharm

thoughts, states he had nervous break down in 2007 and he was managed by the Mental Health Team at HMP

Lewes. Denies to delusions and hallucinations. Ref. MHT



No (Y0428)



No (Y0428)

Does not drink (Xa4IC)








O/E - rate of respiration (235..) 20 Resp/min

Temperature (X75Xk) 35.9 C

Thu 23 Apr 2020 15:02



C35

Printed



Pulse (XaIBo) 78 bpm

Unknown (X90UG)

Unknown (X90UG)

HIV negative (43C2.)


O/E - height (229..) 1.76 m (5 ' 9 ")

Reason for referral (XaIpS)

States he had Nervous breakdown few years ago and was treated by the Mental Health Team at HMP Lewes.

Kindly assess please.

Many thanks

Rob

FH: Anxiety state (1288.)

Blood oxygen saturation (X7708) 100 %


Tuberculosis screening (6831.)



Health information received from outside source (YX002) - Information from the poice, re: attempted to selfharm in

2010, Nervous breakdown in 2007.

Health information received from outside source (YX002)


Able to prepare food for eating (Xa3TG)

No (Y0428)

Able to tell the time (Xa3BE)

Able to clean room (Xa3Nc)

Learning disability assessment (Y2938)

No (Y0428)

Able to manage personal financial activities (Xa7gQ)

Speech observations (Xa4Pg) - Normal

Mood observations (X760o) - Stable in mood

Health related observations about the prisoners physical appearance (YX010) - Appears well

Thought observations (X75xq) - Normal

No (Y0428)

No (Y0428)

Observations relating to self-concept (Xa2je) - Nil

No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)

No partner at present (6123.)

Single current sexual partner (Ub0oN)

HIV screening declined (XaLI7)

No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)


Alcohol screen - AUDIT C completed (XaMwb) 1 - 1. How often do you have a drink containing alcohol?: Monthly or

less

2. How many units of alcohol do you drink on a typical day when you are drinking?: 1-2

3. How often have you had 8 or more units on a single occasion in the last year?: Never

Smoker (137R.)

Hepatitis B immunisation declined (XaLIH)

Hep C test - offered and refused (Y075a)


EBOLA - questionnaire started - (finalised: 16 Feb 2016 10:43)

C36

Thu 23 Apr 2020 15:02



C36

C37

Printed



EBOLA - questionnaire started - (finalised: 16 Feb 2016 10:43)

121 / 77 mmHg

121 / 77 mmHg

Partner: Ms Louise Piper Peasmarsh in Sussex.

GP: States not reg. with GP.




25 Feb 2016 10:06 Surgery: KHUNT, Jayesh (Mr) (Pharmacy Technician) Entered at: HMP Wormwood Scrubs

Medication given (8B311)

Released from prison (Xa0re)


26 Feb 2016 Surgery: KHUNT, Jayesh (Mr) (Pharmacy Technician) Entered at: HMP Wormwood Scrubs

Date of departure (Y3524)

27 Feb 2016 15:32 Surgery: JOANS, Danielle (Miss) (Sister/Charge Nurse)

Single person (XE0oZ)







Safe disposal of drug (Ua1LE)





Patient reports no current disability (XaaYD)


O/E - weight (22A..) 58.6 Kg (9 st 3 lb)

Prescribed medication (YA592) - none


O/E - height (229..) 1.72 m (5 ' 8 ")



Impressions of the prisoners behaviour and mental state (YX023) - Pt appears fit and well and denies any thoughts

of self harm or suicide.

Prisoner has used drugs in the last month (YX014) - cannabis but does not feel like he needs any help.


Prison first reception health assessment completed (XaYXV)

Teetotaller (1361.)

Prisoners alcohol intake week before custody (YX013) 0 Units / Week

Fit and well (Xa96k)


Health Information the prisoner thinks is important (YX024) - none

Health related observations about the prisoners physical appearance (YX010) - pt appears fit and well

Has not stayed in a psychiatric hospital (Y08e2) - had a nervous brack down in 2007 - currently not taking any

medication

Prisoner has received medication for mental health problems (YX019)

Prisoner has not tried to harm themselves (in prison) (Y09f9) - pt tried to kill himself about about a year ago due to

his daughter passing away.

Prisoner has tried to harm themselves (outside prison) (YX021) - pt tried to kill himself about about a year ago due to

his daughter passing away.

126 / 73 mmHg


29 Feb 2016 15:35 Surgery: WILSON, Carole (Ms) (Manager)

02 Mar 2016 11:15 Surgery: HOOKWAY, Victoria (Miss) (Health Professional Access Role)

History: Second day screening complete.

Religion NOS (XE0oe)

Main spoken language English (XaG5t)

Paper medical records unavailable (Y1141)

Thu 23 Apr 2020 15:02



C37

C38

Printed



Smoking cessation advice (Ua1Nz)


Smoker (137R.)


Blood glucose level (X772z) 5 mmol/L


BCG Programme Status - Routinely Vaccinated (Y15a6)

No relevant family history (122..)

MMRII given before 1st birthday (Y0ef1)

Adult screening - second recall (9OC6.)


Testicular self-examination (2657.)

Ability to mobilise (Xa7yC)



Referral declined (XaPBy)


125 / 62 mmHg

09 Mar 2016 15:28 Surgery: NELSON, Brenda (Mrs) (Analyst)

Surname Changed From 'Turner', Former Surname Entered

11 Mar 2016 01:14 Surgery: Unknown Staff Member Entered at: HMP Lewes








11 Mar 2016 01:14 Surgery: Unknown Staff Member

Patient record merged (XaR4R)

11 Mar 2016 13:45 Surgery: NELSON, Brenda (Mrs) (Analyst)

Surname Changed From 'Altel'


Ibuprofen please I/P for headaches.

17 Mar 2016 15:45 Surgery: BARHAM, Anna (Clinical Practitioner Access Role)

Ibuprofen 400mg tablets - 21 tablets - 1 TDS PRN (21 tablets every 7 days) (Future dated medication 18 Mar 2016)

Custom script: Printed On Thu 17 Mar 2016 15:45 By Anna Barham

17 Mar 2016 16:31 Surgery: PANKHANIA, Manish (Mr) (Health Professional Access Role)

18 Mar 2016 15:32 Surgery: HUNNINGS, Julie (Pharmacy Technician)

18 Mar 2016 15:32 Surgery: HUNNINGS, Julie (Admin/Clinical Support Access Role)


Hi Dr please re Px Ibuprofen repeat thanks I/P

Task to G.P

30 Mar 2016 09:24 Surgery: BARHAM, Anna (Clinical Practitioner Access Role)

Ibuprofen 400mg tablets - 21 tablets - 1 TDS PRN (21 tablets every 7 days) (Future dated medication 31 Mar 2016)

Custom script: Printed On Wed 30 Mar 2016 09:24 By Anna Barham

30 Mar 2016 10:04 Surgery: CHOUDHRY, Khurshid (Mr) (Health Professional Access Role)

31 Mar 2016 08:04 Surgery: HUNNINGS, Julie (Pharmacy Technician)

31 Mar 2016 08:05 Surgery: HUNNINGS, Julie (Admin/Clinical Support Access Role)

05 Apr 2016 09:52 Surgery: HOOKWAY, Victoria (Miss) (Health Professional Access Role)

Added to skin clinic upon request.

05 Apr 2016 17:57 Surgery: WILSON, Carole (Ms) (Manager)

08 Apr 2016 09:44 Surgery: ABRAHAM, Joanne (Ms) (Admin/Clinical Support Access Role)

came to the hatch asking for anti biotics for a skin condition he has he is on the waiting list to see the skin GP


Task sent to Dentist and spoken with re appt today for ? abscess, states in "a lot of pain past few days" - difficulty

talking / eating.


Thu 23 Apr 2020 15:02



C38

C39

Printed



Spoken with dentist and slip given to attend this pm on freeflow.

26 Apr 2016 14:15 Surgery: TOMSETT, Marina (Ms) (Dental Officer)

Problem: Dental care (Ua1RH)

History: Emerg appt. co - pain LRQ ? swelling. Pain since Saturday.

Mhx: NRMH.

Another year of sentence to serve.

Non smoker. Occasional alcohol when out.

Examination: Directed exam only

LR8 P.E. and operculum swollen and gum cut where tooth is erupting.

Pus draining from underneath.

Pericoronitits LR8. First episode.

Advised OHI ( small single tufted brush given).

Hot salt water mouthwash.

Px done amoxicillin 500mg tds 5/8 and ibuprofen.

Advised if recurrs then would recommend xla LR8.

Dental care (Ua1RH)

Amoxicillin 500mg capsules - 15 capsules - [08:00-1][12:00-1][16:00-1] (15 capsules every 5 days) (Future dated

medication 27 Apr 2016)

Ibuprofen 200mg tablets - 15 tablets - [08:00-1][12:00-1][16:00-1] (15 tablets every 5 days) (Future dated medication

27 Apr 2016)

Custom script: Printed On Tue 26 Apr 2016 15:56 By Ms Marina Tomsett

Dental care (Ua1RH)

27 Apr 2016 08:40 Surgery: HOOKWAY, Victoria (Miss) (Associate Practitioner)



29 Apr 2016 Surgery: JACKSON, Lauren (Miss) (Healthcare Assistant) Entered: 29 Apr 2016 10:45

Dentistry to HMP Highdown

23 May 2016 15:55 Surgery: LOGAN, Susan (Nurse Access Role)

23 May 2016 15:55 Surgery: LOGAN, Susan (Nurse Access Role)

(From PGD or Homely Remedy) Ibuprofen 200mg tablets - 1 pack of 16 tablet(s) - 1 tablet - Once only (Oral)

Stopped 23 May 2016 Medication has been administered by LOGAN, Susan

31 May 2016 17:01 Surgery: WILSON, Carole (Ms) (Manager)

16 Jun 2016 09:17 Surgery: HUNNINGS, Julie (Admin/Clinical Support Access Role)

(From PGD or Homely Remedy) Paracetamol 500mg tablets - 2 tablets - 2 tablet - Once only (Oral)

Stopped 16 Jun 2016 Medication has been administered by HUNNINGS, Julie



16 Jun 2016 11:40 Surgery: BARHAM, Anna (Clinical Practitioner Access Role)

Paracetamol 500mg tablets - 1 pack of 32 tablet(s) - 2 QDS PRN (32 tablets every 7 days)

Custom script: Printed On Thu 16 Jun 2016 11:40 By Anna Barham

16 Jun 2016 13:46 Surgery: EVANS, Nicola (Health Professional Access Role)

20 Jun 2016 11:23 Surgery: WILSON, Carole (Ms) (Manager)

25 Jul 2016 08:08 Surgery: NAKAYI, Cynthia (Miss) (Nurse Access Role)

(From PGD or Homely Remedy) Ibuprofen 200mg tablets - 1 pack of 16 tablet(s) - 1 tablet - Once only (Oral)

Stopped 25 Jul 2016 Medication has been administered by NAKAYI, Cynthia (Miss)

25 Jul 2016 08:12 Surgery: NAKAYI, Cynthia (Miss) (Nurse Access Role)

29 Jul 2016 11:21 Surgery: NELSON, Brenda (Mrs) (Analyst)

31 Jul 2016 09:09 Surgery: SWAMY, Margarita (Nurse Access Role)

seen today Re-L hand which is swollen. Apparently sustained an injury last Sunday whilst moving a wardrobe.

Finger very painful and unable to straighten.

17 Aug 2016 Prison: TANTON, Karen (Mrs) (Administrator) Entered at: Hmp

Rochester

Entered: 18 Aug 2016 10:11

Consent Form to Unknown

17 Aug 2016 Surgery: TANTON, Karen (Mrs) (Administrator) Entered at: Hmp

Rochester

Entered: 18 Aug 2016 10:11

Signed medication compact and consent to transfer of information.

17 Aug 2016 11:10 Surgery: TRIPTREE, Simon (Mr) (Admin/Clinical Support Access Role)


Discharged from primary healthcare team (XaKHz)

Thu 23 Apr 2020 15:02



C39

Printed



Prescription status (XaFl0) - none

Medical condition comments (Y2578) - no concerns raised


17 Aug 2016 15:09 Surgery: TURNER, Nina (Clinical Team Manager) Entered at: Hmp Rochester




History: Patient seen in reception, no thoughts of self harm or suicide. Advised how to access healthcare. Added to

list for hepb and smoking clinic.

No (Y0428)

Declined consent to share pt data with specified 3rd party (XaNwT)

First night risk assessment form completed (Y4581)

No (Y0428)



Patient registered - GPR (XE2y4) - prison




Suitable for in-possession medication (XaYM5) (New Episode)

Prisoner has tried to harm themselves (outside prison) (YX021) - 2011 Overdose lost daughter.




H/O: mental health problem (YA741) - stated he was seen by inreach for few months after death of daughter 2013

however does not need this now.

Case management risk assessment score (XaLWw) 2 - 1Did you have medication in possession at previous

establishment?: No

2. Has the patient understood and signed IP Compact/Leaflet/Medication Policy?: Yes

3. Has the patient any learning difficulties, problems with reading labels or language difficulties?: No

4. Has the patient any history of alcohol or drug abuse?: No

5. Is there any known history of medication related incidents eg trading, bullying etc?: No

6. Is the patient at risk from self-harm/overdose?: No

7. Is the patient on an open ACCT?: No

8. Is the patient confused or disorientated?: No

9. Has the patient had a recent change in prison status (eg recently sentenced) or a recent life event which has

increased their risk?: No

10. Practioner concern?: No

Has never misused drugs (Ub0mr)

Misused drugs in past (Ub0ms) - cannabis


Teetotaller (1361.)



No (Y0428)

Hep C Test - Not Offered (Y0806)


No (Y0428)




No (Y0428)


Transfer moved in (Y3424)





Smoker (137R.)

Hepatitis C non-immune (Xa0v1)

Hep B Vacc- offered and accepted (Y075c)

C40

Thu 23 Apr 2020 15:02



C40

C41

Printed



Hepatitis B immune (XE2ww)

Asthma: no (Y0944)

Referral for smoking cessation service offered (XaXR4) - added to list

Medication In Possession Status: In possession - 28 days




18 Aug 2016 08:27 Surgery: TANTON, Karen (Mrs) (Clerical Access Role) Entered at: Hmp Rochester

19 Aug 2016 07:29 Surgery: TANTON, Karen (Mrs) (Clerical Access Role) Entered at: Hmp Rochester

03 Oct 2016 09:20 Surgery: CARTER, Ellen (Ms) (Admin/Clinical Support Access Role) Entered at: Hmp Rochester

Smoking cessation drug therapy (XaMlI) - see notes

Smoker (137R.)

Seen by smoking cessation advisor (XaIye)

Seen by smoking cessation advisor (XaIye) - co read 29 issued x 1 pck21mg nrt patches and 1 pck 1.5nrt mints

Smoker (137R.)

Nicotine product (du3..)


Total time smoked (Ub0p2) 12 Years


Smoker (137R.)

Rolls own cigarettes (137M.)

08 Oct 2016 08:07 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at: Hmp Rochester

10 Oct 2016 09:06 Surgery: CARD, Lauren (Miss) (Nurse Access Role) Entered at: Hmp Rochester

SUDOCREM (form not specified) -


Seen by smoking cessation advisor (XaIye) - co read 15 issued x1 pck 21mg nrt patches x 2 pcks 1.5 nrt mints


Seen by smoking cessation advisor (XaIye) - issued 2 weeks supply 2 pcks 21mg nrt patches 2 pcks nrt mini mints

27 Oct 2016 07:25 Surgery: CLIFTON, Hannah (Miss) (Admin/Clinical Support Access Role) Entered at: Hmp

Rochester


Handover Report : Overall Communication (Y4510) - delivered x 1 pck 21mg patches x 1 pck 1.5 nrt mints

07 Nov 2016 08:45 New Healthcare, Surgery: CARTER, Ellen (Ms) Entered at: Hmp Entered: 07 Nov 2016 10:12

Rochester

Did not attend for HC-Smoking Clinic appointment with Ellen Carter


07 Nov 2016 10:18 Surgery: CARTER, Ellen (Ms) (Admin/Clinical Support Access Role) Entered at: Hmp Rochester

Did not attend - no reason (XE2NM)

Did not attend smoking cessation clinic (XaIpo) - DNA letter sent appt rebooked

08 Nov 2016 16:29 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at: Hmp Rochester

Paracetamol 500mg tablets - 16 tablets - 2 qds



Rochester




Rochester



21 Nov 2016 11:39 Surgery: CARTER, Ellen (Ms) (Admin/Clinical Support Access Role) Entered at: Hmp Rochester

Lost to smoking cessation follow-up (XaXUL) - declined to attend appts missd 3


29 Nov 2016 07:38 Surgery: TANTON, Karen (Mrs) (Clerical Access Role) Entered at: Hmp Rochester

01 Jan 2017 Surgery: NIXON, Sharon (Nurse Access Role) Entered at: HMYOI Entered: 22 Mar 2018 15:06

Stoke Heath

Stopped smoking (137K.)

20 Jan 2017 07:54 Surgery: CLIFTON, Hannah (Miss) (Admin/Clinical Support Access Role) Entered at: Hmp

Rochester

Thu 23 Apr 2020 15:02



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21 Jan 2017 08:34 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at: Hmp Rochester



Rochester

26 Jan 2017 12:17 Surgery: ESEKIE, Oseyi (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Seen this morning, taken to SEG yesterday after an attempted suicide. Saul was found

with a noose around his neck, withdrawing from spice and report increased paranoia. He was seen in his cell with

an officer standing at the door, states finding it hard to cope being on basic without a TV to occupied his mind.

Report long history of substance misuse and no reported history of mental health illness, first time of attempted

suicide due to withdrawing from spice. Repot he had spent £14,000 on spice for the past 5 months due release 16

weeks times and already working on how to make back the money he had spent on spice when release by selling

things refused to give more detail what he will be selling. Saul sees being in SEG as a form of punishment by the

prison, He was made to understand this could also be a positive thing for him because he will have the opportunity

meeting with different professionals for support. Saul was still expressing suicidal thought and plan to do things so he

could manipulate staff to get what he wants. He requested to have all his properties from the wing, informed he will

not be having TV but SEG staff had promised to get him a radio. Entry made on his ACCT document and incell pact

will be given later this afternoon.

26 Jan 2017 16:00 Surgery: ESEKIE, Oseyi (Nurse Access Role) Entered at: Hmp Entered: 28 Jan 2017 10:55

Rochester

Overview Notes (Y0028) - incell pack given in SEG.

27 Jan 2017 11:10 Surgery: DEAN, Antony (Mr) (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Seen in segregation unit for segregation rounds, stated that he is ok, no current mental

health needs identified or complained of, interacted well with staff and accepted applications.

27 Jan 2017 12:08 Surgery: HARDING, Tim (Clinical Practitioner Access Role) Entered at: Hmp Rochester

History: Seen in segregation unit (Y0ce3) - Seen in the Seggregation Unit. No complaints, suggested to discuss with

Segg staff should they need to see a member of the healthcare team

Examination: appears well, denies any health concerns



Overview Notes (Y0028) - seen this morning during the round and after in his cell, upset that his clothes were

brought to him from his previous wing wet and damped, Sean told me he flooded his cell before he was brought to

SEG and to the best of his knowledge all his clothes were all packed neatly in a bag and on top of his bed. He

blamed the wing staff for his wet clothes and want contact to any solicitor so He could report the case because his

personal solicitor does not deal with prison case advised to speak with IMB. Sean remain on open ACCT, he

determined not to allow his current situation affect his mental health even thou he had to cancel his visit today

because he has no clean clothes to wear. He denied any thoughts to self-harm when asked. Entry made on his

ACCT document, SEG staff aware.

29 Jan 2017 13:50 Surgery: CARD, Lauren (Miss) (Nurse Access Role) Entered at: Hmp Rochester

Seen in segregation unit (Y0ce3) - seen in segregation nurse rounds. no healthcare concerns raised at this time.

30 Jan 2017 08:56 Surgery: MORRIS, Carolyn (Ms) (Occupational Therapist) Entered at: Hmp Rochester


Overview Notes (Y0028) - Seen for morning review. No mental health concerns or issues raised or identified at the

rpresent time. Declined 1:1. Open ACCT noted and entry made

30 Jan 2017 12:37 Surgery: VIJAYATHARAN, Dr Karthika (GP Locum) Entered at: Hmp Rochester

History: seen in segregation

currently no health concerns, remains well

31 Jan 2017 10:37 Surgery: PEMBLE, Howard (Mr) (Nurse Access Role) Entered at: Hmp Rochester

Overview Notes (Y0028) - Seen for daily MHIRT :- Serving CC . Open ACCT noted . Dark under eyes and not

sleeping well . Looks exhausted and was tense about being asked "again " why he is on the ACCT . Withdrawing

from NPS and uncomfortable but this is lessening - wants to be NPS free . ACCT suggests some £14000 spent over

time on NPS . Had debt outstanding .



Seen in segregation unit (Y0ce3) - seen in nurse segregation unit rounds. no healthcare concerns raised when seen

in cell.

Seen by nurse (XaATp)


General mental state (X75ws) - Looks uncomfortable and low in mood . Used NPS extensively here until recently

when he took himself off it . Angry at HMP Rochester and some staff . Angrily said that no one tried to intervene .

Thu 23 Apr 2020 15:02



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Withdrawal hit him hard . ACCT opened on him . Some paranoia and vague voice as sequelae to his use of NPS

but can challenge this . Said will not go to any wing at Rochester .

[V]Personal history of mental disorder (ZV11.) - No specific history disclosed today.

Clinical management plan (XaJYd)

Home in May .

Has no spent all his money on NPS and has little to go out to .

See daily .

Intends avoiding any return to a wing here .

Does not want RAPT .

Risk classification (Y2462) - On an open ACCT .

[V]Other reasons for encounter NOS (ZV6z.) - Serving CC

Review of admission to segregation unit (XaPmi) - Enhanced review

Levels of observation (Ua1Sw) - As per ACCT .

01 Feb 2017 09:44 Surgery: PEMBLE, Howard (Mr) (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Seen for daily MHIRT :- Open ACCT noted . Again looks tense this morning . Had little to

say other than to indicate that today he feels as he did yesterday .

01 Feb 2017 12:23 Surgery: HARDING, Tim (Clinical Practitioner Access Role) Entered at: Hmp Rochester



Examination: appears well , denies any physical health problems

02 Feb 2017 09:32 Surgery: DEAN, Antony (Mr) (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - No current mental health concerns expressed today, comminucated with staff and

accepted applications. Remains on ACCT no current indication of increased risk, declined any input from inreach

today.

03 Feb 2017 12:09 Surgery: TURPIN, Rachel (Health Professional Access Role) Entered at: Hmp Rochester

Overview Notes (Y0028) - Remains on an ACCT and refused inreach 1:12 today - staff raised no issues and review

this pm. Quiet and engaged with staff.





Examination: appears well, denies any physical health complaints

03 Feb 2017 14:15 Surgery: CARD, Lauren (Miss) (Nurse Access Role) Entered at: Hmp Rochester

Seen by nurse (XaATp) - seen in nurse segregation unit rounds. no healthcare concerns raised. acct document

signed.




Seen with Ms Birch (Duty Gov), MS Fitzmaurice and V Navaratnam (IMB)

In seg for flooding on the wing - 14 days CC- reports he was under the influence and asked for seg as a safe haven

but was declined so flooded cell.

Not engaged with RAPT - reports he was not smoking when he arrived here at all so wanted H wing but asked for

smokers pack to use to get things done for him and then was sharing with spice smokers and gradually used this

and spend £14,000 since arriving here in Aug 2017- is not smoking now but has lost all enhanced status - reports

this is the first time he has been addicted and does not want RAPT as it wrong happen again - seemed empowered

and insightful about this. Feels that he cope better when not bored so support plan will be put in place so he can get

a job etc., Will also get single cell on B wing. nO issues raised with returning to B wing. has 2 or 5 months left. has

put in complaint as duvet lost.ACCT closed with no dissent.

Review of care of detained patnt under Section 120 MHA 1983 (Xa9Ep)

04 Feb 2017 11:14 Surgery: BRYANT, Ian (Mr) ('Other' Community Health Service) Entered at: Hmp Rochester

Overview Notes (Y0028) - Seen this morning in segregation round, Mr Turner reported no issues or concerns

regarding his mental health before leaving segregation to attend visits.

Risk classification (Y2462) - Unknown risk to self or others, no current evidence of risk to self or others. Did not

identify a protective factor just stated 'no' 'sweet'.

General mental state (X75ws) - Well kempt, good eye contact and rapport. Lucid, coherent and mood appeared

euthymic.


05 Feb 2017 13:55 Surgery: VALINO, Maria (Mrs) (Nurse Access Role) Entered at: Hmp Rochester


Thu 23 Apr 2020 15:02



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Segg staff should they need to see a member of the healthcare team (04-02-17)

05 Feb 2017 14:50 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at: Hmp Rochester

Seen in segregation unit (Y0ce3) - c/o headache-2 paracetamol tablets given.

06 Feb 2017 09:11 Surgery: VIJAYATHARAN, Dr Karthika (GP Locum) Entered at: Hmp Rochester


currently well, denies any health concerns

06 Feb 2017 10:19 Surgery: ESEKIE, Oseyi (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Came out from his cell for the daily apps, good interaction with the officers, complained of

cold cell, officer promised to be given extra blanket and no issues were raised concerning his mental health.


Overview Notes (Y0028) - Seen for daily MHIRT :- Looks much better - said feels better and that coming of NPS was

the most difficult thing he has ever done .


08 Feb 2017 11:06 Surgery: MORRIS, Carolyn (Ms) (Occupational Therapist) Entered at: Hmp Rochester



present time.




Examination: appears well ,denies any health complaints except migraine had years try amit

Amitriptyline 25mg tablets - 28 tablets - 1 tablet - admin times: 16:00 (Oral) (Future dated medication 10 Feb 2017)

Stopped 15 Feb 2017 End of course by HARDING, Tim

Custom script: Printed On Wed 08 Feb 2017 12:53 By Tim Harding




present time

09 Feb 2017 13:50 Surgery: KEHOE, Bevan (Pharmacist) Entered at: Hmp Rochester

10 Feb 2017 11:41 Surgery: GONCARAS, Laimonas (Dr) (Clinical Practitioner Access Role) Entered at: Hmp

Rochester



10 Feb 2017 17:25 Surgery: MALINOWSKA, Agnieszka (Ms) (Mental Health Nurse) Entered at: Hmp Rochester




Overview Notes (Y0028) - Seen this morning for MHIRT segregation round, appears bright in mood looking forward

to his visit this morning. No issues were raised concerning his mental health and none was observed.

11 Feb 2017 17:15 Surgery: MAULINO, Rogelio (Mr) (Sister/Charge Nurse) Entered at: Hmp Rochester




Seen in segregation unit (Y0ce3) - seen in nurse segregation daily round. no healthcare concerns when asked.






present time.




Seen for review. Saul stated that eh was started on Amirtiptyline last week for sleep, but doesn't think they are

helping him, and would like the GP to sort this out.

Stated no other concerns at the present time. Is aware that he is awaiting transfer, but not sure where to as yet. Is

happy to remain in current location for 2 weeks

Goading (Xa2mO)

Present:

Thu 23 Apr 2020 15:02



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Gov Martin

IMB

C Morris

S turner





Overview Notes (Y0028) - Seen this morning for MHIRT segregation round, no issues were raised concerning his

mental health. Saul interacted well with the officers, declined 1:1 when offered, took his breakfast and requested to

have shower and exercise from today's apps.


Handover Report : Overall Communication (Y4510) - seen in nurse segregation round. no concerns.





Examination: appears well, denies any health complaints except sl;eep and heasdaches still issue plan ^ dose of

amit

(R) Amitriptyline 50mg tablets - 28 tablets - 1 tablet - admin times: 16:00 (Oral) (Future dated medication 16 Feb

2017)

Amitriptyline 50mg tablets - 28 tablets - 1 tablet

Ended 12 Apr 2017 Re-Authorised by HARDING, Tim




Overview Notes (Y0028) - Saul was seen this morning in the segregation unit, came out for his daily apps, requested

for cell clean and shower. No issues were raised concerning his mental health he collected his breakfast and went

back to his bedroom.


(R) Paracetamol 500mg tablets - 80 tablets - 2 tablet - admin times: 08:45, 12:00, 16:00 (Oral) (Future dated

medication 16 Feb 2017)

Paracetamol 500mg tablets - 80 tablets - 2 tablet

Ended 13 May 2017 Patient Deducted (Sentence Ended)


16 Feb 2017 09:49 Surgery: SEEHRA, Sharon (Miss) (Pharmacist) Entered at: Hmp Rochester

16 Feb 2017 18:31 Surgery: VALINO, Maria (Mrs) (Sister/Charge Nurse) Entered at: Hmp Rochester



17 Feb 2017 09:06 Surgery: BONCHEV, Sevdalin (Dr) (Doctor) Entered at: Hmp Rochester

History: Seen in segregation unit (Y0ce3)

Diagnosis: Medically fit to be held in the segregation unit (Y0d06)

17 Feb 2017 09:35 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at: Entered: 17 Feb 2017 17:14

Hmp Rochester



Overview Notes (Y0028) - Seen this morning, no issues were raised concerning his mental health and none

observed. Saul had good interaction with the officers, appropriate in behaviour and requested to have only shower.





18 Feb 2017 09:32 Surgery: CARD, Lauren (Miss) (Sister/Charge Nurse) Entered at: Hmp Rochester




Seen in segregation unit (Y0ce3) - seen in nurse segregation round. no healthcare concerns when asked.



Overview Notes (Y0028) - Seen this morning in segregation unit, no current mental health issues of note

Thu 23 Apr 2020 15:02



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today,antogistic towards staff declined any input from inreach.




18 Feb 2017 17:04

19 Feb 2017 10:47

Surgery: CARD, Lauren (Miss) (Nurse Access Role) Entered at: Hmp Rochester

Surgery: MAULINO, Rogelio (Mr) (Sister/Charge Nurse) Entered at: Hmp Rochester


19 Feb 2017 13:35 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at:

Hmp Rochester

Entered: 19 Feb 2017 17:04






19 Feb 2017 17:03

20 Feb 2017 11:28

Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at: Hmp Rochester

Surgery: ESEKIE, Oseyi (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Mr Turner came out from his cell this morning for his daily apps, requested to have

shower and cell clean and no issues were raised concerning his mental health.



Seen in segregation unit (Y0ce3) - seen by nurse in segregation unit round. no primary healthcare needs raised.


20 Feb 2017 16:59

20 Feb 2017 16:59



20 Feb 2017 16:59

20 Feb 2017 16:59




History: written retrospectivelty from this morning, seen in segregation currently well denies any health concerns



Overview Notes (Y0028) - Seen for daily MHIRT :- No concerns expressed by him or about him today . Interacting

well with the unit team and myself . Looks well today .

21 Feb 2017 16:19 Surgery: OLADEJI-OLANREWAJU, Olabode Entered at: Hmp Rochester

Second Reception Screening (Y0da6) - Added in bulk

21 Feb 2017 17:04

21 Feb 2017 17:04

Surgery: MAULINO, Rogelio (Mr) (Sister/Charge Nurse) Entered at: Hmp Rochester



22 Feb 2017 09:00 Surgery: MALINOWSKA, Agnieszka (Ms) (Mental Health Nurse) Entered: 22 Feb 2017 14:50

Entered at: Hmp Rochester




Examination: appears well ,declines any health concerns except dandruff - states other mx working now

Ketoconazole 2% shampoo - 120 millilitres - ao (120 millilitres every 28 days) (Future dated medication 24 Feb 2017)




Overview Notes (Y0028) - Seen in the seg round _ appeared physically and mentally well, eye contact good and no

cell or personal hygiene issues. Declined MHIRT 1:1 when offered. Engaged well with prison staff , no concerns

raised by seg staff and complying with prison regime. No risk of DSH or suicide at this time. No further action at this

time.

22 Feb 2017 13:00 Surgery: MALINOWSKA, Agnieszka (Ms) (Mental Health Nurse)


Entered: 22 Feb 2017 14:50

22 Feb 2017 14:49

22 Feb 2017 17:04

Surgery: MALINOWSKA, Agnieszka (Ms) (Mental Health Nurse) Entered at: Hmp Rochester



22 Feb 2017 17:04

23 Feb 2017 14:16


Surgery: ESEKIE, Oseyi (Nurse Access Role) Entered at: Hmp Rochester


Thu 23 Apr 2020 15:02



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Overview Notes (Y0028) - Mr Turner came out from his cell for his daily apps, no issues were raised concerning his

mental health and none was observed. He interacted well with the officers, offered 1:1 but declined.




24 Feb 2017 08:00 Surgery: MALINOWSKA, Agnieszka (Ms) (Mental Health Nurse) Entered: 24 Feb 2017 17:02





Examination: appears well , denies any physical health problems



Entered: 24 Feb 2017 17:02



Overview Notes (Y0028) - Seen this morning in segregation unit, no current mental health concerns verbalised, good

communication with seg staff, no overt concerns today.



24 Feb 2017 17:01

24 Feb 2017 17:02





25 Feb 2017 17:07

25 Feb 2017 17:07





Entered: 26 Feb 2017 17:10



Entered: 26 Feb 2017 17:10


Seen in segregation unit (Y0ce3) - No concerns in regards to his physical health reported. Seen by healthcare on

daily basis for his pm medication.

26 Feb 2017 17:10

26 Feb 2017 17:10





History: seen in segrgation, currently well, denies any health concerns



Overview Notes (Y0028) - Seen in segregation unit this morning, no overt MH concern noted. Engaged well with staff

and accepted applications.


Goading (Xa2mO)

Overview Notes (Y0028) - Seen this afternoon for GOAD review, he will be residing in the seg as he has not been

acepted for transfer by anywhere else as yet. he states he is "happy" in seg, I voiced my concern about lack of

stimulation and interaction with others. he stated that he is coping very well and if there is any concern from staff they

will alert us and we see every day so we can elicit any needs.

27 Feb 2017 17:07 Surgery: VALINO, Maria (Mrs) (Sister/Charge Nurse) Entered at: Hmp Rochester








time.


28 Feb 2017 17:02

28 Feb 2017 17:02




Thu 23 Apr 2020 15:02



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01 Mar 2017 12:49 Surgery: HARDING, Tim (Clinical Practitioner Access Role) Entered at: Hmp Rochester



Examination: appears well, denies any physical health problems

01 Mar 2017 17:36

01 Mar 2017 17:36



01 Mar 2017 17:36 Surgery: MALINOWSKA, Agnieszka (Ms) (Mental Health Nurse) Entered at: Hmp Rochester



02 Mar 2017 11:31 Surgery: ESEKIE, Oseyi (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Seen this morning for his daily apps, no raised mental health concern, I was later asked

by Sarah Nunn to see Mr Turner in his cell. Turner was met standing in his cell with packed bags on the floor he said

he was happy to be transfer to any prison as long he's kept in SEG because he will refuse to stay in normal location

because of his drug problem and would like to stay clean before of his release in 10 weeks' time. Advice long stay in

SEG also has negative effects on his mental states and Inreach does not encourage this. I also spoke to Sarah Nuun

of my disagreement of long stay in SEG and the prison need to decide on the next plan. Mr Turner is not engaging

with Inreach and no reported mental health issues.

02 Mar 2017 17:15 Surgery: VALINO, Maria (Mrs) (Sister/Charge Nurse) Entered at: Hmp Rochester

02 Mar 2017 17:15 Surgery: VALINO, Maria (Mrs) (Nurse Access Role) Entered at: Hmp Rochester

03 Mar 2017 10:51 Surgery: DEAN, Antony (Mr) (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Seen this morning in segregation unit, no current issues of a mental health nature

observed or verbalised, took applications and had good communication with staff.




Examination: appears well, denies any physical health problems


Paracetamol 500mg tablet (di21.) - 2 tabs administered in seg on request


04 Mar 2017 09:15 Surgery: UKPONG, Martine (Mrs) ('Other' Community Health

Service) Entered at: Hmp Rochester

Entered: 04 Mar 2017 11:57


Overview Notes (Y0028) - Mr Turner was well maintained, appropriately dressed and euthymic in mood. He

requested two applications of shower and phone call. He was coherent in conversation, chatting with wing staff as

he collected his breakfast and mail. He reported no concerns with his mental health and declined any input, wing

staff reported no concerns with his mental state.

04 Mar 2017 16:57 Surgery: MAULINO, Rogelio (Mr) (Sister/Charge Nurse) Entered at: Hmp Rochester

04 Mar 2017 16:57

05 Mar 2017 15:27


Surgery: WHITE, Emma (Miss) (Health Professional Access Role) Entered at: Hmp Rochester

Seen in segregation unit (Y0ce3) - No Problems

05 Mar 2017 16:49 Surgery: WHITE, Emma (Miss) (Nurse Manager) Entered at: Hmp Rochester

05 Mar 2017 16:49

06 Mar 2017 10:30

Surgery: WHITE, Emma (Miss) (Health Professional Access Role) Entered at: Hmp Rochester

Surgery: PEMBLE, Howard (Mr) (Nurse Access Role) Entered at: Hmp Rochester

Overview Notes (Y0028) - Seen for daily MHIRT :- Interacting OK with unit team and myself and no concerns

expressed by him or about him . No evidence of distress seen .



06 Mar 2017 17:05 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at:

Hmp Rochester

Entered: 06 Mar 2017 17:10

06 Mar 2017 17:07 Surgery: VIJAYATHARAN, Dr Karthika (GP Locum) Entered at: Hmp Rochester

History: written retrospectively

seen in segregation


07 Mar 2017 10:51 Surgery: PEMBLE, Howard (Mr) (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Seen for daily MHIRT :- Good interaction with the team today . No concerns expressed

about him or by him .


Thu 23 Apr 2020 15:02



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Overview Notes (Y0028) - Seen in segregation unit, good communication with staff, accepted applications no current

mental health concerns.





Examination: Appears well, denies any physical health complaints



Overview Notes (Y0028) - Seen in segregation unit, no overt mental health issues today, interacted well with staff,

and accepted applications.

09 Mar 2017 15:47 Surgery: AKISANYA, Adedun (Mrs) (Sister/Charge Nurse) Entered at: Hmp Rochester

09 Mar 2017 15:48 Surgery: AKISANYA, Adedun (Mrs) (Nurse Access Role) Entered at: Hmp Rochester




Examination: Appears well ,denies any physical health symptoms except dry skin

(R) E45 cream (Forum Health Products Ltd) - 500 grams - ao (500 grams every 28 days)

E45 cream (Forum Health Products Ltd) - 500 grams - ao


Custom script: Printed On Fri 10 Mar 2017 09:25 By Tim Harding



Overview Notes (Y0028) - Saul came out for his daily apps this morning; no issues were raised concerning his

mental health. He requested to have shower, phone calls and no issues were raised concerning his mental health.


10 Mar 2017 17:03 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at: Hmp Rochester

11 Mar 2017 12:27 Surgery: TURPIN, Rachel (Health Professional Access Role) Entered at: Hmp Rochester

Overview Notes (Y0028) - Discussed with seg Gov Terry Martin as he has been in the seg for a long time and will

remain there until release on 6th May as he is refusing to relocate and if moved to another prison will refuse to

relocate there. Staff report that when he is in his cell he does not read, listen to the radio - just stares into space.

Advised wing staff and Mr Turner that he needs to be reviewed regularly by the Inreach team due to longevity within

the seg and the impact that this will have on his mental and physical health. Advised seg staff that he need to have

as much time out of his cell as possible. He is not engaging with RAPT or education at this time and is in the seg at

his own request. He declined to see Inreach today. Appeared calm and quiet.Plan: To discuss with team how we can

support him at this time. Not on an ACCT.









(R) Amitriptyline 50mg tablets - 28 tablets - 1 tablet - admin times: 16:00 (Oral) (Future dated medication 18 Mar

2017)

Custom script: Printed On Mon 13 Mar 2017 09:24 By Dr Karthika Vijayatharan



Overview Notes (Y0028) - Saul came out for his daily application this morning, appears calm in mood and had good

interaction with SEG staff. He was offered 1:1 but declined.

13 Mar 2017 13:39 Surgery: UZOCHUKWU, Patrick (Mr) (Pharmacist) Entered at: Hmp Rochester


History: seen in segregation this morning




Overview Notes (Y0028) - Seen this morning in segregation unit rounds, no current mental health concerns noted or

complained of.

Thu 23 Apr 2020 15:02



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Overview Notes (Y0028) - Saul came out this morning for his daily application with minimal interaction with the

officers and appears low in mood. On the 23rd of this month will be making it his 42days in SEG, Miss Stone had

already completed paper work for DDC. Turner had refused to stay in any normal location even when transfer to

another prison because of his drug problem. Mental health disagreement of long stay in the segregation unit had

been raised and Mr Turner was advised to engage with Seg staff, Inreach or Chaplaincy due to the negative effect

long stay in SEG could cause to his mental health such as anxiety, depression, anger and increase risk to self-harm.

Turner declined 1:1 when offered this morning, I even offered him incell activities pack but declined, he collected his

breakfast, requested to have shower and exercise with minimal interaction with the staff and went back into his cell.

15 Mar 2017 12:30 Surgery: GONCARAS, Laimonas (Dr) (Clinical Practitioner Access Role) Entered at: Hmp

Rochester

History: Admission to segregation unit (XaPma) - No concerns. Appears well. Mood is stable.


Rochester







Overview Notes (Y0028) - Came out for his daily applications this morning, good interaction with the officers, offered

1:1 but declined. He requested to have shower, exercise and cell clean. No issues were raised concerning his

mental health.



Overview Notes (Y0028) - Seen in segregation unit, he stated that he is doing well, no over concerns from him today,

engaged well with the staff and accepted applications.

18 Mar 2017 10:44 Surgery: BRYANT, Ian (Mr) ('Other' Community Health Service) Entered at: Hmp Rochester

Overview Notes (Y0028) - Seen this morning in segregation round, Mr Turner reported no issues or concerns

regarding his mental health


General mental state (X75ws) - Well kempt with good eye contact and rapport, offender was lucid, coherent and

mood appeared euthymic.

Risk classification (Y2462) - Did not disclose suicidal ideation, thoughts of self harm when asked just said 'no'

'alright'.

[V]Other reasons for encounter NOS (ZV6z.) - CC, reason unknown

18 Mar 2017 12:16 Surgery: CARD, Lauren (Miss) (Nurse Access Role) Entered at: Hmp Rochester


Seen in segregation unit (Y0ce3) - seen in nurse segregation rounds. no healthcare concerns raised.

18 Mar 2017 17:04 Surgery: CARD, Lauren (Miss) (Sister/Charge Nurse) Entered at: Hmp Rochester








Overview Notes (Y0028) - Mr Turner was seen this morning, came out for his daily applications, he appears calm in

mood, good interaction with the officers, requested for shower and cell clean. He was offered 1:1 but declined.



History: seen in segregation currently well, denies any health concerns





Overview Notes (Y0028) - Seen for daily MHIRT :- No issues today - interacted well with the team and myself .

Thu 23 Apr 2020 15:02



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Seen by nurse (XaATp) - seen in segregation round. no healthcare concerns raised.





Overview Notes (Y0028) - Seen in his cell this morning with an officer, no issues were raised concerning his mental

health. He was offered 1:1 but declined.



Rochester




Overview Notes (Y0028) - Seen this morning on segregation unit rounds, stated he is ok and no current issues or

concerns, non raised by staff at time of review.




Overview Notes (Y0028) - Came out for his daily applications, no issues were raised concerning his mental health.

He was offered 1:1 which he declined only requested for phone call and shower.



Seen by nurse (XaATp) - seen in nurse segregation round. no healthcare concerns raised.



Overview Notes (Y0028) - Seen this morning in segregation unit rounds, he stated that he is doing ok, no overt

mental health concerns. he accepted applications and conversed well with the staff.






Overview Notes (Y0028) - Seen for daily MHIRT :- greased staff with a smile - said he was OK. Appeared relaxed

and not troubled .




GOAD review this afternoon, due to leave prison in sex weeks time, he wished to stay in seg to stay away from the

drugs available in the wings, he states he keeps himself busy with reading, cell workouts and odd jobs, Cm Martin

offered him to paint some cells, to occupy his mind he accepted, and we spoke about his mental state, he convinced

me that he is doing ok, at present, motivation is good, mood is euthymic, he';s reactive and spontaneous, with

humour and can put across a reasoned argument.

No self harm or suicidal intent. Signed up for another two weeks, he will continue to be seen by inreach daily in seg.

Goading (Xa2mO) - Gov Birch, CM Martin T Dean S Dinn, IMB


History: written in retrospect

Seen in segregation

Patient currently well, denies any health concerns however reportes insomnia over the last 4 days due to excessive

activity and shouting in nearby cells

requesting short term hypnotic

no suicidal thoughst

no illicit drug use

Examination: alert oriented

Plan: any deterioration in mental state or suicidal thoughts let dr know asap

Promethazine hydrochloride 25mg tablets - 5 tablets - 25 mg - admin times: 21:00 (Oral) (Future dated medication 29

Mar 2017)

Custom script: Printed On Mon 27 Mar 2017 18:29 By Dr Karthika Vijayatharan


Overview Notes (Y0028) - Mr Turner came out for his daily apps this morning, he was appropriate in behaviour,

interacted well with staff and collected his breakfast and requested to have shower and exercise. He declined 1:1

Thu 23 Apr 2020 15:02



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Printed



when offered and no issues were raised concerning his mental health.


28 Mar 2017 11:21 Surgery: SEEHRA, Sharon (Miss) (Pharmacist) Entered at: Hmp Rochester



Seen in segregation unit (Y0ce3) - seen in nurse segregaton rounds. no healthcare concerns raised.



29 Mar 2017 07:32 Surgery: TANTON, Karen (Mrs) (Clerical Access Role) Entered at: Hmp Rochester



Overview Notes (Y0028) - Seen in segregation unit this morning, no overt concern this morning, accpted applications

and conversed well with staff




Examination: sleeping but breathing - declined attampts to talk to hoim



Seen by nurse (XaATp) - seen by nurse in segregation rounds. no healthcare concerns raised.






Overview Notes (Y0028) - Mr Turner was seen this morning for MHIRT segregation round, he interacted well with the

officers, offered 1; 1 but declined. he requested to have all the three application and no issues were raised

concerning his mental health.



Seen in segregation unit (Y0ce3) - seen in nurse segregation unit round. no healthcare concerns raised.





Seen by nurse (XaATp) - seen in nurse segregation unit. no healthcare concerns.







time.




01 Apr 2017 10:31 Surgery: ESEKIE, Oseyi (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Seen by Inreach this morning, he looks tired heard telling the officers he did not sleep very

well last night due to disturbance from another offender in next cell, he raised no mental health concern, declined 1:1

when offered.

01 Apr 2017 16:52 Surgery: MOMOH, Aminata (Mental Health Nurse) Entered at: Hmp Rochester



02 Apr 2017 14:42 Surgery: VALINO, Maria (Mrs) (Nurse Access Role) Entered at: Hmp Rochester



02 Apr 2017 17:03 Surgery: VALINO, Maria (Mrs) (Sister/Charge Nurse) Entered at: Hmp Rochester



Thu 23 Apr 2020 15:02



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Printed



03 Apr 2017 09:19 Surgery: BONCHEV, Sevdalin (Dr) (Doctor) Entered at: Hmp Rochester

History: Seen in segregation unit (Y0ce3)Insomnia NOS (X007s)

Examination: Insomnia NOS (X007s)

Diagnosis: Medically fit to be held in the segregation unit (Y0d06)Insomnia NOS (X007s)

Plan: SUGGESTED REVIEW BY MHIRT ROUND

03 Apr 2017 18:15 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at:

Hmp Rochester

Entered: 04 Apr 2017 08:50

04 Apr 2017 08:50 Surgery: MAULINO, Rogelio (Mr) (Sister/Charge Nurse) Entered at: Hmp Rochester



Overview Notes (Y0028) - Mr Turner came out for his daily apps this morning, no issues were raised concerning his

mental health, requested to have all the three apps, collected his breakfast and went back into his cell.


Overview Notes (Y0028) - Seen this morning for MHIRT segregation round, he was appropriate in behaviour, good

interaction with the officers and no issues were raised concerning his mental health.


05 Apr 2017 12:01 Surgery: HARDING, Tim (Clinical Practitioner Access Role) Entered at: Hmp Rochester



Examination: appears well, denies any new physical health problems


History: Seen this morning in segregation unit during nurses rounds. Appears well. No health care concerns raised

05 Apr 2017 16:46 Surgery: CARD, Lauren (Miss) (Sister/Charge Nurse) Entered at: Hmp Rochester

05 Apr 2017 16:46 Surgery: CARD, Lauren (Miss) (Nurse Access Role) Entered at: Hmp Rochester

06 Apr 2017 09:34 Surgery: DEAN, Antony (Mr) (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Seen this morning in segregation unit, he accepted applications and interacted well with

the staff, normal voice tone and content, took breakfast, no overt concerns this morning.

06 Apr 2017 17:00 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at: Entered: 07 Apr 2017 11:39

Hmp Rochester

06 Apr 2017 17:03 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at: Entered: 07 Apr 2017 17:03

Hmp Rochester

07 Apr 2017 11:09 Surgery: MORRIS, Carolyn (Ms) (Occupational Therapist) Entered at: Hmp Rochester



present time.



Drug Administration Marked in Error: Wrong data entered

Amitriptyline 50mg tablets, Quantity given: 1.0, Entered: 06/04/2017 17:00, Desc: Fully administered, Done:

06/04/2017 17:00, Given for: 07/04/2017 16:00

07 Apr 2017 17:03

08 Apr 2017 10:17


Surgery: DEAN, Antony (Mr) (Nurse Access Role) Entered at: Hmp Rochester

Overview Notes (Y0028) - Seen on segregation unit rounds this morning, no stated mental health concerns,

accepted applications, good communication with the seg staff.








10 Apr 2017 09:02 Surgery: TURPIN, Rachel (Health Professional Access Role) Entered at: Hmp Rochester




time.




Thu 23 Apr 2020 15:02



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Printed




Examination: appears well, denies any new health concerns


Goading (Xa2mO)

Present:

Gov Martin

P Martin

K Spalding (IMB)

E Carauna

C Morris

S Turner


Due for release in a month, next review due in 2 weeks. Stated he is happy to remain in the seg for the duration. Has

been exercising in cell, has declined any other gym. Has declined all other activities.

No mental health concerns noted at the present time.

10 Apr 2017 17:32 Surgery: AKISANYA, Adedun (Mrs) (Sister/Charge Nurse) Entered at: Hmp Rochester

10 Apr 2017 17:32 Surgery: AKISANYA, Adedun (Mrs) (Nurse Access Role) Entered at: Hmp Rochester



Overview Notes (Y0028) - No current mental health concerns noted, accepted applications and good communication

with staff.



Overview Notes (Y0028) - Came out for his daily apps, no reported mental health concern, he was appropriate in

behaviour and had good interaction with the officers.


(R) Amitriptyline 50mg tablets - 28 tablets - 1 tablet - admin times: 16:00 (Oral) (Future dated medication 15 Apr

2017)

Amitriptyline 50mg tablets - 28 tablets - 1 tablet


Custom script: Printed On Wed 12 Apr 2017 10:49 By Tim Harding

12 Apr 2017 13:24 Surgery: BOBIE, Nina (Miss) (Pharmacist) Entered at: Hmp Rochester





Overview Notes (Y0028) - Seen this morning, no issues were raised concerning his mental health. He was offered

1:1 which he declined. He accepted his applications, collected his breakfast and went back into his cell.

13 Apr 2017 17:16 Surgery: VALINO, Maria (Mrs) (Sister/Charge Nurse) Entered at: Hmp Rochester


14 Apr 2017 09:06 Surgery: UKPONG, Martine (Mrs) ('Other' Community Health Entered: 14 Apr 2017 10:30



Overview Notes (Y0028) - Mr Turner was bright in mood, smiling and coherent in conversation, chatting with wing

staff as he collected his breakfast. He was dressed appropriately, he requested a shower and exercise as his daily

applications. He reported no concerns to Inreach, wing staff reported no concerns. Continue with current

management plan.



15 Apr 2017 09:08 Surgery: UKPONG, Martine (Mrs) ('Other' Community Health Entered: 15 Apr 2017 13:35


Overview Notes (Y0028) - Mr Turner was bright in mood, smiling and coherent in conversation, chatting with wing

staff as he collected his breakfast. He was dressed appropriately, he requested a shower as his daily application,

he said it was "too cold" for exercise. He reported no concerns to Inreach, wing staff reported no concerns.

Continue with current management plan.



History: Medically fit to be held in the segregation unit (Y0d06)

Admission to segregation unit (XaPma) - No concerns. Appears well. Mood is stable.

Diagnosis: Medically fit to be held in the segregation unit (Y0d06)

Thu 23 Apr 2020 15:02



C54

C55

Printed




Seen by nurse (XaATp) - seen in segregation unit cell in nurse rounds. seems well - no healthcare concerns or

requests when asked.

Seen by triage nurse (XaFk6)






Seen by nurse (XaATp) - He was seen today in the segragation unit during the nurses rounds. He appears settled

and pleasant on approach. No healthcare concerns raised





Overview Notes (Y0028) - Seen for morning review. No mental health concerns or isuues raised or identified at the

present time.




Overview Notes (Y0028) - Mr Turner came out from his cell for his daily applications this morning, he was calm in

mood and appropriate in behaviour. No issues were raised concerning his mental health, requested to have shower,

exercise and cell clean. Next Good review will be on the 24th of April 2017.







present time.




Examination: Appears well, denies any new physical health problems




Overview Notes (Y0028) - Seen this morning, no issues were raised concerning his mental health and none was

observed. Mr Turner declined 1:1 when offered this morning. He interacted well with the officers, requested for

shower, exercise and cell clean.


21 Apr 2017 10:08 Surgery: TURPIN, Rachel (Health Professional Access Role) Entered at: Hmp Rochester





time.




Overview Notes (Y0028) - Seen in segregation unit rounds, came out of cell for applications, he accepted all offered

and had good communication with staff, no indication of any overt mental health needs, declined any input from

Inreach at this juncture.








Thu 23 Apr 2020 15:02



C55

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Printed







Examination: appears well ,denies any new physical health problems



Overview Notes (Y0028) - Seen this morning, no issues were raised concerning his mental health. He was

appropriate in behaviour, accepted his daily applications and declined 1:1 from Inreach when offered.



Seen by nurse (XaATp) - seen in nurse segregation round no issues or concerns.



Overview Notes (Y0028) - attended Mr Turner's GOOD review in the segregation unit this afternoon, meeting chaired

by Governor Terry Martin, attended by Shafiq from Chaplaincy, IMB, SO Perry and the offender. Turner engaged

well I the review, he was able to ask questions when necessary, maintained good eye contact and was happy to

remain in SEG until release two weeks' time. He was signed up for another two weeks and next review will be on the

5th of May 2017.

Goading (Xa2mO)






present time. Declined 1:1 input







26 Apr 2017 09:48 Surgery: PEMBLE, Howard (Mr) (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Seen for daily MHIRT :- Interacting well with team and myself with no distress seen or

reported . Looking forward to going home soon - needs to see services concerning accomodation .





present time. Declined 1:1 input this morning





Seen by nurse (XaATp) - seen this morning in seg health care concerns








Overview Notes (Y0028) - Seen this morning in seg rounds, he declined any input from Inreach or chaplaincy,

accepted applications and returned to his cell. Good communication with the staff, no overt concerns this morning.





Overview Notes (Y0028) - Came out for his daily apps, he raised no mental health concern. He was offered 1:1 but

declined. He accepted his daily applications, collected his breakfast and went back into his cell.

Thu 23 Apr 2020 15:02



C56

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Printed






Seen by nurse (XaATp) - nil concerns








01 May 2017 09:29 Surgery: UKPONG, Martine (Mrs) ('Other' Community Health Service) Entered at: Hmp Rochester



Mr Turner was not seen in the segregation round this morning as it had finished before Inreach arrived. Wing staff

said that the segregation round always starts at 08:30 at the weekend and Bank Holidays. Inreach Worker (MU)

has never experienced a segregation round starting before 09:00.

The Daily History Sheet was reviewed for Mr Turner's contact with staff this morning. According to the history sheet

he collected breakfast, made his application of a shower and he had no issues.

01 May 2017 11:42 Surgery: AKISANYA, Adedun (Mrs) (Nurse Access Role) Entered at: Hmp Rochester



Seen by nurse (XaATp) - seen on seg round nil concerns

01 May 2017 16:35 Surgery: AKISANYA, Adedun (Mrs) (Sister/Charge Nurse) Entered at: Hmp Rochester


02 May 2017 09:52 Surgery: PEMBLE, Howard (Mr) (Nurse Access Role) Entered at: Hmp Rochester

Overview Notes (Y0028) - Seen for daily MHIRT :- Has 10 days left to serve then home and the time is dragging for

him . Interacting OK with team and myself and he has not told me of any issues or concerns today .


02 May 2017 16:48 Surgery: MAULINO, Rogelio (Mr) (Sister/Charge Nurse) Entered at: Hmp Rochester

02 May 2017 16:48 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at: Hmp Rochester

03 May 2017 09:36 Surgery: ESEKIE, Oseyi (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Seen this morning, no issues were raised concerning his mental health and none was

observed. He was appropriate in behaviour, declined 1:1 when offered.



04 May 2017 10:04 Surgery: CARD, Lauren (Miss) (Nurse Access Role) Entered at: Hmp Rochester

Seen in segregation unit (Y0ce3) - seen by nurse in segregation round no concerns.




Overview Notes (Y0028) - Came out for his daily applications, states he only has few days left to complete his

sentence. Turner accepted all his applications and no issues were raised concerning his mental health.

05 May 2017 09:37 Surgery: HARDING, Tim (Clinical Practitioner Access Role) Entered at: Hmp Rochester



Examination: appears well denies any new physical health problems

05 May 2017 11:41 Surgery: MORRIS, Carolyn (Ms) (Occupational Therapist) Entered at: Hmp Rochester

Overview Notes (Y0028) - Seen for morning review. No mental health concerns or issues were raised or identified at

the present time.


05 May 2017 17:01 Surgery: MOREEA, Yacoob (Mr) (Practice Nurse) Entered at: Hmp Rochester

05 May 2017 17:01 Surgery: MOREEA, Yacoob (Mr) (Nurse Access Role) Entered at: Hmp Rochester

05 May 2017 17:50 Surgery: TURPIN, Rachel (Health Professional Access Role) Entered at: Hmp Rochester

Overview Notes (Y0028) - No TV in his cell - seemed very contemplative and setlted -is happy in the seg and has 1

week left _ returning to Portsmouth and raised no issues with this. Presented as quiet and happy to be in the seg.

Staff raised no concerns, eye contact was good, well presented, calm, insightful, apropriate and no risks posed at

this time, not on an ACCT. staff report that he is able to bring issues up as they arise. Has been in seg an

excpetionally long time and this was raised but he had no issues with this.

Goading (Xa2mO)

Thu 23 Apr 2020 15:02



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Printed






present time. Declined 1:1 this morning






08 May 2017 09:06 Surgery: BONCHEV, Sevdalin (Dr) (Doctor) Entered at: Hmp Rochester



08 May 2017 10:11 Surgery: DEAN, Antony (Mr) (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Seen this morning on segregation unit rounds, no current mental health concerns of note,

declined 1-1. Accepted applications and had good communication with staff.





Overview Notes (Y0028) - Mr Turner came out for his daily apps this morning, no issues were raised concerning his

mental health and none was observed. He declined 1:1 when offered, GOOD review 12/05/2017.




09 May 2017 16:46 Surgery: CARD, Lauren (Miss) (Sister/Charge Nurse) Entered at: Hmp Rochester





present time




10 May 2017 12:02 Surgery: HARDING, Tim (Clinical Practitioner Access Role) Entered at: Hmp Rochester

(R) Amitriptyline 50mg tablets - 28 tablets - 1 tablet - admin times: 16:00 (Oral) (Future dated medication 13 May

2017)

Stopped 13 May 2017 Sentence Ended by MAULINO, Rogelio (Mr)

Custom script: Printed On Wed 10 May 2017 12:02 By Tim Harding

10 May 2017 13:27 Surgery: UZOCHUKWU, Patrick (Mr) (Pharmacist) Entered at: Hmp Rochester






present time. Declined offer of 1:1 this morning.






12 May 2017 08:51 Surgery: BONCHEV, Sevdalin (Dr) (Doctor) Entered at: Hmp Rochester



Diagnosis: Discharged from segregation unit (XaPmh)


30 Sep 2017 15:22 Surgery: O'SULLIVAN, Thomas (Mr) (Nurse Access Role) Entered at: HMP Lewes




Thu 23 Apr 2020 15:02



C58

Printed




Consent obtained (Y001d)


Other Consent Given (Y9959)


BCG vaccine (n42..)

HIV test offered (XaDvy)

Health assessment questionnaire (XM0e6) 0 - 1. Can the Patient tell the time?: Yes

2. Can the patient read?: Yes

3. Can the patient write?: Yes

4. Does the patient live independently (in the community)?: Yes

5. Does the patient have a job (in the community)?: Yes

6. Has the patient had previous contact with the LD services?: No

7. Has the patient had specialist schooling?: No

Tetanus (A37..)

Has not been in prison before (Y08dc)




O/E - height (229..) 1.72 m (5 ' 8 ")

No (Y0428)




Rolls own cigarettes (137M.)

Wants to stop smoking (XaLQh)

Cigarette smoker (XE0oq)

Impressions of the prisoners behaviour and mental state (YX023) - settled


Case management risk assessment score (XaLWw) 0 - Is the patient on an open ACCT?: No

Is there a history of non-compliance with medication in the last year?: No

Are there any concerns about the ability of the patient to follow instructions / directions re. medication?: No

Is there any information to indicate that the patient is being bullied for medication or trading medication?: No

Have the Mental Health Team Raised any concerns regarding this patient and in-possession medication?: No


Yes (Y0427)

Refer to doctor Re: prisoners physical health (YX028)

Consent obtained (Y001d)

Health Information the prisoner thinks is important (YX024) - depression

Syphilis screening declined (XaLNB)

Hep C test - offered and refused (Y075a)

Syphilis screening offered (XaLN9)



Emotional state observations (Ua16B) - settled



Hepatitis B immune (XE2ww)

[V]Measles-mumps-rubella (MMR) vaccination (ZV064)

130 / 68 mmHg





02 Oct 2017 08:31 Surgery: JEWSON, Nicola (Clerical Access Role) Entered at: HMP Lewes


Reminder/Alert: No SCR record, therefore no NHS number or gp - Priority: Normal

04 Oct 2017 09:36 Surgery: HARVEY, Adrian (Nurse Access Role) Entered at: HMP Lewes

Word Document: turner refferal.doc

C59

Thu 23 Apr 2020 15:02



C59

Printed



Referral In to HMP Highdown for In Reach: Ended on 16 Nov 2017 00:00


Transferred - in custody

Status Update for In Reach Referral In: Waiting For Assessment


Date Of Birth Changed From '08 Dec 1982'

05 Oct 2017 12:55 Surgery: HILL, Rachel (Mrs) (Health Professional Access Role) Entered at: HMP Lewes

Risk Screening Tool - questionnaire started



I saw Saul on FNC.

Index offence: multiple burglaries. On remand. Due in court later in the month.

Current mental health: Saul reports that he feels depressed and has been unable to cope with life. He said that

since the breakdown of his relationship in May 2017 he said that he has not been able to function. Difficult to elicit

from Saul what he finds difficult to manage in his life as he would often say _I don_t know, it_s my mental health_.

Saul reported that he went on a _rampage_ of burglaries as he said that he wanted to get back into prison. He said

that his life was not _working_ and thought that by coming into prison he could get his life back on track. Saul

reports that he would be keen to understand how he can help himself in prison by engaging with mental health.

He reports to feeling depressed. He presented as low in mood. Some biological symptoms of depression notably

reduced appetite, sleep and concentration. He reports that he has felt like this for many months. He spoke about

previously being on antidepressant (amitriptyline) which he said had helped his mood. He reported that he was on

this the last time he was in prison (evidence shows that he was prescribed this) but he stopped taking it once he left

prison as he felt better. He thinks that being back on it would be helpful. Advised that this is not first line treatment for

depression and potentially unlikely to be prescribed. However an SSRI could be considered.

Past psychiatric history: recent attendance at A&E following an overdose. He said that he was seen by the mental

health team at the Conquest hospital with the notes on care note. He was advised to attend time to talk and to

contact his GP.

He denies that he has been involved with a mental health team in the community and did not most recently approach

time to talk. Saul reports being on healthcare back in 2009 when he was in prison. He said that he was in

healthcare due to depression but felt that he had been helped.

He reports seeing a psychiatrist in prison but I can not see evidence of this on system 1however notes only go back

to 2009.

Personal history: Saul reports that his mother was a prostitute and he was fathered by one of her clients. He reported

he did not find out until he was 12 yrs old. Up until this time he was brought up by his stepfather. He said that he

struggled to comprehend this when his mother told him. He referred to his mother as being "wicked" and reports

having no relationship with her. He reports being involved in crime since a young age. He reported that he feels that

he has previously been successful financially through crime.

Substance misuse: history of alcohol misuse in regards to binge drinking. He denies use of illicit substances.

C60

Risk:

To self: history of overdosing. Last overdose on 2/8/2017 whereby he took an overdose of paracetamol. He called

an ambulance and was taken to A&E.

He reports history of trying to end his life since 2007. He said that he has tried to end his life before by hanging

himself in a park. He said that he had tied a noose around a tree and was under the influence alcohol. He did not go

through with it as he thought that it would be too painful. No current thoughts of suicide or self harm.

To others: he denies a history of risk to others. Long history of being in prison for burglaries.

MSE: casually dressed male, small in stature. Moderate rapport and eye contact. No evidence of psychomotor

agitation or retardation. Speech normal. Mood objectively low and subjectively depressed. No overt anxiety. No

psychotic symptoms. No formal thought disorder. Cognition intact. No current suicidal or self harm thoughts

Formulation: 31 yr old who reports a previous diagnosis of depression dating back to 2007. He reported that being

in prison is the place where he thinks that he will be able to sort himself out and stated he deliberately got himself

back into prison. He presents as low in mood and evidence of emotionally unstable personality traits. Appears to

have poor coping strategies and a somewhat external locus of control around his life and how he functions.

However reporting that he wants to make a change in his life. He is keen to engage in the mood management

Thu 23 Apr 2020 15:02



C60

Printed



group

Plan: to ensure he is on waiting list for GP _ would benefit from introduction of an antidepressant

To be added to mood management waiting list _ non f wing.

C61

Mental health assessment (XaIYN)




11 Oct 2017 13:30 Surgery: PERT, Caroline (Health Professional Access Role) Entered at: HMP Lewes

11 Oct 2017 13:31 Surgery: GRIFFIN, Elizabeth (Ms) (Health Professional Access Role) Entered at: HMP Lewes


Letter to Patients to Mr Saul Turner

26 Oct 2017 09:00 Surgery: BARDEN, Anne (Clerical Access Role) Entered at: HMP Lewes

27 Oct 2017 08:28 Surgery: TURNER, Teresa (Ms) (Clerical Access Role) Entered at: HMP Lewes

30 Oct 2017 09:28 Surgery: PHILP, Kelly (Clerical Access Role) Entered at: HMP Lewes


02 Nov 2017 08:46 Surgery: JEWSON, Nicola (Clerical Access Role) Entered at: HMP Lewes

06 Nov 2017 10:32 Surgery: HOSSAIN, Jahura (Dr) (Clinical Practitioner Access Role) Entered at: HMP Lewes

History: 1) Low mood and depression since 20007. When low, can't sleep, can't eat, has bad thoughts in his head.

Previously found Amitriptylline helped. Says Citalopram and Setraline did not work. Has found some benefit from

Miratizipine

Hx of self harm - has OD'ed and tried to hang himself. No active suicidal ideation. Recognises he needs to be back

on antideps to stabilise his mood.

2) Requesting tx for acne - requesting oral antibiotics.

3) Requesting help with stop smoking.

Examination: Alert, calm, flat, good eye contact, engages well.

Mild acne on forehead and upper back. Multiple old acne scars.

Plan: 1) Start Mirtazipine 15mg (in view of previous hx of what has/ has not helped his mood).

2) Refer to Smoking Cessation

3) Acne - discussed continuosu antibiotic use in Acne causes resistance. Better to have a maximum 12 wk course at

a time. Try tpoical Duac (limit to 12 wks).


112 / 73 mmHg


Mirtazapine 15mg tablets - 28 tablets - 1 tablet - admin times: 19:00 (Oral)

Stopped 07 Nov 2017 End of course (Change to 7/7 IP) by HOSSAIN, Jahura (Dr)

Benzoyl peroxide 5% / Clindamycin 1% gel - 1 pack of 30 gram(s) - Apply ONCE at night (30 grams every 28 days)

(Future dated medication 07 Nov 2017)

Custom script: Printed On Mon 06 Nov 2017 14:27 By Sandra Clark

06 Nov 2017 14:27 Surgery: CLARK, Sandra (Health Professional Access Role) Entered at: HMP Lewes


History: Message request - Tue 07 Nov 10:17 - Lisa Jakens

'Please change Mirtazapine to weekly in possession.

Thanks.'

Mirtazapine 15mg tablets - 7 tablets - [16:00-1 tablet] (7 tablets every 7 days)

Custom script: Printed On Tue 07 Nov 2017 11:17 By Sandra Clark

07 Nov 2017 11:17 Surgery: CLARK, Sandra (Health Professional Access Role) Entered at: HMP Lewes

07 Nov 2017 11:18 Surgery: JAKENS, Lisa (Health Professional Access Role) Entered at: HMP Lewes



09 Nov 2017 11:20 Surgery: GODDEN, Sara (Ms) (Nurse Access Role) Entered at: HMP Lewes


10 Nov 2017 01:44 Surgery: TAYLOR, Graham (Mr) (Nurse Access Role) Entered at: HMP Lewes


13 Nov 2017 09:04 Surgery: PHILP, Kelly (Clerical Access Role) Entered at: HMP Lewes


13 Nov 2017 12:10 Surgery: RAYCHAUDHURI, Bikram (Dr) (Clinical Practitioner Access Role) Entered at: HMP

Lewes

(R) Mirtazapine 15mg tablets - 28 tablets - [16:00-1 tablet] (7 tablets every 7 days) (Future dated medication 14 Nov

Thu 23 Apr 2020 15:02



C61

C62

Printed



2017)

Stopped 17 Nov 2017 Other (Ended after on admission medication review) by GONCARAS, Laimonas (Dr)

Mirtazapine 15mg tablets - 28 tablets - [16:00-1 tablet]

Ended 16 Nov 2017 Patient Deducted

Custom script: Printed On Mon 13 Nov 2017 13:10 By Veronica Hook

13 Nov 2017 13:10 Surgery: HOOK, Veronica (Health Professional Access Role) Entered at: HMP Lewes

14 Nov 2017 08:29 Surgery: JEWSON, Nicola (Clerical Access Role) Entered at: HMP Lewes



15 Nov 2017 12:26 Surgery: SALT, Darren (Mr) (Health Professional Access Role) Entered at: HMP Lewes


15 Nov 2017 20:31 Surgery: DALTON, Diane (Mrs) (Health Professional Access Role) Entered at: HMP Lewes


16 Nov 2017 Prison: TANTON, Karen (Mrs) (Clerical Access Role) Entered at: Entered: 17 Nov 2017 10:54

Hmp Rochester


16 Nov 2017 Surgery: TANTON, Karen (Mrs) (Clerical Access Role) Entered at: Entered: 17 Nov 2017 10:55

Hmp Rochester

Signed Medication Compact and Consent to Transfer of Information.

16 Nov 2017 15:08 Surgery: Unknown Staff Member Entered at: HMP Guys Marsh Entered: 02 Oct 2018 13:34


16 Nov 2017 15:08 Surgery: Unknown Staff Member Entered at: HMYOI Portland Entered: 25 Apr 2018 07:45


16 Nov 2017 15:08 Surgery: Unknown Staff Member Entered at: HMYOI Stoke Heath Entered: 09 Mar 2018 12:17


16 Nov 2017 15:08 Surgery: Unknown Staff Member Entered at: Hmp Rochester

(Admission Med) Mirtazapine 15mg tablets - 28 tablets - [16:00-1 tablet]

(Admission Med) Benzoyl peroxide 5% / Clindamycin 1% gel - 1 pack of 30 gram(s) - Apply ONCE at night

16 Nov 2017 15:08 Surgery: CARD, Lauren (Miss) (Nurse Access Role) Entered at: Hmp Rochester






Hep B Vacc - Not Offered (Y09f2) - states has had all

Hep C Test - Not Offered (Y0806)


Hepatitus B status unknown (Y0905)


Not known if had Tetanus vaccination (Y08f2)

Blood test declined (XaZOq)

No (Y0428)

No (Y0428)

No (Y0428)




Interpreter not needed (XaI8Y)




Patient not registered (9121.)

Smoker (137R.)

Asthma: no (Y0944)

Referral for smoking cessation service offered (XaXR4)




Prisoner receiving prescribed medication (YX007) - weekly re ordered due tuesday

Thu 23 Apr 2020 15:02



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First night risk assessment form completed (Y4581)

No (Y0428)

Has never misused drugs (Ub0mr)

Suitable for in-possession medication (XaYM5) (New Episode)

No (Y0428)

Consent given to share patient data with specified 3rd party (XaNwR)




Level 3 (Xa0VQ)

Green (XC08c)







Prisoner has stayed in a psychiatric hospital (YX017)


Patient has not previously used drugs (Y09fb)

No (Y0428)

Case management risk assessment score (XaLWw) 0 - 1Did you have medication in possession at previous

establishment?: Yes

2. Has the patient understood and signed IP Compact/Leaflet/Medication Policy?: Yes

3. Has the patient any learning difficulties, problems with reading labels or language difficulties?: No

4. Has the patient any history of alcohol or drug abuse?: No

5. Is there any known history of medication related incidents eg trading, bullying etc?: No

6. Is the patient at risk from self-harm/overdose?: No

7. Is the patient on an open ACCT?: No

8. Is the patient confused or disorientated?: No

9. Has the patient had a recent change in prison status (eg recently sentenced) or a recent life event which has

increased their risk?: No

10. Practioner concern?: No



Teetotaller (1361.)


16 Nov 2017 22:47 Surgery: PARKER, Kate (Nurse Access Role) Entered at: HMP Lewes

17 Nov 2017 07:33 Surgery: TANTON, Karen (Mrs) (Clerical Access Role) Entered at: Hmp Rochester

17 Nov 2017 09:54 Surgery: GONCARAS, Laimonas (Dr) (Clinical Practitioner Access Role) Entered at: Hmp

Rochester

(R) Mirtazapine 15mg tablets - 28 tablets - [16:00-1 tablet] (7 tablets every 7 days) (Future dated medication 21 Nov

2017)

Stopped 12 Dec 2017 Form, strength, or route change by GONCARAS, Laimonas (Dr)

Mirtazapine 15mg tablets - 28 tablets - [16:00-1 tablet]

Ended 09 Mar 2018 Patient Deducted

Custom script: Printed On Fri 17 Nov 2017 09:55 By Dr Laimonas Goncaras

17 Nov 2017 10:31 Surgery: CLIFTON, Hannah (Miss) (Admin/Clinical Support Access Role) Entered at: Hmp

Rochester

Health promotion (6B...) - Issued with Healthcare Induction pack - letter, application form and healthcare booklet.

17 Nov 2017 15:43 Surgery: ERDOGAN, Zerin (Miss) (Pharmacist) Entered at: Hmp Rochester


Rochester

Health promotion (6B...) - Issued with Healthcare Induction Pack - letter, application form and booklet.






Rochester

Thu 23 Apr 2020 15:02



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Printed



Smoking cessation advice (Ua1Nz) - No clinic due to staff shortage - this would've been patient's first appointment,

so rebooked for 1/52.




01 Dec 2017 Surgery: SKINNER, Margaret (Assistant Practitioner) Entered at: Entered: 25 Apr 2018 11:14

HMYOI Portland

Stopped smoking (137K.)

04 Dec 2017 11:00 Surgery: CLIFTON, Hannah (Miss) (Admin/Clinical Support Access Role) Entered at: Hmp

Rochester

Attends stop smoking monitoring (9OO1.) - Attended first appt. Patient has been on the course before and is aware

of how it runs. All treatment options discussed and patient has chosen to start with NRT - issued. Review 1/52,

appointment booked.

04 Dec 2017 11:02 Surgery: CLIFTON, Hannah (Miss) (Admin/Clinical Support Access Role) Entered at: Hmp

Rochester

Smoking cessation programme start date (XaIth)

Age at starting smoking (Ub0p3) - 12

Expired carbon monoxide concentration (X77Qd) 12 PPM

Smoker (137R.)


Quantity (X75QM) - Seven day supply


Expired carbon monoxide concentration (X77Qd) 26 PPM

NiQuitin CQ 21mg/24hours clear patch (du3s.)

Smoking cessation programme start date (XaIth)

Advice about treatment (Ua02O)

Advice about side effects of treatment (Xa9zk)

05 Dec 2017 10:31 Surgery: MOREEA, Yacoob (Mr) (Nurse Access Role) Entered at: Hmp Rochester

05 Dec 2017 10:31 Surgery: MOREEA, Yacoob (Mr) (Nurse Access Role) Entered at: Hmp Rochester

08 Dec 2017 07:34 Surgery: TANTON, Karen (Mrs) (Clerical Access Role) Entered at: Hmp Rochester

11 Dec 2017 11:02 Surgery: CARTER, Ellen (Ms) (Admin/Clinical Support Access Role) Entered at: Hmp Rochester

Seen by smoking cessation advisor (XaIye) - co read 12 issued x 1 pack 21mg nrt patches x 2 packs 4mg nrt mints

12 Dec 2017 08:42 Surgery: TANTON, Karen (Mrs) (Clerical Access Role) Entered at: Hmp Rochester

12 Dec 2017 09:45 Surgery: GONCARAS, Laimonas (Dr) (Clinical Practitioner Access Role) Entered at: Hmp

Rochester

(R) Mirtazapine 15mg tablets - 28 tablets - 1 tablet - admin times: 16:00 (Oral) (Future dated medication 13 Dec

2017)

Mirtazapine 15mg tablets - 28 tablets - 1 tablet


Custom script: Printed On Tue 12 Dec 2017 09:45 By Dr Laimonas Goncaras

12 Dec 2017 09:49 Surgery: PEMBLE, Howard (Mr) (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Seen for daily MHIRT :- No issues or concerns disclosed and he interacted well with the

team a and myself . When asked why he is in the unit he told me he had returned to NPS use . His last period in the

unit last sentence was also related to NPS use .

12 Dec 2017 10:30 Surgery: AKISANYA, Adedun (Mrs) Entered at: Hmp Rochester Entered: 12 Dec 2017 15:18

Did not attend for HC Weekly Collection-Tuesday appointment with Mrs Adedun Akisanya.



Levels of observation (Ua1Sw) - Normal segregation unit observations .

General mental state (X75ws) - Saul in a much better place now he is in the unit . Was using NPS to £1.5K debt .

Feels powerless to resist his cravings for NPOS when he is being offered it . Chaotic when on the wing .

[V]Other reasons for encounter NOS (ZV6z.) - Saul refused to locate and is now in the unit .

Risk classification (Y2462) - No risk of self harm or suicide disclosed or identified today .

Review of admission to segregation unit (XaPmi) - Enhanced review

Clinical management plan (XaJYd) - Wants transfer .

[V]Personal history of mental disorder (ZV11.) - No specific mental heal;th history disclosed . Was in unit when last

here also having used NPS and built debt . Extensive withdrawal at that time . Was out to liberty which failed when

he had no accomodation and lost his job .

12 Dec 2017 15:25 Surgery: MUVUNGANI, Catherine (Miss) (Admin/Clinical Support Access Role) Entered at: Hmp

Rochester

Thu 23 Apr 2020 15:02



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Substance misuse monitoring 6 month review (XaauR) - States he is £1500 in debt in the prison for NPS. He is

happy to be in the seg and declined to engage with the services. He stated that it will be his decision to stop using

NPS as he has never done drugs outside prison in his life. He does in here to get away from his thoughts and for

time to go quickly. Stated will not be needing to engage with the service

Substance misuse team (XaJRs)

Substance misuse team (XaJRs) - Catherine Muvungani

Substance misuse monitoring 6 month review (XaauR)


Overview Notes (Y0028) - Seen for daily MHIRT round :- No issues or concerns expressed about him or by him

today . Good interaction with team and no overt distress noted . Told me he is OK .


13 Dec 2017 11:49 Surgery: HARDING, Tim (Clinical Practitioner Access Role) Entered at: Hmp Rochester



Examination: appears well denies any new health concerns

13 Dec 2017 16:59 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at: Hmp Rochester


14 Dec 2017 Prison: TANTON, Karen (Mrs) (Clerical Access Role) Entered at: Entered: 15 Jan 2018 13:49

Hmp Rochester

F213 - Report of injury to inmate to Unknown

14 Dec 2017 Surgery: TANTON, Karen (Mrs) (Clerical Access Role) Entered at: Entered: 15 Jan 2018 13:49

Hmp Rochester

F213 -SH

14 Dec 2017 13:52 Surgery: DEAN, Antony (Mr) (Nurse Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Seen in seg this morning, no current mental health concerns expressed or noted.

Accepted applications and has a good rapport with staff and remembered me from previous encounters in seg.



15 Dec 2017 Prison: METCALFE, Jane (Ms) (Clerical Access Role) Entered at: Entered: 22 Dec 2017 13:13

Hmp Rochester


15 Dec 2017 Surgery: METCALFE, Jane (Ms) (Clerical Access Role) Entered at: Entered: 22 Dec 2017 13:13

Hmp Rochester

signed mhirt consent form



Overview Notes (Y0028) - Seen in segregation unit this morning, Saul had a suicide attempt last evening by cutting

wrist, he stated he is determined and will end his life. There will be a review this afternoon, he is due to have the

ACCT assessment this morning, I will attend this and then continue with triage.

Reminder/Alert: Constant watch in segregation unit following suicide attempt. - Priority: High


Referral from other (Y1940) - In segregation unit, after act of self harming in a suicide attempt

Patients perception of current problem (Y3029)

I've had enough of life and I'm fed up "with my life I wish to die, it's been a long time coming", He stated that he is

happy with his decision. Agreed to be seen for assessment but does not think that he needs help, and has stated in

ACCT assessment that he does not want any help.

I want to die with "dignity and some self respect"

Reason for referral (XaIpS) - Attempted suicide by cutting right forearm with a scissor blade. Statement by staff in

seg on ACCT document that this was "over him not getting a smoke", not passing tobacco from another cell.

[V]Mental and behavioural problems (ZV40.)

Tobacco smoking behaviour (Ub0oo)

Substance misuse behaviour (XaJz5)

Mental health triage nurse follow up (XaL0v)

Prisoner has been in prison before (YX004) - Numerous times in jail previously.,

Seen in segregation unit (Y0ce3) - In constant watch cell, with O Daniels whom was doing the ACCT assessment.

Convicted for criminal activity (Ua0Sg) - Burglary sent to 3yrs and 5 months he is out in August 2019.

Prisoner constant watch commenced (XaaeK) - Has already commenced constant.

Open ACCT (YA213)

Thu 23 Apr 2020 15:02



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Agencies and organisations (XaBfS) - No interventions from forward trust or mental health teams.

Overview Notes (Y0028) - Has two previous suicide attempts by overdose of cocodamol and alcohol, 1st about 9

years ago and again this year in the summer between July and September this year. Stated that he attempted to

hang self last evening but he "lost bottle". No previous mental health history prior to this event.

Clinic note (XaIgp) - Index offence of Burglary, most crimes of an acquisitive nature.

Summary of needs (XaX3D)

A 34 yrs old man with a long offending history, stated that he used to use CNBS regularly years ago but has not

used this for "quite a while now", not a drinker on a regular basis and describes self as "virtually teetotal". Saw R Hill

when in Lewes last month for a short one off session, he described this as "business like" and he did manage to get

the mirtazapine re prescribed that he says he only uses on jail. He stated that he never goes to the GP outside as he

stated this too much like hard work. In prison he finds easier access to healthcare.

He stated that he has felt unhappy or "depressed for a long time" he states that he cannot remember the last time he

felt happy. He describes the feeling of being happy likening it to "winning at the gambling table" and that it has been

very short lived for him. He states no that he "has had enough, I've reached the end, I really have made up my mind,

I am content with the decision I've made". I cannot go with the concerns for others, as I will not change my mind to

please other people. He was speaking to the safer custody.

I have never been fulfilled in my life, in any was shape or form, I have had a traumatic life with one thing and another,

He states he had counselling through the probation service and attended a 12 week "course" and this was for

gambling but we did not speak about my gambling at all, we spoke about everything else. Right at the end he stated

that she told him that there was not much she could do for him, she could not give him a conclusion, as she needed

more time with him, but this was not possible, due the constraints placed there by the contract from probation. He

stated that she did not tell him anything he did not already know.

Saul has a family of an ex partner and a nine year old daughter whom he does not have contact with any more due

to his criminal behaviour.

During the assessment for ACCT Saul said that he "never had this conversation before and feels this is a very

unfamiliar place" for him. " I feel this is my life and my choice" He was challenged about several aspects of this and

how "we" can help? He stated clearly that he does not want help he was not angry and his demeanour was such that

he stated he "could not find" a reason to live for.

Longest period out of prison was from 2013 to 2015.

Current presentation is emotionally subdued, not flat, he did have some reactivity and spontaneity, good eye contact,

normal voice tone, rate of speech is normal, content is subdued and calm.

He reports that sleep is easily attained, he can normally have good rapport with staff and peers alike.

No FTD, not responding to unseen stimuli, no history of psychosis or contact with mental health services. On

reflection in my opinion he presents as dysthymic with learned responses to social cues and does quite effectively

disarm concern when he smiles appropriately and displays humour in the right places.

Computer record NOS (934Z.) - System one and ACCT assessment.

Prisoner has received medication for mental health problems (YX019) - Mirtazapine 15mg nocte with good hypnotic

effect.

No (Y0428)

Self inflicted injury (Xa0EN)

Suicidal intent (XaA1G)

No (Y0428)

Destructive behaviour toward property (X765R)

Attempted suicide NOS (Xa3jI)

Suicidal thoughts (1BD1.)



Long and in depth review, with the panel and Saul engaged well, he is determined to end his life and the panel are

aware of this. He will remain on constant observations and he can have clothes back and he was offered a TV which

he declined.

Mood I would describe as dysthymic with learned responses to social cues.

Review of care of detained patnt under Section 120 MHA 1983 (Xa9Ep) - Gov Langridge, IMB G Griffiths OMU, O

Thu 23 Apr 2020 15:02



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daniels safer custordy, Oscar 1, CM Shcaefer. T Dean and saul Tuner in Adjudication room of segregation unit.

15 Dec 2017 16:34 Surgery: AKISANYA, Adedun (Mrs) (Nurse Access Role) Entered at: Hmp Rochester


15 Dec 2017 16:35 Surgery: AKISANYA, Adedun (Mrs) (Nurse Access Role) Entered

at: Hmp Rochester

Entered: 15 Dec 2017 16:37

Handover Report : Overall Communication (Y4510) - Officer Sarah reported that Mr Turner refused his meals both

lunch and supper and i went to him he refused his medication also that is the first day.

16 Dec 2017 Prison: TANTON, Karen (Mrs) (Clerical Access Role) Entered at:

Hmp Rochester

Entered: 19 Dec 2017 13:05



Hmp Rochester

Entered: 15 Jan 2018 13:54



Hmp Rochester

Entered: 20 Feb 2018 14:14

F213 - Report of injury to inmate to Hmp Rochester

16 Dec 2017 Surgery: TANTON, Karen (Mrs) (Clerical Access Role) Entered at:

Hmp Rochester

Entered: 15 Jan 2018 13:54

F213 - SH

16 Dec 2017 12:40 Surgery: ESEKIE, Oseyi (Nurse Access Role) Entered at: Hmp Rochester


Review in SEG, still determined to end his life and nothing will change this. Spoke about his last sentence briefly,

how he was release without any accommodation, no family support, survived by stealing only has a lady friend who

calls him occasionally. Read in the communication book of the attempted self-harm early this morning with a broken

ceramic cup given to him by the night officer on duty. Saul said he knew he was not supposed to be given a ceramic

cup but accepted it; felt it was not his obligation to notify the staff. Stated feeling hopeless and sees no point of living.

Risk to self remains high, constant watch nurse need to be vigilant. Declined incell pack when offered, stated he was

initially contemplating of going on hunger strike but changed his mind, had four biscuit last night. From TD entry, it

appears the prison already aware of Saul's risk.


Paracetamol 500mg tablets - 2 tablets - now


17 Dec 2017 Prison: METCALFE, Jane (Ms) (Clerical Access Role) Entered at: Entered: 22 Dec 2017 12:28

Hmp Rochester

Miscellaneous to Unknown

17 Dec 2017 Surgery: METCALFE, Jane (Ms) (Clerical Access Role) Entered at: Entered: 22 Dec 2017 12:28

Hmp Rochester

ACCT review







18 Dec 2017 Surgery: TURPIN, Rachel (Health Professional Access Role)


Entered: 21 Dec 2017 09:27

Date (Xa0ck)


18 Dec 2017 09:15 Surgery: CARD, Lauren (Miss) (Nurse Access Role) Entered at: Hmp Rochester

Paracetamol 500mg tablets - x2 given nip

18 Dec 2017 10:45 Surgery: CARTER, Ellen (Ms) Entered at: Hmp Rochester Entered: 18 Dec 2017 11:42

Did not attend for HC-Smoking Clinic appointment with Ms Ellen Carter.


18 Dec 2017 11:47 Surgery: CARTER, Ellen (Ms) (Admin/Clinical Support Access Role) Entered at: Hmp Rochester

Did not attend smoking cessation clinic (XaIpo) - dna appt posted x 2 weeks nrt x 2 packs 21mg nrt patches next

appt 2/1/208

18 Dec 2017 15:26 Surgery: ESEKIE, Oseyi (Nurse Access Role) Entered at: Hmp Rochester

Thu 23 Apr 2020 15:02



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Good and constant watch review this afternoon in SEG, Good review was chaired by Governor Langridge and the

ACCT review by safer custody manager Ugin, attended by IMB Dickson, Etienne (chaplaincy), R.Esekie(inreach) and

the offender Mr Turner. Mr Turner asked for his constant watch closed as soon as he walked into the room, stated

feeling more positive today, felt no different been on constant watch, also asked for his antidepressant to be

changed, report history of severe depression for the past seven years, tried different antidepressant medications

over the years and nothing seems to help apart from Amitriptyline. Mr Turner engaged well at the review, the

comment he made of ending his life was pointed out to him and the reason why he wanted his constant watch to

discontinued, no clear answer was given apart from making reference to how it took him long time to see the mental

health when in custody, how he was prescribed mirtazapine instead of Amitriptyline when seen. I remembered Mr

Turner stating how pleased he was to his current medication when seen last Saturday never mentioned change.

Mr Turner was on Amitriptyline 50mg up till 13th of May 2017 after his sentence. Team were briefed by Governor

Langridge of the transfer request to HMP Winchester which has been put in place; the plan is for Mr Turner to remain

in SEG until transfer. Risk to self remains high, Governor Langridge plan to get Turner painting job in SEG to keep

him busy.

Next review will be on Wednesday 20/12/2017.

Review of care of detained patnt under Section 120 MHA 1983 (Xa9Ep)










20 Dec 2017 14:06 Surgery: TURPIN, Rachel (Health Professional Access Role) Entered at: Hmp Rochester


Seen in seg round - engaged to gets apps and was polite- reported twice " i have never been so strong" - but had

little meaning or strength behind this- seemed more odd and negative than real. Remains on constant watch.

Accepted all apps. Not malodourous but clothes were worn.

Team in the seg are fully aware and he engaged with them sufficiently.

Has psychiatric review and Constant watch review today.


20 Dec 2017 15:16 Surgery: SINGH, Sourabh (Dr) (Consultant) Entered at: Hmp Rochester

Mental health review follow-up (XaMJ8)

Mental health medication review (XaJr3)

Follow-up psychiatric assessment (6654.)

Outpatient (Ua0WZ)

Seen by forensic psychiatrist (XaATE)

Risk Assessment Review (Y2168)

Outcome (XaIXy)

Seen in Seg and also attended the ACCT review

In the ACCT review, all the MDT supported stopping 1:1 observations. HE will remain on ACCT monitoring.

C68

During my interview he admitted suffering from prolonged period of pervasive low mood. He can remember being low

in mood since 2007. Never felt that hsi mood returned to normal since then.

He has suefferd from 4-5 episodes of low mood, which were persistent and pervasive with suicidal thoughtss,

anhedonia, poor motivation,. low energy, negative thoughts in addition to the chronic baseline low mood. He also

admitted suicidal attempts by taking overdoses.

1st episode of overdose was at the age of 12. After that 3-4 suicidal attempts, mainly taking numerous tablets of

co-codamol.

The most recent attempt was in segregation unit by cutting himself. This is the first time he has cut himself.

He was born and brought up in Kent. He reported that hsi mother used to work as prostitute and hsi father was one

of her clients. Mr Turner reporetd that he never met hsi biologicalk father. His mother then married a man, with whom

she had 2 daughters. HE remembers not being treated as well as his half-sissters.

He was in amainstream school. He remembers being very difficult and disruptive at school, He was expelled from

secondary school. HE did nto finish schoolign and got into trouble with law.

Thu 23 Apr 2020 15:02



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He has been in prison numerous times before this current episode.

He admitted using cannabis regularly in the community before. HE has used spice in the prison. HE reported that he

used spice worth thousands of pounds in prison. He admitted tot he ACCT team that he used spice to kill bordeom

and was at risk of using more if left on normla location.

No psychotic features evident. No formal thought disorder.

IMP: Double depression (recurrent depressive disorder on a backhground of dysthymia) with co-morbid

cannabis/spice misuse.

Plan:

1. MDT involveemnt in treatment. Pharmacological and psychological treatments

2. referral to substance misuse team

3. Sodium valproate for prophylaxis of recurrent depression

4. To be managed by Inreach team

5. F/u in my clinic in 4-6 weeks

C69

Valproic acid 250mg gastro-resistant tablets - 28 tablets - 250 mg - admin times: 08:45 (Oral)

Valproic acid 500mg gastro-resistant tablets - 28 tablets - 500 mg - admin times: 16:00 (Oral) (Future dated

medication 22 Dec 2017)

Custom script: Printed On Wed 20 Dec 2017 15:28 By Dr Sourabh Singh


Referral In to HMP Highdown for Continuing Care other Levels: Ended on 09 Mar 2018 00:00

Status Update for Continuing Care other Levels Referral In: Receiving Care

20 Dec 2017 17:00 Surgery: VALINO, Maria (Mrs) (Nurse Access Role) Entered at: Hmp Rochester




Yes (Y0427)

Other note (XaIgC) - on constant watch - has clearly attempted to end his life.

Other note (XaIgC) - self on seg

Other note (XaIgC) - saw psychiatrist and is now on caseload

Yes (Y0427)

Other note (XaIgC) - depression - ongoing risk


Overview Notes (Y0028) - Inreach seg round - engaged and accepted apps - requested inside Times which was

delivered to him and he thanked me. Constant watch has been reduced and is now on ACCT - no reported issues

over night. saw psychiatrist yesterday. Declined 1: 1 when offered. No concerns raised by staff and no issues raised

from presentation.







Review of care of detained patnt under Section 120 MHA 1983 (Xa9Ep) - Mark Crowhurst, CM Martin, T Dean and S

Turner in segregation unit.


Discussion and observations about his mental state, also his intent for suicide and risk to self discussed. He denied

the latter and obj he is brighter in emotional state. To remain on ACCT, I have informed him that I will place an alert

on system one to inform future prescribers of the risk of death if he again becomes depressed in the future and he

has suicidal ideation and asks again for Amitryptiline as this is cardio toxic in O/D, he is aware of this and stated if

he'd known this previously he would have asked for this a long time ago.

ACCT to remain open for the next week or so review in a week.


Overview Notes (Y0028) - Seen this morning, he has commenced Sodium valproate this morning, he states he is

feeling a little better emotionally not as flat. ACCT Review this morning.

Reminder/Alert: If depressed and suicidal do not prescribe amitryptiline as Saul is aware of the Cardio toxicity of this

antidepressant.

Thu 23 Apr 2020 15:02



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He is aware of this alert. - Priority: High



22 Dec 2017 17:08

23 Dec 2017 08:47


Surgery: SEEHRA, Sharon (Miss) (Pharmacist) Entered at: Hmp Rochester

23 Dec 2017 09:35 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at: Entered: 23 Dec 2017 12:33

Hmp Rochester


Overview Notes (Y0028) - Seen in seg round - he thanked me for the prompt Inside Times this week. cell seen as

was immaculate. engaged well asked some questions about the timeframe for the new medication working - I

suggested a week to feel any affect. Raised no issues with any side effects but reports it " had an impact". Staff

raised no concerns - remains on ACCT.






24 Dec 2017 09:19 Surgery: BONCHEV, Sevdalin (Dr) (Doctor) Entered at: Hmp Rochester



24 Dec 2017 10:05 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at:

Hmp Rochester

Entered: 24 Dec 2017 15:57

24 Dec 2017 15:56

24 Dec 2017 16:53



24 Dec 2017 16:53

24 Dec 2017 16:53




Hmp Rochester

Entered: 25 Dec 2017 11:44


25 Dec 2017 14:56

25 Dec 2017 14:56



25 Dec 2017 14:56

26 Dec 2017 09:03






Overview Notes (Y0028) - Seen this morning in segregation unit for rounds, no overt current mental health concerns,

stated he would like to "come off the ACCT" due to being woken at night every hour by observations. Review will be

later this week. Stated that he feels the medication is "working" and he feels a little better than previously.



26 Dec 2017 15:32

27 Dec 2017 09:10


Surgery: DEAN, Antony (Mr) (Nurse Access Role) Entered at: Hmp Rochester


Seen in segregation unit this morning, no current mental health concerns of note at the moment, no concerns raised

by staff. Engaged well and accepted applications.

Due for ACCT review this morning.



History: appears well , denies any new health concerns xcept superficial self inflicted wound right wrist not

infected see nursing staff for review / ? dressing -

Examination: [HC informed to kindly arrange]




Overview Notes (Y0028) - Seen for ACCT review saul stated that he now feels a lot better than the other week where

he was verbalising his determination to end his life. He feels the current medication is doing the job and he feels a

little brighter but not "out of the woods yet". Obj not much difference and he understands that he has a depression

and dysthymia, which he has had explained to him. he agrees that he does have the symptoms that match

depression and the dysthymia. The risk is significantly reduced but it in our opinion there is still as risk due to huis

Thu 23 Apr 2020 15:02



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Printed



past impulsivity we would be happier to manage this risk through the ACCT over the new year low staffing period.

Review of care of detained patnt under Section 120 MHA 1983 (Xa9Ep) - CM Martin T Dean and Saul Turner with

Officer Jeffries in adjudication room.





Overview Notes (Y0028) - seen in the seg round - engaged well and agreed to see TD later today to complete care

plan. No concerns raised re his mental health, appeared less tired than previous. seen to be engaging with other

offenders in the seg in relaxed manner. remains on ACCT.




28 Dec 2017 10:45 Surgery: BICKER, Ian Entered at: Hmp Rochester Entered: 28 Dec 2017 10:59

Did not attend for HC-Nurse Lead Clinics appointment with Ian A Bicker.




Overview Notes (Y0028) - Seen this morning and completed the initial care plan, he was somewhat bemused by this

as he had never completed one previously. Conversation was not flowing but he engaged with the process, and has

now a better understanding of the reasons for the care plan, this will be completed soon.



28 Dec 2017 16:56

29 Dec 2017 08:50


Surgery: BONCHEV, Sevdalin (Dr) (Doctor) Entered at: Hmp Rochester




Hmp Rochester

Entered: 29 Dec 2017 11:29


Overview Notes (Y0028) - Seen in the seg round- accepted all apps, engaged well with staff, eye contact good,

raised no issues and no issues were raised re his mental health and no issues evident from presentation. Declined to

have 1: 1 when offered today.




Goading (Xa2mO)


Seen in adjudication office with G. Pullinger - seg staff, Paul Martin seg CM, Andy Cooper- security gov, L. Langridge

seg gov, Etienne Caruna - Chaplain and IMB.

Acct to remain as Xmas period. new medication- awaiting to see some affect. to remain in seg as wants to avoid

Spice, eye contact good, some emotion shown, declined work as not paid- Langridsge will explore this engaging with

Inreach.

29 Dec 2017 17:02

29 Dec 2017 17:02








Overview Notes (Y0028) - Seen in segregation unit this morning for rounds, No stated mental health concerns and

non observed. Engaged well with staff and accepted applications.










Thu 23 Apr 2020 15:02



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01 Jan 2018 10:20 Surgery: TURPIN, Rachel (Health Professional Access Role) Entered at: Hmp Rochester


Overview Notes (Y0028) - Inreach segregation round- engaged to get apps, was polite and declined 1: 1 when

offered. No concerns raised or evident regarding his mental health.




02 Jan 2018 Surgery: CLIFTON, Hannah (Miss) (Admin/Clinical Support Access Role) Entered at: Hmp

Rochester

Negotiated date for cessation of smoking (XaIQj)



02 Jan 2018 09:38 Surgery: h PEMBLE (Practitioner) Entered at: Hmp Rochester


Overview Notes (Y0028) - Seen for daily MHIRT round :- Open ACCT noted . Saul told me he is concerned that his

mood is variable and that his current medication has not yet lifted it . Objectively he does look down .


Outcome (XaIXy) - Discussed in team meeting - remains at considerable risk to self in seg or if removed to normal

location - is seen daily in the seg round and team aware of issues.

Outpatient (Ua0WZ)

Discussion about a problem (XaA2r)


02 Jan 2018 16:39 Surgery: CARTER, Ellen (Ms) (Admin/Clinical Support Access Role) Entered at: Hmp Rochester


Brief intervention for smoking cessation (XaQVQ) - posted to seg x 1 pack 21 mg nrt patches x 1 pack 4mg nrt mints








Overview Notes (Y0028) - SEG ROUND: Declined to be seen when offered today. Concerns raised by Paul Martin

Seg CM due to incident that was not discussed as no time - however to remain on acct as still in low mood despite

reporting " I'm fine" to me this morning. No signs of self neglect or cell neglect.




seen in cell which was very clean and tidy, sparse with minimal belongings - reports " I need a radio and a bed".

Reports that he has been observing and monitoring himself since starting the medication and feels that his mental

health has deteriorated since starting it with increased anxiety and decreased sleep and increased irritability. Also

reports trembling and sweating. We discussed that various options can be tried. We discussed several options to

take now and he agreed to see TD on Monday , to engage fully with Howard and myself in seg round. he advises

that he has stopped the medication last night and this morning. Discussed longer term issues- reports he has been in

prison for 20 years- mostly at his own volition and that the last 20 years has been a debate of " death or prison" and

we discussed that he has done well to remain true to himself and that we hope that medication can change this.

Engaged well, no signs of abnormal experiences and no signs of altered state of perception - no risks reported but

feels that he has been more agitated towards others. Declined that I contact GP in first instance. reports good

relationship with Tony Dean.

Discussed with Seg CM Paul martin and that we suport him remaining int he seg and that he remains at risk and has

medication issues. I will contact primary care to advise he is not taking the meds at present.


Reminder/Alert: DOES NOT WANT TO TAKE SODIUM VALPROATE CURRENTLY UNTIL REVIEWED - Priority:

Normal

Reminder/Alert: Does not want to take valproic acid until reviewed as struggling with side effects - Priority: Normal


Thu 23 Apr 2020 15:02



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Overview Notes (Y0028) - Seen for daily MHIRT round :- Open ACCT noted . Saul' presentation and response to me

remain as he has been recently with a matter of fact " I'm all right " when asked . When I suggested I return to talk to

him later his response was "if you want". Segregation staff are aware of him .




Overview Notes (Y0028) - Spent time with Saul this afternoon as supportive contact . Saul describes periods of

increased anxiety , agitation and aggression and links these to his current Valproic acid prescription . He wants to

achieve a permanent lift to his overall low mood . Long talk about his love of gambling and his inability to say no to

NPS if it is presented to him . Saul is looking forward to meeting with AD on Monday and then Dr Singh on Tuesday .

Overall quite a positive meeting .









Examination: Appears well , denies any new health concerns


Overview Notes (Y0028) - Seen in seg round- agreed to be seen later for support during difficult period. Remains on

ACCT_ engaged to get needs and apps with officers but little else. No concerns raised o re his mental health.





seen in his cell through the glass panel- as there were no officers around on the seg- remains on acct - engaged

really well, asked me why I thought he had depression and we discussed flat affect and lack of interest- reports he is

an introvert and was honest about is failed relationships and we tentatively connected his depression and anhedonia

to this. Showed little knowledge of depression but admitted to feeling sad and lacking in interest unless it is extreme

such as gambling or thieving - we discussed that he could connect with the adrenaline rush from this. Reports being

motivated on this sentence as his daughter is now 11 and he wants to have contact with her - not seen since she

was 3 years old.

level 1 paperwork given re sleep and depression and advised to mark sections that apply and we can discuss them

with him.

No risk reported.

ACCT completed.

05 Jan 2018 15:20

05 Jan 2018 16:52

Surgery: TURPIN, Rachel (Health Professional Access Role) Entered at: Hmp Rochester




06 Jan 2018 10:20 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at:

Hmp Rochester

Entered: 06 Jan 2018 17:05


Overview Notes (Y0028) - Agreed to be seen for 1: 1 when in seg round- will be seen today.


06 Jan 2018 16:02 Surgery: MOREEA, Yacoob (Mr) Entered at: Hmp Rochester Entered: 06 Jan 2018 17:04

Did not attend for HC-Treatments appointment with Mr Yacoob Moreea.



Outcome (XaIXy)

is currently on acct.

TURNER

Agreed to be seen as per previous plan- was seen in immaculate cell in seg.

Thu 23 Apr 2020 15:02



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When asked if he had read the paperwork on depression he said yes and now he feels _ fantastic_ also appreciated

the meditation paperwork and feels calm. Feels that he related to the PD paperwork and learnt a lot.

This is a brief overview of the history of his life that he told me without prompting for 30 minutes.

As I sat down he started to talk and told me his story of his life from birth to today- he retold this story with clarity and

honesty. He reports that his mother is a high class prostitute who did not want a son - he was a mistake. He has 2

siblings who are younger than him. His father is a drug baron. He was bought up by his sisters father. He reports that

his mother is manipulative and devious and did not treat him well, at one point he was looking after one sibling and

caring for her the whole time as his mother was working. He reports loving his mother but not liking her. He left home

at 12 years old ( when he found out his father was not his biological father) and moved from Hastings to Tunbridge

wells and left school. Reports was in prison by 15 and when he left at 18 returned to live with his mother in

Hastings. Reports his nan was also _ very nasty_ and that his maternal line was _ difficult_. At 18 started to sell

drugs and make money- met Cheryl- who had a child already and after some times in prison she became pregnant

with Ruby (now 11 ). As he came into prison his mother started to babysit for Cheryl- who she never liked- and had

++ contact with Ruby- while he was in prison social services approached by phone and said that unless he gives

permission for Ruby to go to his others immediately she will be put into care as her mother was not looking after her

well. Ruby went to live with his mother and when he was released he went home. He observed that Ruby was being

singled out compared to other children and treated in similar ways to him as a child. He gradually became suspicious

and went to speak to Cheryl. It transpired that his mother had paid 2 social workers 10K each ( he named then) to

fabricate risk to Ruby so he would transfer care to her. He then took this to court and she was found out and

collapsed in court. As a result of this he lost contact with his step father, mother and 2 sisters. But at this point had

contact with ruby. Relationship with Cheryl ended and he moved to Portsmouth. With no contact with Ruby. He

found new relationship _ her husband had treated her badly and life continued. Was then identified as a _Pedo_ by

someone _ and as he has no contact with any of his family his current partner believed it and _ all hell broke loose_

-and this relationship ended. Ended up in court after getting caught and was in such a poor state that he needed an

appropriate adult to support him- was on suicide watch from court. Feels very angry towards this person ( who lives

in Hull) and feels that if he ever saw him again he would be convicted of murder- has no thoughts of finding him to

act on this thought but now has not contact with anyone.

Reports previous Inreach teams have not engaged him and he does not trust them.

Reports issues in the seg as was given china cup with which he cut his arm and also despite his bag being searched

at Lewes, on admission here and also seg searched that even while on suicide risk he was given possessions which

included scissors in his shaver pack. So used this to cut up and cut an artery with them. Reports fully intending this

suicide to end his life. Reports has one friend, no family, no access to child and second relationship ended. Reports

worrying about resuming spice as this is his comfort zone. Motivated not to return to prison as realises the impact

that this has had on his life.

Presented as very keen to talk, spoke fluently without prompting or support for 30 minutes. Was animated at the end

and eye contact improved, seemed lighter in posture and manner _ was moving more freely - we discussed that

this was a hard story to tell but that he may now start to move on and wants to prepare for release in 20 months and

not return. No signs of cell or self neglect- reports is sleeping ++ and feels _ great_. Showed insight, clarity,

motivation and honesty. No signs of abnormal expericences, cognitive issues, delusions or manipulation for

secondary gain.

Plan: he wants to stay in HMP Rochester as he feels that he can trust the Inreach team after observing and working

with us for some time. Discussed with officer Perry- he advises that this may not be possible as he is due for transfer

as wont relocate. ? medical hold due to ongoing depression _ may struggle to gain trust with Inreach in a new

prison _ to be discussed. TD to see next week .


Outpatient (Ua0WZ)

Wing officer (Y4746) - discussed with officer Perry- he is going to be transferred




07 Jan 2018 Surgery: COOPER, Deborah (Miss) (Clerical Access Role) Entered Entered: 08 Jan 2018 12:19

at: Hmp Rochester

Date (Xa0ck)


Handover Report : Overall Communication (Y4510) - Informed MHIRT via task re: Mr Turner in the Segregation who

is refusing his medications.


07 Jan 2018 14:51 Surgery: VALINO, Maria (Mrs) (Nurse Access Role) Entered at: Hmp Rochester



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08 Jan 2018 09:30 Surgery: CLIFTON, Hannah (Miss) Entered at: Hmp Rochester Entered: 08 Jan 2018 11:47

Did not attend for HC-Smoking Clinic appointment with Miss Hannah Clifton.





Drug Administration Marked in Error: Wrong data entered

patient refused

Valproic acid 250mg gastro-resistant tablets, Quantity given: 250.0, Entered: 08/01/2018 09:41, Desc: Fully

administered, Done: 08/01/2018 09:41, Given for: 08/01/2018 08:45



Rochester

Did not attend smoking cessation clinic (XaIpo) - UTA for smoking cessation appt, due to being in the Seg. 14mg

niquitin patches (24hr) sent. Will check with seg staff that patient is actually attempting to quit smoking.

08 Jan 2018 11:51 Surgery: GONCARAS, Laimonas (Dr) (Clinical Practitioner Access Role) Entered at: Hmp

Rochester





Overview Notes (Y0028) - Seen for daily MHIRT round :- No immediate issues this morning . Good interaction with

team and myself . Well turned out and cell very tidy . He is expecting to meet with TD for a one to one session today

.



Overview Notes (Y0028) - Addendum to the above :- Open ACCT noted .

08 Jan 2018 12:18 Surgery: COOPER, Deborah (Miss) (Clerical Access Role) Entered at: Hmp Rochester

Yes (Y0427)

Other note (XaIgC)

Hi,

This is to inform you that Mr Turner in the Segregation Unit has been refusing his medication.

Tah

Other note (XaIgC) - MAULINO, Rogelio

Other note (XaIgC) - on caseload. caseholder TD informed

Referral In to HMP Highdown for Triage: Ended on 08 Jan 2018 12:19


Rejected - Duplicate referral request

Status Update for Triage Referral In: Rejected - Duplicate referral request

Status Update for Triage Referral In: Discharged From Care



Overview Notes (Y0028) - Long discussion with saul in his cell, he describes not feeling at ease with recovery and

this makes him feel anxious. He will re start meds this evening and I have asked the primary care team to offer it. I

will continue to see tomorrow in segregation

08 Jan 2018 17:01 Surgery: MOREEA, Yacoob (Mr) (Nurse Access Role) Entered at: Hmp Rochester






Overview Notes (Y0028) - Seen this morning in segregation unit, he stated he is ok today and I will see again later,

he accepted applications and had good rapport with staff.





Thu 23 Apr 2020 15:02



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Overview Notes (Y0028) - Seen this morning in segregation unit, no overt current metal health needs identified,

remains on ACCT which will be reviewed this afternoon.





(R) Mirtazapine 15mg tablets - 28 tablets - 1 tablet - admin times: 16:00 (Oral)

Stopped 15 Jan 2018 Change of Dosage by BONCHEV, Sevdalin (Dr)

Custom script: Printed On Wed 10 Jan 2018 11:33 By Tim Harding

10 Jan 2018 16:39 Surgery: WHITE, Emma (Miss) (Nurse Manager) Entered at: Hmp Rochester

10 Jan 2018 16:39 Surgery: WHITE, Emma (Miss) (Health Professional Access Role) Entered at: Hmp Rochester







12 Jan 2018 08:39 Surgery: BONCHEV, Sevdalin (Dr) (Doctor) Entered at: Hmp Rochester






Overview Notes (Y0028) - Seen for MHIRT segregation round this morning, no issues were raised concerning his

mental health and none was observed. Declined 1:1 when offered.










From daily briefing this morning, Mr Turner ACCT was re-opened after making threats to harm himself. He

appears low in mood although coherent in speech and was mentally stable when seen, He spoke about yesterday

incident and what led to his action of making threat to self-harm, told me he was thinking about his future and how he

will cope without an accommodation or financial support when release, even though he mentioned during the

conversation that having an accommodation will not change how he feels, risk was not discussed as Saul stopped

engaging as He heard two officers laughing outside his door.

Saul has found sodium valproate helpful, but want mirtazapine increase from 15mg to 30mg.

C76

Message send to healthcare for medication review with the GP

13 Jan 2018 17:00 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at:

Hmp Rochester

Entered: 14 Jan 2018 08:42









14 Jan 2018 16:30

15 Jan 2018 09:00


Surgery: BONCHEV, Sevdalin (Dr) (Doctor) Entered at: Hmp Rochester


Thu 23 Apr 2020 15:02



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Segg staff should they need to see a member of the healthcare teamON MIRTAZAPINE 15 DXEPRESSEDE

WILLING TO ESCALATE to 30 mg PO ON

Examination: C/O - feeling depressed (XM0CR)

Diagnosis: Medication review with patient (XaJCO)

Plan: Treatment given (8BC..)

Mirtazapine 30mg tablets - 28 tablets - 1 tablet - admin times: 21:00 (Oral) (Future dated medication 16 Jan 2018)

Custom script: Printed On Mon 15 Jan 2018 09:03 By Dr Sevdalin Bonchev



Overview Notes (Y0028) - Seen for daily MHIRT :- Open ACCT noted . Last threat to self harm was on the night of

12 / 01 . OK since . Today his demeanor was as it usually is at unlock. He told me he is OK . No concern expressed

by team .

15 Jan 2018 09:30 Surgery: CARTER, Ellen (Ms) Entered at: Hmp Rochester Entered: 15 Jan 2018 11:21






Review of care of detained patnt under Section 120 MHA 1983 (Xa9Ep) - Gov Langridge CM Martin, T Dean IMB

Chaplaincy and saul Turner in adjudication room of seg

Overview Notes (Y0028) - belated entry form 10th January. Saul indicated that he has no intent for self harming or

suicide, he engaged well with the panel and engaged appropriately, good eye contact, normal voice tine, rate of

speech and content all appropriate. Panel agreed to close the ACCT and Saul is content with this. He is keen to

engage with Inreach here and wished to be s=considered for H wing where he feel he will benefit from our input. He

is referred for counselling and he will have assessment this week.




Overview Notes (Y0028) - Seen this morning in segregation unit, Saul was a little avoidant of staff, he did not engage

as well as he had been doing, he stated that he is tired and has not been sleeping well, and this is he thinks down to

not having sufficient dose of Mirtazapine. I think he could do with a few nights of some hypnotic to re establish a

sleep patter, but more importantly he needs to go to a wing, for some meaningful activity.





(R) Valproic acid 250mg gastro-resistant tablets - 28 tablets - 1 tablet - admin times: 08:45 (Oral)

Stopped 16 Jan 2018 Change of Dosage by SINGH, Sourabh (Dr)

(R) Valproic acid 500mg gastro-resistant tablets - 28 tablets - 1 tablet - admin times: 16:00 (Oral)

Stopped 16 Jan 2018 End of course by SINGH, Sourabh (Dr)

Valproic acid 250mg gastro-resistant tablets - 28 tablets - 1 tablet


Valproic acid 500mg gastro-resistant tablets - 28 tablets - 1 tablet


Custom script: Printed On Tue 16 Jan 2018 11:05 By Tim Harding

16 Jan 2018 14:05 Surgery: SINGH, Sourabh (Dr) (Consultant) Entered at: Hmp Rochester

Valproic acid 500mg gastro-resistant tablets - 56 tablets - 500 mg - admin times: 08:45, 16:00 (Oral)

Zopiclone 7.5mg tablets - 3 tablets - 7.5 mg - admin times: 21:00 every 7 day(s) (Oral) (Future dated medication 17

Jan 2018)

Custom script: Printed On Tue 16 Jan 2018 14:10 By Dr Sourabh Singh






17 Jan 2018 11:26 Surgery: GONCARAS, Laimonas (Dr) (Clinical Practitioner Access Role) Entered at: Hmp

Rochester




Overview Notes (Y0028) - Seen in segregation unit this morning, no overt current mental health concerns, yesterday

Thu 23 Apr 2020 15:02



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the Sodium valproate was increased and he should have the increased dose from today, also he has three zopiclone

over a two week period to aid sleep.


17 Jan 2018 14:30 Surgery: CORCORAN, Tina (Miss) (Health Professional Access Role) Entered at: Hmp Rochester

Clinic note (XaIgp) - Having the space to talk openly about the way that he is feeling.

Clinic note (XaIgp)

Childhood issues

Anxiety

Seen by counsellor (9N2B.)

Clinic note (XaIgp) - Engaged and talkative

Clinic note (XaIgp) - No current risk of DSH and no current risk of suicide

Clinic note (XaIgp) - Tina Corcoran

Clinic note (XaIgp) - Counsellor

Clinic note (XaIgp) - Mr Turner stated that he feels that he has had many issues in his life that he feels he has not

processed. He states that this is something that he would like to do.

Clinic note (XaIgp) - Counselling Assessment

Clinic note (XaIgp) - Mr Turner is currently in the SEG. In order to start Counselling sessions Mr Turner needs to be

residing on one of the other wings. I have explained this to Mr Turner, once Mr Turner is on a different wing sessions

will begin.


Referral In to HMP Highdown for Counselling: Ended on 09 Mar 2018 00:00

Status Update for Counselling Referral In: Waiting For Care

17 Jan 2018 15:29 Surgery: UZOCHUKWU, Patrick (Mr) (Pharmacist) Entered at: Hmp Rochester








Overview Notes (Y0028) - Seen this morning in segregation unit, saul looks well and accepted applications and went

to the shower, I have asked the wing CM for a space for him soonest and this is in for consideration. No overt new

issues today.




Overview Notes (Y0028) - Seen this afternoon in segregation unit with Ash Gardener from OMU, I had spoken to the

wing CM about getting him a place on the wing as the seg had not done this with the wing manager. CM Saunders

agreed to take him on a trial basis and that he would have to work off the wing, This makes sense as he would only

isolate further but in a bigger environment using the wing to do so. Initially saul thought this was about making him

"Jump through hoops" that he could not possibly achieve but it was clear after a short time that his anxiety about his

is significant and he wants to succeed here. He has agreed that H wing may be the only place for him here and he

will go there next week for his first meeting with the wing CM. Due to start counselling next weds providing that he is

on a wing and not in the segregation unit.







Overview Notes (Y0028) - Seen in segregation unit rounds this morning, no overt concerns this morning and

accepted applications,









Overview Notes (Y0028) - Seen in segregation unit today, no current mental health issues of note, engaged with the

Thu 23 Apr 2020 15:02



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staff accepted applications and is well kempt, clean and cell is very tidy.



21 Jan 2018 10:30 Surgery: MAULINO, Rogelio (Mr) (Nurse Access Role) Entered at: Entered: 21 Jan 2018 11:02

Hmp Rochester









Overview Notes (Y0028) - Seen this morning in segregation unit, he accepted applications and has a good rapport

with the seg staff. No overt concerns today, he should be going to H wing this week.


22 Jan 2018 14:58 Surgery: HOLMAN, Joanna (Admin/Clinical Support Access Role) Entered at: Hmp Rochester

Did not attend smoking cessation clinic (XaIpo) - Unable to see due to not being able to hold clinic due to staffing. No

rading so unable to send products to patient, rebooked for 1 weeks time,

22 Jan 2018 16:15 Surgery: AKISANYA, Adedun (Mrs) (Nurse Access Role) Entered at: Hmp Rochester




23 Jan 2018 07:25 Surgery: TANTON, Karen (Mrs) (Clerical Access Role) Entered at: Hmp Rochester





Outcome (XaIXy)

Seen on H wing with the wing CM Jade Saunders, saul was on his way to collect medication from new healthcare, he

is settling in well on the wing and is not having any problems so far. he joked that others think he may be a "grass"

because he came from the seg to H wing, but he said he can handle anything thrown his way, clean and well

groomed, looking a little tired, he asked for some Zopiclone, but he has still to collect another two from this

prescription over two weeks. he will ask primary care for this this afternoon.

I will see again soon, he is due to start counselling tomorrow mane in old Healthcare.

Outpatient (Ua0WZ)

23 Jan 2018 16:26 Surgery: TIDY, Michael (Mr) (Nurse Access Role) Entered at: Hmp Rochester






Clinic note (XaIgp) - Having the space to talk openly

Clinic note (XaIgp)

Anxiety

Childhood issues




Clinic note (XaIgp) - No current risk of DSH and no current risk of Suicide


Clinic note (XaIgp) - Mr Turner stated that there are issues with childhood that he would like to go over, also issues

with gambling and feelings of anxiety about the way that he will be when he leaves prison.

Clinic note (XaIgp) - Session 1







Thu 23 Apr 2020 15:02



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26 Jan 2018 09:06 Surgery: JACOBS, Sarah (Miss) (Nurse Access Role) Entered at: Hmp Rochester



Outcome (XaIXy)

Seen o H wing in Cm's office, Saul was asking to see me, this was about the medication he has and he has to attend

the treatment room twice daily for medications, he is wondering when he can have this I/P, I have said he needs to

be off the ACCT for two weeks then he could in theory go onto daily I/P then after further two weeks risk assess and

then if ok weekly i/p, he is keen to engage and is looking forwards to working soon. Application has gone into

stonemasonry and we expect him to start next week. No overt issues at present, and he had started counselling, he

is keen to continue and will go next week, he gets on with the counsellor. No problems on the wing and like the wing

staff.

See again soon.


Outpatient (Ua0WZ)






27 Jan 2018 16:00 Surgery: CARD, Lauren (Miss) Entered at: Hmp Rochester

Did not attend for HC-Treatments appointment with Miss Lauren Card.













Rochester

Seen by smoking cessation advisor (XaIye) - Attended appt. CO reading 5. Issued with 21mg niquitin patches

(24hr) and 1.5mg mini mint lozenges (2x20pk). Review 1/52, appointment booked.





30 Jan 2018 15:14 Surgery: SINGH, Sourabh (Dr) (Consultant) Entered at: Hmp Rochester

Outcome (XaIXy)

Tried to see him.

He was not on the wing, and the offciers report that he went to work in Floplast.

No serious concerns about him.

Plan:

1. Reschedule to see him in next available clinic slot

Follow-up psychiatric assessment (6654.)

Clinical administration (Xa4HB)







Thu 23 Apr 2020 15:02



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Clinic note (XaIgp)

Anxiety

Childhood issues






Clinic note (XaIgp) - Mr Turner stated today that he is unsure of how to feel about his life. He stated that he feels that

he is in a position with his daughter where he would really like to see her but feels that maybe he should not be too

much a part of her life.








01 Feb 2018 15:56 Surgery: JACOBS, Sarah (Miss) (Nurse Access Role) Entered at: Hmp Rochester







Outcome (XaIXy) - Seen in grounds on two occasions yesterday- notes entered retrospectively - engaged really well

- reports has been sleeping with asisstance of the medication. dark circles under eyes reducing. Keen to engage in

Stonemasonry course as " i get into trouble when I don't have enough to do "- contact made with ACU and he started

course today.

Outpatient (Ua0WZ)


History: Paracetamol 500mg tablet (di21.) - Box of 16 Paracetamol tablets given for a headache. Two tablets up to

four times a day when required. No more than 8 to be taken in 48 hours and no more than 2 to be taken at any one

time.



03 Feb 2018 09:35 Surgery: WHITE, Emma (Miss) (Nurse Manager) Entered at: Hmp Rochester

03 Feb 2018 09:35 Surgery: WHITE, Emma (Miss) (Health Professional Access Role) Entered at: Hmp Rochester







05 Feb 2018 09:04 Surgery: AKISANYA, Adedun (Mrs) (Nurse Access Role) Entered at: Hmp Rochester


05 Feb 2018 11:10 Surgery: CLIFTON, Hannah (Miss) (Admin/Clinical Support Access Role) Entered at: Hmp

Rochester

Smoking cessation advice (Ua1Nz) - No clinic due to staff shortage. 21mg niquitin patches (24hr) and 1.5mg mini

mint lozenges (1x20pk) delivered. Review 1/52, appointment already booked.










Thu 23 Apr 2020 15:02



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07 Feb 2018 15:32 Surgery: CORCORAN, Tina (Miss) (Health Professional Access Role) Entered at: Hmp Rochester

Clinic note (XaIgp)

Anxiety

Childhood issues



Clinic note (XaIgp) - Having the spaec to talk openly about the way that he is feeling





Clinic note (XaIgp) - Mr Turner stated that he is feeling like he would like to be normal. He states that he has been

reflecting on the session last week and states that he is surprised to find similarities between himself and others who

have been a part of his life. He stated that he would like to continue to be reflective




08 Feb 2018 08:41 Surgery: MOREEA, Yacoob (Mr) (Nurse Access Role) Entered at: Hmp Rochester







Outpatient (Ua0WZ)

Outcome (XaIXy) - Seen on the wing today, Saul stated that he is doing very well and feels the best he's felt in very

long time. The medications appear to be working and he feels that he is on the right amount and combination. We

will book CPA for the spring and he is aware of what this entails. Working in Stonemasons and enjoying it more than

he thought he would.



















Rochester

Seen by smoking cessation advisor (XaIye) - Attended appt. CO reading 3. Issued with 1.5mg mini mint lozenges

(2x20pk). Patient declined patches. Review 1/52, appointment booked.






Stopped 13 Feb 2018 Form, strength, or route change by SINGH, Sourabh (Dr)

Valproic acid 500mg gastro-resistant tablets - 55 tablets - 1 tablet - admin times: 08:45, 16:00 (Oral)

Stopped 13 Feb 2018 End of course by SINGH, Sourabh (Dr)

Custom script: Printed On Tue 13 Feb 2018 11:25 By Tim Harding

13 Feb 2018 15:28 Surgery: SINGH, Sourabh (Dr) (Consultant) Entered at: Hmp Rochester

Thu 23 Apr 2020 15:02



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Mirtazapine 30mg orodispersible tablets - 28 tablets - [20:00-1] (7 tablets every 7 days) (Future dated medication 14

Feb 2018)

Sodium valproate 500mg gastro-resistant tablets - 56 tablets - [08:00-1][20:00-1] (14 tablets every 7 days) (Future

dated medication 14 Feb 2018)

Custom script: Printed On Tue 13 Feb 2018 15:30 By Dr Sourabh Singh





History: CYST BEHIND LEFT EAR OCC INFLAMED > REFER MINOR OP

(R) E45 cream (Forum Health Products Ltd) - 500 grams - ao (500 grams every 28 days) (Future dated medication

19 Feb 2018)

E45 cream (Forum Health Products Ltd) - 500 grams - ao


Custom script: Printed On Thu 15 Feb 2018 10:57 By Tim Harding

16 Feb 2018 15:45 Surgery: TIDY, Michael (Mr) (Nurse Access Role) Entered at: Hmp Rochester

History: Code Blue Headcorn wing

Examination: Conscious and orientated. Oxygen saturation at periphery (X770D) 97 % and O/E - pulse rhythm

regular (2431.)90

Diagnosis: Suspected use of spice

Plan: Ambulance stood down. Staff to observe

17 Feb 2018 09:22 Surgery: CARD, Lauren (Miss) Entered at: Hmp Rochester Entered: 17 Feb 2018 16:00



17 Feb 2018 10:01 Surgery: COOPER, Deborah (Miss) (Clerical Access Role) Entered at: Hmp Rochester

Outcome (XaIXy) - Seen at the request of H wing staff with regards to accessing a TV whilst he is on basic following

an incident yesterday in which he was in a cell with 2 others and suspected as under the influence of NPS. Mr Turner

stated that he was fine and no concerns were raised. H wing staff were advised that there was no current mental

health reason evident that he should be allowed his TV whilst on basic.


Overview Notes (Y0028) - Seen in MHIRT seg round. Dressed in clean clothes and made appropriate eye contact.

Requested 1 to 1 with MHIRT staff. Attempted to see in cell but he did not want to talk with the door open and an

officer outside so agreed to return later when I could see him in an interview room.

Outpatient (Ua0WZ)




Rochester

NICOTINE 1.5mg fresh mint lozenges (du7w.) - 2x20pk

Seen by smoking cessation advisor (XaIye) - Attended appt. CO reading 2. Issued with 1.5mg mini mint lozenges

(2x20pk). Review 1/52, appointment booked.


Outpatient (Ua0WZ)

Outcome (XaIXy)

Seen on the wing yesterday on behalf of TD - notes entered retrospectively - engaged really well, reports coping

without TV - seemed embarrassed by spice use and basic. reports feeling odd on H wing- reports that the mayhem is

more what he is used to - reports has one friend on H wing who he really enjoys spending time with.Reports is

enjoying stonemasonry and counselling is a " big help". No risk reported, reports sleep is much improved.

Discussed with officer Doors - who is aware of the considerable risk of self harm or suicide with saul.




Outcome (XaIXy) - Saul seen as intoxicated on H wing last Friday ? NPS use ? Saul now on BASIC . Wing plan to

move him out of H wing . I have asked Gov Davies to consider giving Mr Turner a chance to redeem himself on H

wing and stay there. Rational I am concerned that a move to another wing may trigger a crisis , further relapse into

NPS use , increased low mood . Gov Davies will speak to both the wing staff and Mr Turner and consider.

Outpatient (Ua0WZ)

20 Feb 2018 16:20 Surgery: CARD, Lauren (Miss) Entered at: Hmp Rochester Entered: 20 Feb 2018 16:48



21 Feb 2018 11:57 Surgery: CORCORAN, Tina (Miss) (Health Professional Access Role) Entered at: Hmp Rochester

Thu 23 Apr 2020 15:02



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Clinic note (XaIgp)

Mr Turner is aware of how to refer back to the service in the future if he would like to.


Clinic note (XaIgp) - Session 4 (case closed)


Clinic note (XaIgp) - Mr Turner stated today that he feels that he has had enough counselling for now. He stated that

he is now on the level of medication that he is happy with and he states that this is helping him and making him feel

ok.






Outcome (XaIXy)

Reports may be able to remain on H wing- but not certain - engaged well, smiling- reports enjoying smiling. reports is

now meds IP and is taking Mirtazapine later so sleep and "hangover" in am is bad so will take at 4pm again. is

engaging with stonemasonry - also will self ref to SLMC and to film workshop to give a break from stonemasonry with

stonemasons permission. No self harm or suicidal thoughts reported. Reports " i havent felt this good for years".

feels medicaiotn is good.

Advised to contact inreach if required and has knowledge of all agenices if needed.

Outpatient (Ua0WZ)

26 Feb 2018 09:30 Surgery: CLIFTON, Hannah (Miss) Entered at: Hmp Rochester Entered: 26 Feb 2018 10:37




Discussion about a problem (XaA2r) - Telecon-Dean/Coleman

Outpatient (Ua0WZ)


Outcome (XaIXy)

Saul is currently on SSI Basic, he has been using spice last week and no longer meets the criteria for staying on H

wing. The wing CM Ms Coleman is potentially looking at moving him off the wing today but the location is not yet

known. he is still currently working in Stonemasonry and doing ok there. He reported last week that he is feeling

good and the medication is the "right level". Sleep is easily attained.

There does however seem to be some self sabotage going on and I note from the entries that he has withdrawn from

Counselling, also that he had used spice and I wonder if he is deliberately trying to get the move off the wing? Mood

state seems to be ok and he is due to see the psychiatrist next on the 13th March.

I will see him again soon.

26 Feb 2018 11:11 Surgery: CARTER, Ellen (Ms) (Admin/Clinical Support Access Role) Entered at: Hmp Rochester

Did not attend smoking cessation clinic (XaIpo) - dna appt wing called letter sent appt rebooked





05 Mar 2018 08:45 New Healthcare, Surgery: CARTER, Ellen (Ms) Entered at: Hmp

Rochester

Entered: 05 Mar 2018 09:27



05 Mar 2018 13:14 Surgery: CARTER, Ellen (Ms) (Admin/Clinical Support Access Role) Entered at: Hmp Rochester

Did not attend smoking cessation clinic (XaIpo) - dna wing called appt rebooked letter sent



07 Mar 2018 09:09

07 Mar 2018 09:09




Thu 23 Apr 2020 15:02



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Outcome (XaIXy)

Has now lost his place on the enhanced wing H wing and is now residing on D wing, he is sporting a black eye (left)

and he states he got this through falling over whilst under the influence of spice. He is in debt, he reports to the tune

af about £1200, he states that he feels his life is at risk as a result.

I had spoken to OMU yesterday and CM Townsend and OCA have applied to another prison to look at the possibility

of transfer, he agrees he needs to be transferred as his life is at risk if he remains here at Rochester. HMP Stoke

Heath has accepted him as part of an exchange. he will be travelling tomorrow 8th March.

Mental health he is still low in mood but stable at present, he is concordant with medication and this does seem to be

effective. There have been periods where he is using spice and not been taking medication but this is not that often.

He wishes to engage with Inreach at HMP Stoke heath, and I will call them on Friday to discuss his needs and

intervention by counselling if necessary.

Outpatient (Ua0WZ)

08 Mar 2018 12:03 Surgery: BONCHEV, Sevdalin (Dr) (Doctor) Entered at: Hmp Rochester

Mirtazapine 30mg orodispersible tablets - 28 tablets - [21:00-1] (7 tablets every 7 days)

Stopped 14 Mar 2018 End of course by KHAN, Joblu (Dr)

Sodium valproate 500mg gastro-resistant tablets - 56 tablets - [08:00-1][18:00-1] (14 tablets every 7 days)


Custom script: Printed On Thu 08 Mar 2018 12:04 By Dr Sevdalin Bonchev



Outcome (XaIXy) - seen on the wing and advised that TD wil be advising his new prison f his mental health and

counseling needs tommorow.He had lage black eye- reports was using drugs and woke up on floor with thissuggests

may have banged head on desk. Engaged well - asked about new prison - I was unable to give any details.

Discussed self sabotage and denial of life patterns. No reported thoughts to harm self or others. Pleased to be

leaving Rochester.

Outpatient (Ua0WZ)

09 Mar 2018 12:17 Surgery: OAKLEY, Helen (Mrs) (Clerical Access Role) Entered at: HMYOI Stoke Heath



09 Mar 2018 12:17 Surgery: Unknown Staff Member Entered at: HMYOI Stoke Heath

(Admission Med) Mirtazapine 30mg orodispersible tablets - 28 tablets - [21:00-1]

(Admission Med) Mirtazapine 30mg orodispersible tablets - 28 tablets - [20:00-1]

(Admission Med) E45 cream (Forum Health Products Ltd) - 500 grams - ao

(Admission Med) Paracetamol 500mg tablets - 2 tablets - now



(Admission Med) Paracetamol 500mg tablets - 16 tablets - 2 qds


(Admission Med) Sodium valproate 500mg gastro-resistant tablets - 56 tablets - [08:00-1][18:00-1]

(Admission Med) Sodium valproate 500mg gastro-resistant tablets - 56 tablets - [08:00-1][20:00-1]


12 Mar 2018 08:45 New Healthcare, Surgery: CLIFTON, Hannah (Miss) Entered at: Entered: 12 Mar 2018 09:49

Hmp Rochester



12 Mar 2018 20:22 Surgery: NIXON, Sharon (Nurse Access Role) Entered at: HMYOI Stoke Heath

History: Patient seen on G Wing this evening as he did not turn up for his clinic appointment for 1st assessment.

Patient says he did not know about it. Patient tells me he is known to in reach and has medication for his mood

stabilisation. Patient has IP meds and has a few days left. No thoughts of self harm. Patient says he is ok.

Plan: Patient to be seen tomorrow. Will hand over to night staff as no room to fit appointment in tomorrow.

13 Mar 2018 14:27 Surgery: PERKINS, Jane (Pharmacy Technician) Entered at: HMYOI Stoke Heath

14 Mar 2018 09:51 Surgery: ROBERTSON, Maria (Ms) (Nurse Access Role) Entered at: HMYOI Stoke Heath

Review of admission to segregation unit (XaPmi) - No problems expressed by prisoner



Segregation unit referral for cellular confinement (XaPmd) - Retrospect entry for 13/3/18. Spoke to prisoner as he

was taken from B wing to the SRU. No injuries reported from prisoner none noted by nurse. Saul stated he was fine

to be in the SRU. No problems expressed.


Thu 23 Apr 2020 15:02



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Printed



Seen by nurse (XaATp) - Retrospect entry for 13/3/18. Seen prisoner in the SRU from B wing no injuries reported by

prisoner none noted by nurse. 213 completed.

14 Mar 2018 11:21 Surgery: KHAN, Joblu (Dr) (General Medical Practitioner) Entered at: HMYOI Stoke Heath

History: Medication requested (8B3H.)

Tue 13 Mar 14:29 - PERKINS, Jane

Repeat WEEKLY prescription reqiured for sodium valporate 500mg g/r and mirtazapine 30mg orodispersible.

Plan: Na Val off label

(R) Mirtazapine 30mg tablets - 1 pack of 28 tablet(s) - One to be taken daily (7 tablets every 7 days) (Future dated

medication 16 Mar 2018)


(R) Sodium valproate 500mg gastro-resistant tablets - 56 tablets - To be taken Twice Daily (14 tablets every 7 days)

(Future dated medication 16 Mar 2018)


Mirtazapine 30mg tablets - 1 pack of 28 tablet(s) - One to be taken daily

Ended 25 Apr 2018 Patient Deducted

Sodium valproate 500mg gastro-resistant tablets - 56 tablets - To be taken Twice Daily

Ended 19 Apr 2018 End of course by APPLEFORD, James (Dr)

Custom script: Printed On Wed 14 Mar 2018 11:27 By Dr Joblu Khan

14 Mar 2018 11:46 Surgery: WISE, Charlotte (Occupational Therapist) Entered at: HMYOI Stoke Heath

SystmOne Incoming Record Sharing consent changed to: Not asked - Record not shared


History: Community mental health team (Ua0um)

Examination: Task recieved from Dr Khan, GP re: transfer of care

Transferred from HMP Rochester - no handover recieved yet

Reviewing system one

It appears Saul had contact with in-reach mental health team - various entries from different professionals

C86

It appears he has been using substances recently - entry from 8th March highlights he has a black eye and woke up

on his floor, suggesting he fell over and banged head on desk

No thoughts of self-harm or harm to others noted

7th March - Recently lost place on enhanced wing due to being under the influence of spice, in debt and there were

concerns his life would be at risk if he was not transferred

Mental health - low in mood, but stable, compliant with medication but not effective. He is keen to engage with

in-reach at Stoke heath.

PLAN

To discuss in clinical team meeting on Thursday 15th March as a transfer of care

14 Mar 2018 14:00 Surgery: COLLEY, Dianne (Nurse) Entered at: HMYOI Stoke

Heath

Entered: 15 Mar 2018 06:43

Did not attend for Triage and Assessment Clinic appointment with Nurse Dianne Colley.


15 Mar 2018 Surgery: RIDGWAY, Gemma (Mrs) (Administrator) Entered at:

HMYOI Stoke Heath

Entered: 21 Mar 2018 09:54

Miscellaneous to HCC


HMYOI Stoke Heath

Entered: 21 Mar 2018 09:55

Admission to segregation unit (XaPma) - ALGORITHM (Ongoing Episode)


16 Mar 2018 08:57 Surgery: KHAN, Joblu (Dr) (General Medical Practitioner) Entered at: HMYOI Stoke Heath

History: Medication review done (XaF8d)

Thu 15 Mar 18:25 - NIXON, Sharon (Nurse)

Please can this patient have his meds changed to not IP as he is on the SAU

thanks

Sodium valproate 500mg gastro-resistant tablets - 1 pack of 100 tablet(s) - 1 tablet - admin times: 07:45, 16:00 (Oral)

Mirtazapine 30mg tablets - 1 pack of 28 tablet(s) - 1 tablet - admin times: 16:00 (Oral)

Custom script: Printed On Fri 16 Mar 2018 08:59 By Dr Joblu Khan

16 Mar 2018 09:48

16 Mar 2018 09:49

Surgery: ROBERTSON, Alina (Miss) (Nurse Access Role) Entered at: HMYOI Stoke Heath


16 Mar 2018 09:50 Surgery: ROBERTSON, Alina (Miss) (Nurse Access Role) Entered at: HMYOI Stoke Heath

Thu 23 Apr 2020 15:02



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Review of admission to segregation unit (XaPmi)

Overview Notes (Y0028) - Seen by nurse, reporting concerns that he should be on medication. G.P has prescribed

this medication and this has been completed. due to have reception screen completed today.

16 Mar 2018 10:05 Surgery: COLLEY, Dianne (Nurse) Entered at: HMYOI Stoke Entered: 16 Mar 2018 14:40

Heath

No access visit for Triage and Assessment Clinic appointment with Nurse Dianne Colley

Home visit - no reply (9NFC.)

16 Mar 2018 10:05 Surgery: HUMPHRIES, Emma L (Health Professional Access Role) Entered at: HMYOI Stoke

Heath



Examination: RETROSPECTIVE ENTRY FROM 15TH MARCH 2018

Clinical Team meeting – 15th March 2018

Present - Julie Roper (chair, CPN), Sandra Douglas (team leader), Charlotte Wise (OT), Beth Cole (CPN), Wendy

Sweeney (HCC manager), Paul Fountaine (social worker), Dr Appleford (psychiatrist). Apologises – substance

misuse team

Saul was discussed at the meeting yesterday, following a transfer from HMP Rochester

Within the meeting, limited information available and no handover received from HMP Rochester

It was decided to discuss again next week when information has been gathered and a handover has been received

whether he has been under primary or secondary mental health services

‎Telephone call made to HMP Rochester on 01634 803100 – spoke to someone from switchboard they were unable

to put me through to someone in the mental health team

Reviewing notes – engaging in counselling until 21st February 2018 – he decided to stop engaging in the

intervention, substance misuse – using NPS and is in debt, mentions in the notes around self-sabotage to move off

enhanced wing, Saul was due to see a psychiatrist on 13th March however transferred on 9th March, last seen

psychiatrist on 20th December 2017.

Diagnosis – impression: double depression (recurrent depressive disorder on a background of dysthymia) with

co-morbid cannabis/spice misuse (taken from entry on 20th December 2017)

Medication – Sodium Valproate 500mg (BD), Mirtazapine 30mg (PM)

It appears Saul was under the in-reach team from the notes and has seen a psychiatrist where the plan was to

engage with the in-reach team – to continue to attempt to make contact with the mental health team

16 Mar 2018 17:07 Surgery: BAILEY, Martyn (Mr) (Nurse Access Role) Entered at: HMYOI Stoke Heath

16 Mar 2018 17:07

16 Mar 2018 17:08

Surgery: BAILEY, Martyn (Mr) (Nurse Access Role) Entered at: HMYOI Stoke Heath


17 Mar 2018 00:23 Surgery: JACKSON, Melanie (Mrs) (Admin/Clinical Support Access Role) Entered at: HMYOI

Stoke Heath


Stoke Heath

17 Mar 2018 09:38 Surgery: COLLEY, Dianne (Nurse) (Nurse Access Role) Entered at: HMYOI Stoke Heath


17 Mar 2018 17:08 Surgery: BIBBY, Lynn (Ms) (Nurse Access Role) Entered at: HMYOI Stoke Heath




Stoke Heath


Stoke Heath

18 Mar 2018 09:18 Surgery: COLLEY, Dianne (Nurse) (Nurse Access Role) Entered

at: HMYOI Stoke Heath

Entered: 18 Mar 2018 14:18

18 Mar 2018 09:30 Surgery: COLLEY, Dianne (Nurse) Entered at: HMYOI Stoke

Heath

Entered: 18 Mar 2018 21:22



18 Mar 2018 14:17

18 Mar 2018 16:21

Surgery: COLLEY, Dianne (Nurse) (Nurse Access Role) Entered at: HMYOI Stoke Heath

Surgery: COLLEY, Dianne (Nurse) (Nurse Access Role) Entered at: HMYOI Stoke Heath


Thu 23 Apr 2020 15:02



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C88

Printed




18 Mar 2018 22:16 Surgery: PRITCHARD, Bridie (Admin/Clinical Support Access Role) Entered at: HMYOI Stoke

Heath


Heath

19 Mar 2018 10:37 Surgery: DANIELS, Sara (Mrs) (Nurse Access Role) Entered at: Entered: 20 Mar 2018 10:37

HMYOI Stoke Heath

19 Mar 2018 14:07 Surgery: COLLEY, Dianne (Nurse) Entered at: HMYOI Stoke Entered: 20 Mar 2018 03:42

Heath



19 Mar 2018 17:39 Surgery: EDE, Michelle (Miss) (Nurse Access Role) Entered at: HMYOI Stoke Heath




Heath


Heath

20 Mar 2018 10:36 Surgery: DANIELS, Sara (Mrs) (Nurse Access Role) Entered at: HMYOI Stoke Heath






Heath


Heath


Heath

Clinic Letter to Mr Saul Turner




21 Mar 2018 13:06 Surgery: FRANKE, Theodorus (General Medical Practitioner) Entered at: HMYOI Stoke Heath

Plan: Seen in CSU - no issues





Heath


Heath


HMYOI Stoke Heath

Entered: 26 Mar 2018 14:21

Consent Form to hcc


HMYOI Stoke Heath

Entered: 26 Mar 2018 14:22

Consent obtained (Y001d) - consent to share info and medication compact (Ongoing Episode)


Heath

22 Mar 2018 10:18 Surgery: PRICE, Linda (Mrs) (Nurse Access Role) Entered at: HMYOI Stoke Heath



History: Patient seen on the segregation unit for his first reception screen. Unable to acess the first screen template

as i accidently clicked off it when i was looking a patient history. Patient has c/o a cyst behind his left ear. He says he

would like to see a GP to be referred for removal of it. Appointment made.



Herpes zoster vaccination invitation (XaasI)

Herpes zoster vaccination declined (Xaa9j)

Thu 23 Apr 2020 15:02



C88

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Hepatitis C screening counselling (XaLTu)

Hepatitis C screening offered (XaLDh)

Screening offered (6812.)

Gonorrhoea screening declined (XaLHo)

Seasonal influenza vaccination declined (XaZ0i)

Meningitis C vaccination offered (XaQGB)

Booster meningitis C vaccination declined (XaaXb)


Family history unknown (XaJ2K)


Hep B Vacc - offered and refused (Y075b)

Measles mumps rubella catch-up vaccination invitation (XaQPt)

Measles mumps rubella vaccination declined (XaLkV)

Screening (XE1TS)

Referral to smoking cessation service declined (XaaDx)

Attended new patient screening (9OW1.)

Ex-smoker (Ub1na)



O/E - height (229..) 1.72 m (5 ' 8 ")



Hepatitis B screening counselling (XaLTv)

HIV screening counselling (XaLIE)


Hepatitis C screening declined (XaLNE)

Patient given advice (8CA..) - Patient says he has h/o depression and his medications are working well for him.


Referral to mental health team (XaIPw) - Patient alresdy known to the mental health team at Stoke Heath prison.

Hepatitis B screening offered (XaLFK)

Hepatitis B screening declined (XaLND)

118 / 69 mmHg



Outpatient (Ua0WZ)


Outcome (XaIXy) - Discussed with Charlotte White from Stoke heath prison- update given.




Examination: Clinical Team Meeting – 23rd March 2018

Present – Charlotte Wise (chair, OT), Beth Cole (CPN), Jill Crawley (IDTS nurse), Linda Price (Primary mental health

team)

Apologises – Paul Fountaine (social worker), Julie Roper (CPN), Sandra Douglas (CPN, team leader), Dr Appleford

(psychiatrist)

Handover telephone call with HMP Rochester – 01634 803122, spoke to Rachel Turpin

Saul was under secondary care in HMP Rochester

Diagnosis – double depression (taken from psychiatrist clinic in December 2017)

Medication – Sodium Valproate and Mirtazapine has been effect

Rachel reported he had been engaging in counselling, however disengaged, keen for him to continue this at Stoke

Heath, I have placed him on the waiting list for counselling – 34th on the list, current wait around 28 weeks

Rachel discussed Saul goes through phases of using NPS, self-sabotage and engaging with services, wanting to do

well.

She reported he is reluctant to state he is depressed and this is often indicated by large dark circles under his eyes,

as he stops sleeping.

Large amounts of time spent in SRU – reviewing notes, Rachel reported he had been in SRU between Jan 17 – May

17 and Dec 17 – Jan 18.

RISK – has made serious self-harm attempts, she reported he had managed to smuggle a blade through visits at

one point so he could end his own life

Transferred out of HMP Rochester as his life was at risk due to increased debt

Thu 23 Apr 2020 15:02



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Saul was discussed in the meeting today, transferred from HMP Rochester – no handover received. Reviewing the

notes, he saw a psychiatrist in December 2017 and appears to be under the in-reach team.

Telephone call to SRU where Saul currently resides, concerns raised from officers that he appears low in mood and

would benefit from seeing someone from the mental health team. Beth Cole (CPN) agreed to out-reach him.

PLAN

To discuss with Beth Cole (CPN) on her return from SRU - reviewed mood and mental state, agreed to remain on

waiting list at this time. Beth to complete a full entry in due course. No increased risk factors noted. Beth agreed

to out-reach next week whilst on SRU to monitor mood and mental state. Saul is aware is will not be allocated to an

in-reach worker at this time.





Stoke Heath




23 Mar 2018 13:38 Surgery: COLE, Elizabeth (Ms) (Nurse Access Role) Entered at: HMYOI Stoke Heath

Community mental health team (Ua0um)

I visited Saul in SRU yesterday, in order to conduct a welfare check and inform him that he is currently on our waiting

list. Saul presented as pleasant and co operative, he gave an account of being under in reach at his previous prison,

and having weekly supportive appointments with his worker. Saul stated that he knew his diagnosis to be Dysthymia

with additional depressive eisodes, or 'double depression.' He stated that the medication he is currently on is helpful.

Saul identified that he has previously had issues with NPS, although does not see himself as a drug addict, and he

shows insight into the harmful effects of NPS. Saul stated that outside of prison, he does not take drugs, but has a

gambling problem. He tells me that he prefers to be in segregation, and feels that this is a good way to stay away

from drugs. He also has no desire to associate with other prisoners. Saul did not appear obviously low in mood, he

denies any feelings of self harm or suicide. He stated he has tried to cut his wrist in the past, but this was specifically

intended to be sucide, and staed that he is 'not a self harmer.'

I explained to Saul that he was currently on our waiting list, and that I would out reach him again next week. He is

happy to recieve in reach input.

SRU officers tell me that Saul does not speak to them but is not a management problem.


Stoke Heath


Stoke Heath




24 Mar 2018 10:00 Surgery: PEARCE, Eirian (Nurse Access Role) Entered at: HMYOI Stoke Heath






Stoke Heath


Stoke Heath









Review of admission to segregation unit (XaPmi) - No problems expressed.




Thu 23 Apr 2020 15:02



C90

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Printed




27 Mar 2018 00:46 Surgery: STANIER-FILIP, Paul (Mr) (Admin/Clinical Support Access Role) Entered at: HMYOI

Stoke Heath

27 Mar 2018 00:57 Surgery: STANIER-FILIP, Paul (Mr) (Admin/Clinical Support Access Role) Entered at: HMYOI

Stoke Heath



Seen in the SRU no concerns raised.



27 Mar 2018 15:37

27 Mar 2018 17:24






Stoke Heath


Stoke Heath


28 Mar 2018 09:27

28 Mar 2018 09:46



Seen in segregation unit (Y0ce3) - medication given as per prescription. nohealth issues to raise.

28 Mar 2018 16:10

28 Mar 2018 16:10





Stoke Heath


Stoke Heath



29 Mar 2018 15:53 Surgery: COLE, Elizabeth (Ms) (Nurse Access Role) Entered at: HMYOI Stoke Heath

Community mental health team (Ua0um) - Visited Saul in SRU today. He appears settled. Saul reports that he is

hoping to be transferred back 'cown south' soon. Adcised Saul that if he is still here, I have booked him an

appointment to see me on 10/04/18. Saul was happy with this and stated he had no immediate mental health

concerns.

29 Mar 2018 18:11

29 Mar 2018 18:12

Surgery: EDE, Michelle (Miss) (Nurse Access Role) Entered at: HMYOI Stoke Heath




Stoke Heath


Stoke Heath








Heath


Heath


Review of admission to segregation unit (XaPmi) - Seen in the SRU no concerns.


31 Mar 2018 09:50

31 Mar 2018 15:12

Surgery: PEARCE, Eirian (Nurse Access Role) Entered at: HMYOI Stoke Heath



Thu 23 Apr 2020 15:02



C91

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Printed





Heath


Heath

01 Apr 2018 10:00 Surgery: COLLEY, Dianne (Nurse) Entered at: HMYOI Stoke Entered: 02 Apr 2018 00:42

Heath



01 Apr 2018 10:45

01 Apr 2018 10:45

Surgery: PRICE, Linda (Mrs) (Nurse Access Role) Entered at: HMYOI Stoke Heath


01 Apr 2018 14:37 Surgery: DANIELS, Sara (Mrs) (Nurse Access Role) Entered at: HMYOI Stoke Heath




01 Apr 2018 21:52 Surgery: PRITCHARD, Bridie (Admin/Clinical Support Access Role) Entered at: HMYOI Stoke

Heath


Heath

02 Apr 2018 10:49 Surgery: PRICE, Linda (Mrs) (Nurse Access Role) Entered at: HMYOI Stoke Heath


02 Apr 2018 16:37 Surgery: EDE, Michelle (Miss) (Nurse Access Role) Entered at: HMYOI Stoke Heath


02 Apr 2018 16:38

02 Apr 2018 20:34



03 Apr 2018 08:38 Surgery: SWEENEY, Wendy (Mrs) (Health Professional Access Role) Entered at: HMYOI Stoke

Heath

Medication In Possession Status: Not in possession

03 Apr 2018 09:23

03 Apr 2018 09:23



03 Apr 2018 15:21 Surgery: JACKSON, Melanie (Mrs) (Admin/Clinical Support Access Role) Entered at: HMYOI

Stoke Heath

03 Apr 2018 17:53

03 Apr 2018 17:53



03 Apr 2018 17:53 Surgery: PEARCE, Eirian (Nurse Access Role) Entered at: HMYOI Stoke Heath

04 Apr 2018 11:11

04 Apr 2018 11:11




04 Apr 2018 17:59

04 Apr 2018 17:59



05 Apr 2018 Surgery: RIDGWAY, Gemma (Mrs) (Administrator) Entered at:

HMYOI Stoke Heath

Entered: 06 Apr 2018 09:35

Prescription or Medication details to HCC


HMYOI Stoke Heath

Entered: 06 Apr 2018 09:35

Prescription (X904q) - PRESCRIPTION (New Episode)

05 Apr 2018 09:08 Surgery: BAILEY, Martyn (Mr) (Nurse Access Role) Entered at: HMYOI Stoke Heath

05 Apr 2018 09:50 Surgery: KHAN, Joblu (Dr) Entered at: HMYOI Stoke Heath Entered: 06 Apr 2018 05:00

Did not attend for GP Clinic appointment with Dr Joblu Khan.


05 Apr 2018 12:40 Surgery: BIBBY, Lynn (Ms) (Nurse Access Role) Entered at: HMYOI Stoke Heath




06 Apr 2018 01:52 Surgery: WALSHAW, Catherine (Ms) (Nurse Access Role) Entered at: HMYOI Stoke Heath

06 Apr 2018 01:53 Surgery: WALSHAW, Catherine (Ms) (Nurse Access Role) Entered at: HMYOI Stoke Heath

06 Apr 2018 01:53

06 Apr 2018 05:43

Surgery: WALSHAW, Catherine (Ms) (Nurse Access Role) Entered at: HMYOI Stoke Heath

Surgery: WALSHAW, Catherine (Ms) (Nurse Access Role) Entered at: HMYOI Stoke Heath

06 Apr 2018 10:22 Surgery: NIXON, Sharon (Nurse Access Role) Entered at: HMYOI Stoke Heath

Thu 23 Apr 2020 15:02



C92

C93

Printed




06 Apr 2018 15:22

06 Apr 2018 15:22

Surgery: NIXON, Sharon (Nurse Access Role) Entered at: HMYOI Stoke Heath

Surgery: NIXON, Sharon (Nurse Access Role) Entered at: HMYOI Stoke Heath


07 Apr 2018 00:45 Surgery: STANIER-FILIP, Paul (Mr) (Admin/Clinical Support Access Role) Entered at: HMYOI

Stoke Heath


Stoke Heath


Paracetamol 500mg tablets - x 2 - 500mg



07 Apr 2018 16:45

07 Apr 2018 16:45




Stoke Heath


Stoke Heath







Stoke Heath


Stoke Heath


09 Apr 2018 10:50

09 Apr 2018 12:50

Surgery: BIBBY, Lynn (Ms) (Nurse Access Role) Entered at: HMYOI Stoke Heath

Surgery: FRANKE, Theodorus (General Medical Practitioner) Entered at: HMYOI Stoke Heath

Plan: Seen in CSU - not taking meds: Urgently advised to take meds:





Stoke Heath


HMYOI Stoke Heath

Entered: 13 Apr 2018 14:22

Miscellaneous to HCC

10 Apr 2018 Surgery: RIDGWAY, Gemma (Mrs) (Administrator) Entered at: Entered: 13 Apr 2018 14:22

HMYOI Stoke Heath

Seen in segregation unit (Y0ce3) - SRU ALGORITHM (Ongoing Episode)

10 Apr 2018 08:50 Surgery: DANIELS, Sara (Mrs) (Nurse Access Role) Entered at:

HMYOI Stoke Heath

Entered: 11 Apr 2018 08:50



visited in the SRU, declined his medication. Noted to have not taken his medication over the last few days. Has been

advised by GP to start taking his medication again.

SRU officers have raised concerns regarding Sauls presentation, thathe does not apper to be himself and mood

appears to be low.

Task sent to inreach



10 Apr 2018 10:13 Surgery: PERKINS, Jane (Pharmacy Technician) Entered at: HMYOI Stoke Heath

(R) Mirtazapine 30mg tablets - 1 pack of 28 tablet(s) - One to be taken daily (7 tablets every 7 days)

Stopped 13 Apr 2018 Other (CSU) by FRANKE, Theodorus

(R) Sodium valproate 500mg gastro-resistant tablets - 56 tablets - To be taken Twice Daily (14 tablets every 7 days)

Stopped 13 Apr 2018 Other (CSU) by FRANKE, Theodorus

Custom script: Printed On Tue 10 Apr 2018 10:14 By Jane Perkins

10 Apr 2018 13:40 Surgery: PERKINS, Jane (Pharmacy Technician) Entered at: HMYOI Stoke Heath

Thu 23 Apr 2020 15:02



C93

Printed



Prescribed medication (YA592) - 13/04/18

10 Apr 2018 16:42 Prison: COLE, Elizabeth (Ms) (Mental Health Nurse) Entered at: HMYOI Stoke Heath


I saw Saul in SRU today following reports that he is refusing medication. Saul reports that he is refusing his

medication because he wants to be transferred back down south, to a jail with a healthcare wing. He stated that

since his mental health deteriorated, he knows he cannot cope on normal location, because he is weakened. He tells

me that he has been in prison many times, and is used to prison life, but his menatl health has now changed this. I

explained to Saul that refusing medication would potentially make his menatl health worse, and his response was

'death would be bliss.' I asked what had precipitated his deterioration and Saul explained that in 2013, his partner ran

away with his daughter. This was preceeded by a court battle with his own family to obtain custody of the child from

his mother. When he entered prison shortly after this, his partner disappeared with his daughter. Saul staed he has

lost everything now. He became tearful and distressed. Saul also disclosed that he has refused food for two days.

He is drinking water. He stated he was not engaging in any other self harm behaviours. SRU staff confirmed that he

is refusing meals. They inform me that from tomorrow they would be opening an ACCT document due to food

refusal. After returning to healthcare and siscussing with Wendy Sweeney Healthcare Manager, I have decided to

open an ACCT document today.

ACCT OPENED 1630hrs.

To be discussed at CTM meeting on 12/04/18.

10 Apr 2018 17:30 Surgery: DANIELS, Sara (Mrs) (Nurse Access Role) Entered at: Entered: 11 Apr 2018 08:50

HMYOI Stoke Heath


Stoke Heath



Stoke Heath




11 Apr 2018 15:41 Prison: COLE, Elizabeth (Ms) (Mental Health Nurse) Entered at: HMYOI Stoke Heath


Seen today in SRU. Saul remains on his ACCT document, on hourly observations. Saul's presentation remains

unchanged; tearful and expressing feelings of hopelessness. He states that he feels refusing to eat is his only option,

as he cannot be at Stoke Heath. He explained that when he tried to cope on normal location in his previous prison,

he took NPS and was deteriorating. Saul expressed that no one has regard for his life, and therefore he does not. He

feels he has nothing to lose, and his only hope is being in a healthcare wing where he has 'space' and time to talk. I

explained that we could support him at Stoke Heath, but that he would need to progress to normal location at some

point which he is adamant he will not do. He stated that he would rather they carry his body out. Saul appears low in

mood, although was able to articulate himself. Rapport established, good eye contact.

Saul reports he feels a little dizzy, and gets headaches but this is helped by drinking water. I will ask our visiting

Psychiatrist to see Saul tomorrow if he is able.


Stoke Heath

11 Apr 2018 16:22 Surgery: COLE, Elizabeth (Ms) (Nurse Access Role) Entered at: HMYOI Stoke Heath

Community mental health team (Ua0um) - I have spoken with my Primary Care colleagues in relation to the Food

Refusal policy, and requested a GP appt for Saul. I will also provide SRU staff tomorrow with a copy of the policy if

they require it, and copies of food and fluid charts, and log book as per policy. To be discussed in tomorrow's CTM

meeting.





Stoke Heath

12 Apr 2018 Surgery: WHITE, Carla (Mrs) (Administrator) Entered at: HMYOI

Stoke Heath

Psychiatry to HMP Stoke Heath

12 Apr 2018 Surgery: WHITE, Carla (Mrs) (Administrator) Entered at: HMYOI

Stoke Heath

Dr Appleford clinic 12.04.18

C94

Entered: 23 Apr 2018 14:43

Entered: 23 Apr 2018 14:43

12 Apr 2018 09:07 Prison: FRANKE, Theodorus (General Medical Practitioner) Entered at: HMYOI Stoke Heath

History: I was asked to see Mr Turner, re Food refusal.on the CSU unit

Thu 23 Apr 2020 15:02



C94

C95

Printed



He refused to see me.

However, i discussed his case with Nurse, and advsed her accordingly.

Diagnosis: Refusing food (X767f)

Plan: Continue care and obtain weight measurments,

Collect urine for ketones,

fill in food/drink chart,

Offer emotional support.

Consider re feeding protocol after refusal is stopped.

I will see him tomorrow on the CSU round.


Seen by nurse (XaATp) - Spoke to Saul on the SRU this morning during medication round. He has assured me that

although he has not eaten for the last three days, that he is drinking plenty. Have arranged for a full set of

observations and also urine tests to be completed Saturday morning if he has still not eaten. Saul was fully aware of

the implications of not eating. He is currently well and does not have any symptoms of dehydration.



12 Apr 2018 12:15 Surgery: APPLEFORD, James (Dr) (Clinical Practitioner Access Role) Entered at: HMYOI Stoke

Heath

History: Seen with Beth Cole, RMN.

Saul has refused food for 5 days, but has been drinking fluids. He has not been taking medication.

Saul has been extensively assessed.

Today, Saul reports depressive symptoms, low mood, some tearfulness, reduced appetite, loss of interest,

enjoyment, motivation, poor memory and concentration, with suicidal thoughts. He gives a history of similar

episodes, and suicide attempts. He states that there are underlying issues, including circumstances leading to lack of

contact with his daughter, and subsequent family issues.

Examination: Slim. Well kempt. Good eye contact and rapport. Flat, depressed affect. Suicidal thoughts, no psychotic

features.

Diagnosis: Depressive disorder (X00SO) (New Episode)

Plan: Lengthy discussion

Explained treatment might include medication and therapy, but that it is essential that he continues to eat

Saul has agreed to eat

For continued regular support

For medication review once he is eating regularly

Will need therapy referral

Liaise with Governor re support for move to local establishment near his home area and where he might have access

to healtcare unit

Suggest continue ACCT and food refusal protocol




13 Apr 2018 08:33 Surgery: ROBERTSON, Alina (Miss) (Nurse Access Role) Entered at: HMYOI Stoke Heath


Community mental health team (Ua0um) - Contacted SRU this morning, who inform me that Saul has begun eating. I

have also spoken with Mr Lishman OMU regarding our support for Saul's transfer on mental health grounds. He

informs me that he saw Saul in his ACCT review yesterday following our visit, and was aware of the situation. He

believes there are plans to transfer, and OCA are currently negotiating transfer to somewherer closer to home. I have

asked SRU staff to inform Saul that I will see him on Tuesday on my return to Stoke Heath.

13 Apr 2018 12:19 Surgery: FRANKE, Theodorus (General Medical Practitioner) Entered at: HMYOI Stoke Heath

Plan: Seen in CSU - no issues.

13 Apr 2018 13:02 Surgery: FRANKE, Theodorus (General Medical Practitioner) Entered at: HMYOI Stoke Heath


Stopped 24 Apr 2018 Other (transferred to another establishment) by HUMPHRIES, Emma L

Sodium valproate 500mg gastro-resistant tablets - 28 tablets - 1 tablet - admin times: 07:45, 16:00

Stopped 19 Apr 2018 End of course by APPLEFORD, James (Dr)

Custom script: Printed On Fri 13 Apr 2018 13:06 By Theodorus Franke





Stoke Heath


Thu 23 Apr 2020 15:02



C95

C96

Printed



Stoke Heath

14 Apr 2018 07:42

14 Apr 2018 10:08



14 Apr 2018 10:08

14 Apr 2018 10:48



Food intake (Ub09i) - Seen this morning to administer morning medication however Saul declined. Saul stated that

he has started to eat now and has had his breakfast this morning. Wing staff continue to monitor, acct remains open,

no need to implement policy for food refusal at this time unless situation changes.


14 Apr 2018 16:39

14 Apr 2018 16:39




Stoke Heath


Stoke Heath

15 Apr 2018 10:21 Surgery: ROBERTSON, Maria (Ms) (Nurse Access Role) Entered at: HMYOI Stoke Heath






Heath


Heath

16 Apr 2018 15:59 Surgery: OAKLEY, Helen (Mrs) (Clerical Access Role) Entered at: HMYOI Stoke Heath


16 Apr 2018 16:12

16 Apr 2018 17:37

Surgery: DANIELS, Sara (Mrs) (Nurse Access Role) Entered at: HMYOI Stoke Heath


16 Apr 2018 17:37

16 Apr 2018 17:37




Heath


Heath

17 Apr 2018 09:10 Surgery: PEARCE, Eirian (Nurse Access Role) Entered at: HMYOI

Stoke Heath

Entered: 17 Apr 2018 11:45

17 Apr 2018 11:45

17 Apr 2018 13:30


Prison: COLE, Elizabeth (Ms) (Mental Health Nurse) Entered at: HMYOI Stoke Heath


Seen today in SRU. Saul appears brighter in mood. He reports that he is now eating and feels that he is having a

good day today. In formed Saul that I have liaised with his Offender Supervisor and that a tranfer is being looked

into, however I could not make any guarantees. He was happy with this and remains keen to engage with treatment

and therapy. Saul spoke about underestimating the impact of depression in the past, and feeling overwhelmed

recently.

He remains in SRU, on an open ACCT document.

I will see him again on Thurday, with Dr Appleford to review.

17 Apr 2018 16:37 Surgery: COLLEY, Dianne (Nurse) (Nurse Access Role) Entered at: HMYOI Stoke Heath




Heath



Heath


Heath

18 Apr 2018 11:44 Surgery: ROPER, Julie (Mrs) (Nurse Access Role) Entered at: HMYOI Stoke Heath


Plan: Today I have attended the MASH meeting with the prison and informed the team of the recommendations from

Dr Appleford and the clinical team. His ACCT was closed 17 April 2018. I will inform E. Cole CMHN of this. Awaiting

Thu 23 Apr 2020 15:02



C96

C97

Printed



a transfer.







Heath


Heath

19 Apr 2018 Surgery: BAILEY, Sharon (Mrs) (Administrator) Entered at: HMYOI Entered: 03 May 2018 15:03

Stoke Heath

Psychiatry to HMYOI STOKE HEATH

19 Apr 2018 Surgery: BAILEY, Sharon (Mrs) (Administrator) Entered at: HMYOI Entered: 03 May 2018 15:03

Stoke Heath

Dr Appleford - Psychiatric clinic letter - 19th April 2018




Heath

History: Review in CSU with Julie Roper, RMN

Saul is now eating and drinking. His ACCT has been closed.

Saul said that he feels better. He is not sleeping well. He wakes every few hours, and feels tired. He reports no other

symptoms. On enquiry, he did not report depressed mood, anxiety, or suicidal thinking.

Examination: Tidy and clean cell. Well kempt. Normal eye contact, rapport and speech. Subjectively not depressed.

Objectively a little flat in affect. Not suicidal. No psychotic features.

Plan: Discussed treatment options.

I note Saul has not been taking medication. Advised Mirtazapine may help with sleep and mood. He has agreed to

take this.

Advised Valproate could be discontinued at present, and may be reserved for use if his mood does not stabilize with

Mirtazapine.

Discussed role of psychological therapies. Saul is aware that he is being considered for a move. Therapy may be

offered after his move; it would be unproductive to begin a therapy that would not be completed prior to transfer.

Continued support while he remains here. Will need a handover when transferred.

Letter to follow


Heath



19 Apr 2018 21:55 Surgery: GASTON, Pascal (Mr) (Admin/Clinical Support Access Role) Entered at: HMYOI Stoke

Heath



Heath

20 Apr 2018 09:11 Surgery: CARNAHAN, Aaron (Mr) (Nurse Access Role) Entered at: HMYOI Stoke Heath


Overview Notes (Y0028) - No health concerns expressed



I visited Saul today in SRU. He appears settled and reports he feels 'ok.' Saul has now recommenced Mirtazepine,

and reports he had a really good night's sleep last night. We spoke today about his previous NPS use, and Saul

explained that he has taken large amounts of it in the past, but only whilst in priosn. He stated that for him, it is like

no other drug, but that he only takes it because he cannot get Cannabis. Saul is aware of the dangers of NPS, and

acknowledges them, however this did not stop him using NPS in the past. He did state that he has no intention to

continue using, as his mental health is more important to him now.

Plan- I will continue to see Saul and liaise with OCA regarding his transfer.




Heath

Thu 23 Apr 2020 15:02



C97

C98

Printed








Heath

23 Apr 2018 11:28 Surgery: RIDGWAY, Gemma (Mrs) (Clerical Access Role) Entered at: HMYOI Stoke Heath

23 Apr 2018 13:32 Surgery: HUMPHRIES, Emma L (Health Professional Access Role) Entered at: HMYOI Stoke

Heath

Medication Approval Marked in Error: Medication has changed

23 Apr 2018 13:32 - HUMPHRIES, Emma




Stoke Heath


Review of admission to segregation unit (XaPmi) - No problems expressed.



24 Apr 2018 14:27 Surgery: HUMPHRIES, Emma L (Health Professional Access Role) Entered at: HMYOI Stoke

Heath

25 Apr 2018 Surgery: BOSWELL, Karen (Miss) (Admin/Clinical Support Access Entered: 25 Apr 2018 14:02

Role) Entered at: HMYOI Portland

Consent Forms to Healthcare, HMP YOI Portland

25 Apr 2018 Surgery: BOSWELL, Karen (Miss) (Admin/Clinical Support Access Entered: 25 Apr 2018 14:02

Role) Entered at: HMYOI Portland

Medication Compact & Consent to share information

Medication management plan in situ (YA461) (New Episode)


25 Apr 2018 07:45 Surgery: PRICE, Ashlee (Miss) (Admin/Clinical Support Access Role) Entered at: HMYOI Portland




25 Apr 2018 07:45 Surgery: Unknown Staff Member Entered at: HMYOI Portland

(Admission Med) Paracetamol 500mg tablets - x 2 - 500mg








25 Apr 2018 08:54 Surgery: RIMELL, Lynne (Mrs) (Admin/Clinical Support Access Role) Entered at: HMYOI Portland

25 Apr 2018 11:08 Surgery: COOKE, Karen (Systems Support Access Role) Entered Entered: 02 Aug 2018 16:03

at: HMYOI Portland

Depression interim review (XaK6f)

25 Apr 2018 11:08 Surgery: SKINNER, Margaret (Admin/Clinical Support Access Role) Entered at: HMYOI Portland

Diagnosis: Are you taking any medicines that have been prescribed for you on prescription or do you take any

medicines that you buy yourself? - No

Does the patient have a problem with alcohol or using drugs? - No

Has the patient had any problems in the last 12 months with bullying or trading medicines? - No

Has the patient had any problems in the last 12 months with not taking, or not remembering to take their medicines

as prescribed? - No

Has the patient had any problems in the last 12 months with not being able to collect their medicines? - No

Has the patient had any problems in the last 12 months with not being able to get their medicines out of their

containers? - No

Has the patient self-harmed or attempted suicide in the last 12 months? - Yes

Has the patient overdosed with medicines in the last 12 months? - No

Does the patient have an open ACCT document? - No

Is the patient confused or disorrientated? - No

Thu 23 Apr 2020 15:02



C98

C99

Printed



Is it the patient's first time in prison? - No

Has there been a change in their custodial status? (e.g. licence recall; long sentence to serve; manslaughter or

murder charge) - No

Other recent life changing event? - No

Assessment Outcome:

IP Status: Consider Risks and Consider 7 Day In Possession with Follow-Up and Review

Medium Risk Score: 10-20

Plan: Assessment of risk of prisoner in-possession medication (Xab5S)



Medical condition comments (Y2578) - Pt states that he was next to a pt in CSU who was diagnosed with TB

Further background information (Y2299) - none

O/E - height (229..) 1.727 m (5 ' 8 ")


N/A (Y0426)

Further background information (Y2299) - Book appointment with GP to discuss

Able to perform personal care activity (Xa2u6)

No current problems or disability (1152.) (Ongoing Episode)




Fever symptoms (X76Dl)

[V]Contact with or exposure to tuberculosis (ZV011)


Loss of appetite (XM07Y)



N/A (Y0426)

Reason for action (XaIVN) - Pt was prescribed weekly IP before going into CSU .


Ex-smoker (Ub1na)


Lack of energy (X76Ai)


Main spoken language English (XaG5t)

Theft (X765j) - Burgulary

Medical records review (XaE42)

No (Y0428)

No (Y0428)

No (Y0428)



No (Y0428)


No (Y0428)

No (Y0428)

No (Y0428)

Further background information (Y2299) - Pt would like a GP appointment to discuss exposure to TB from last prison


No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)

Is informed (Ua29U)

Current medication as reported by patient (XaQnH) - none

Referral to GP (8H62.)


Not fit for normal location, work and any cell occupancy (Y0b8b) - Preference to single cell

Prisoner receiving prescribed medication (YX007)


Current medication as reported by patient (XaQnH) - Mirtazapine 30mg

Thu 23 Apr 2020 15:02



C99

C100

Printed





No (Y0428)

Overview Notes (Y0028) - Mitrazapine 30mg


No suicidal thoughts (XaIJ7)

Prisoner has tried to harm themselves (in prison) (YX020) - Pt make cuts to wrists approx 3 to 4 months ago. Pt was

treated while in CSU .


H/O: depression (1465.)

Impressions of the prisoners behaviour and mental state (YX023) - Engaging well during reception screening with

good eye contact. No apparent concerns at this present time. Pt states that he has a past history of depression but

does not wish to engage with the mental health team at this present time. I have explained to pt that if he wishes to

engage with mental health at any time he can submit a H?C application .




No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)


Pt took two overdoses of co codamol and alcohol.

This resulted in pt being admitted to hosputal where he remained for 2 to 3 weeks.

Prisoner has tried to harm themselves (outside prison) (YX021)

No (Y0428)

No (Y0428)

No (Y0428)

126 / 64 mmHg


25 Apr 2018 11:42 Surgery: SAMOUELLE, Richard (Dr) (Clinical Practitioner Access Role) Entered at: HMYOI

Portland

(R) Mirtazapine 30mg tablets - 28 tablets - one at night (7 tablets every 7 days)

Mirtazapine 30mg tablets - 28 tablets - one at night

Ended 11 Jul 2018 Patient Preference by SAMOUELLE, Richard (Dr)

Custom script: Printed On Wed 25 Apr 2018 11:45 By Dr Richard Samouelle

26 Apr 2018 13:17 Surgery: GRUNDONNER, Mark (Mr) (Clerical Access Role) Entered at: HMYOI Portland

Medical records transfer (XaAKm)

Sources of information (XaIKS)

Medicines reconciliation performed (XaRF0)

Medication reconciliation (XaXfG)

(Admission Med) Mirtazapine 30mg tablets -

26 Apr 2018 15:46 Surgery: NDONGO, Andrew (Mr) (Nurse Access Role) Entered at: HMYOI Portland

History: Telephone encounter (9N31.)

Examination: Received telephone call from the Mental health in-reach Team HMP Stoke Heath, tel: 01630636184.

Staff member Berth handed over aabout Mr Turner, that he has been under their care at HMP Stoke Heath for a

while. He has been in and out of prison, long history of substance misuse and has been using NPS whilst in prison.

He was in seg for a while as he was refusing to be locate to the main wing. Suffered from depression, had low

mood, refused medication (sodium valproate) and food for a while. He was seen by a psychiatrist, who believed, he

had untreated depression and some psychological issues that needed to be addressed. Appeared to be very keen to

stay on healthcare wing, refusing to locate to main wing.

Plan: Triage assessment


Generalised anxiety disorder 7 item score (XaNkT)

Generalised anxiety disorder 7 item score (XaNkT) 1 - 1.Feeling nervous, anxious or on edge: Not at all

2. Not being able to stop or control worrying: Not at all

3. Worrying too much about different things: Several days

4. Trouble relaxing: Not at all

5. being so restless that it is hard to sit still: Not at all

6. Becoming easily annoyed or irritable: Not at all

7. Feeling afraid as if something awful might happen: Not at all

Thu 23 Apr 2020 15:02



C100

C101

Printed



Patient health questionnaire (PHQ-9) score (XaLDN) 0 - 1. Little interest or pleasure in doing things: N/A

2. Feeling down, depressed or hopeless: Not at all

3. Trouble falling or staying asleep, or sleeping too much: Not at all

4. Feeling tired or having no energy: Not at all

5. Poor appetite or overeating: Not at all

6. Feeling bad about yourself - or that you are a failure or have let yourself or your family down: Not at all

7. Trouble concentrating on things, such as reading the newspaper or watching television: Not at all

8. Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless

that you have been moving around a lot more than usual: Not at all

9. Thoughts that you would be better off dead, or of hurting yourself in some way: Not at all

Depression screening using questions (XaLIc)


Family history of mental disorder (128..) - Says he has a long standing history of depression, has no contact in the

community, no family, no where to stay when he gets released.

H/O: mental health problem (YA741) - States he has been in seg for 6 weeks before he was transfered to Portland.

Stated that he did not like the prison, he wanted to get out desperately. Says he selfharmed whilst in prison around

December 2017, was trying to commit suicide, also took an overdose of 120 cococdamol and alcohol in 2007 and

another one in 2011. Stated he wanted to end it all but failed.

Mental health care programme approach care plan (Xa4HV) (Ongoing Episode)

Impressions of the prisoners behaviour and mental state (YX023) - Stated that he is feeling much better, mood, self

rated 8/10. He appeared well kempt, interacted appropriately maintaining good eye contact, rational conversation, no

significant mood disorder or perceptional disturbances. Denied having thoughts of deliberate selfharm or suicidal

thoughts, intent or plan.

Mental symptom findings (XaBfp) - States he is having poor sleep, has not received medication (mirtazepine) as yet.

Says today he is feeling "great" but at times he feels down.

No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)


Yes (Y0427)

Discharged from care of mental health triage nurse (XaL0w)



Outcome (XaIXy)

He says he feels well at HMP Portland and he does not want to engage with mental health team, stated that he

knows how to contact the team if he needs help. Declined to do emotional well being, however advise given

regarding same and contacting mental health if he begins to feel being unwell.

He however agreed to take two patient information books about : low mood and depression: sleep advise.

He was discharged from carer of mental health traige nurse.

Substance misuse behaviour (XaJz5) - States he smoked cannabis before coming into prison, denied use of any

other drugs.

Prisoner has received medication for mental health problems (YX019) - Mirtazepine 30mg



22 May 2018 08:52 Surgery: RIMELL, Lynne (Mrs) (Admin/Clinical Support Access Role) Entered at: HMYOI Portland

23 May 2018 Surgery: SHERRATT, Claire (Miss) (Pharmacist) Entered at: HMYOI Portland


Custom script: Printed On Mon 14 May 2018 07:59 By Miss Claire Sherratt

27 May 2018 09:09 Surgery: HAMPSHIRE, Ann (Miss) (Nurse Access Role) Entered at: HMYOI Portland

Paracetamol 500mg tablets - 2 - 2

05 Jun 2018 13:50 Surgery: SHERRATT, Claire (Miss) (Pharmacist) Entered at: HMYOI Portland

12 Jun 2018 10:49 Surgery: BOSWELL, Karen (Miss) (Admin/Clinical Support Access Role) Entered at: HMYOI

Portland

13 Jun 2018 08:00 Surgery: RIMELL, Lynne (Mrs) (Admin/Clinical Support Access Role) Entered at: HMYOI Portland

13 Jun 2018 14:30 Surgery: SHERRATT, Claire (Miss) (Pharmacist) Entered at: HMYOI Portland

20 Jun 2018 Surgery: SHERRATT, Claire (Miss) (Pharmacist) Entered at: HMYOI Portland


Stopped 11 Jul 2018 Patient Preference by SAMOUELLE, Richard (Dr)

Thu 23 Apr 2020 15:02



C101

C102

Printed



Custom script: Printed On Wed 13 Jun 2018 09:18 By Miss Claire Sherratt

22 Jun 2018 09:55 Surgery: GREGORIOUS, Mathew (Nurse Access Role) Entered at: HMYOI Portland

(From PGD or Homely Remedy) Paracetamol 500mg tablets - 2 tablets - 1-2 tablet - Once only (Oral)

Stopped 22 Jun 2018 Medication has been administered by GREGORIOUS, Mathew

22 Jun 2018 09:55

11 Jul 2018 09:04

Surgery: GREGORIOUS, Mathew (Nurse Access Role) Entered at: HMYOI Portland

Surgery: SHERRATT, Claire (Miss) (Pharmacist) Entered at: HMYOI Portland

11 Jul 2018 11:59 Surgery: SAMOUELLE, Richard (Dr) (Clinical Practitioner Access Role) Entered at: HMYOI

Portland

Drug Dispensing Schedule Marked in Error: Wrong data entered

18 Jul 2018 00:00

Drug Dispensing Schedule Marked in Error: Wrong data entered

18 Jul 2018 00:00

Medication Marked in Error: Wrong data entered

18 Jul 2018 00:00, Mirtazapine 30mg tablets, one at night, 28 tablets, , 29

Drug Chart Details Marked in Error: Wrong data entered

18 Jul 2018 00:00

18 Jul 2018 Surgery: SHERRATT, Claire (Miss) (Pharmacist) Entered at: HMYOI Portland

Custom script: Printed On Tue 10 Jul 2018 14:26 By Miss Claire Sherratt

31 Jul 2018 Surgery: SKINNER, Margaret (Assistant Practitioner) Entered at: HMYOI Portland

Risk assessment required (YA465)

13 Aug 2018 09:08 Surgery: SMITH, Lynda (Mrs) (Nurse Access Role) Entered at: HMYOI Portland

(From PGD or Homely Remedy) Ibuprofen 200mg tablets - 2 tablets - 1-2 tablet - Once only (Oral)

Stopped 13 Aug 2018 Medication has been administered by SMITH, Lynda (Mrs)





13 Aug 2018 12:00 Surgery: ROOM, Dental Entered at: HMYOI Portland Entered: 13 Aug 2018 15:20

Did not attend for Dentist appointment with Dental Room.



(From PGD or Homely Remedy) Ibuprofen 200mg tablets - 1 pack of 24 tablet(s) - 1-2 tablet - Once only (Oral)


(From PGD or Homely Remedy) Paracetamol 500mg tablets - 1 pack of 16 tablet(s) - 1-2 tablet - Once only (Oral)



16 Aug 2018 09:58

16 Aug 2018 09:58

Surgery: HAMPSHIRE, Ann (Miss) (Nurse Access Role) Entered at: HMYOI Portland

Surgery: HAMPSHIRE, Ann (Miss) (Nurse Access Role) Entered at: HMYOI Portland

(From PGD or Homely Remedy) Paracetamol 500mg tablets - 1 pack of 16 tablet(s) - 1-2 tablet - Once only (Oral)

Stopped 16 Aug 2018 Medication has been administered by HAMPSHIRE, Ann (Miss)

20 Aug 2018 09:01 Surgery: ROBSON, Bryan (Nurse Access Role) Entered at: HMYOI Portland


(From PGD or Homely Remedy) Ibuprofen 200mg tablets - 2 tablets - 1-2 tablet - Once only (Oral)

Stopped 20 Aug 2018 Medication has been administered by ROBSON, Bryan


Stopped 20 Aug 2018 Medication has been administered by ROBSON, Bryan


20 Aug 2018 12:05 Surgery: BARNES, Trevor (Mr) (Health Professional Access Role) Entered at: HMYOI Portland

History: Dental,Pat c/o pain LR

O/e pericoronitis LR8 , not too inflamed but could be pushing ,

Pat advised re , cotton bud , HSMW s ,interspace to keep gum flap healthy ,

To take aspirin / paracetamol if it is trying to erupt

To refer ext LR8

23 Aug 2018 Surgery: BOSWELL, Karen (Miss) (Clerical Access Role) Entered

at: HMYOI Portland

Entered: 23 Aug 2018 10:27

Referral to Orthodontic Department, Dorset County Hospital

23 Aug 2018 Surgery: BOSWELL, Karen (Miss) (Clerical Access Role) Entered

at: HMYOI Portland

Entered: 23 Aug 2018 10:27

Dental referral

Thu 23 Apr 2020 15:02



C102

C103

Printed




Seen in oral surgery clinic (9N1q.)

25 Aug 2018 15:19 Surgery: HAMPSHIRE, Ann (Miss) (Nurse Access Role) Entered at: HMYOI Portland


Stopped 25 Aug 2018 Medication has been administered by HAMPSHIRE, Ann (Miss)

25 Aug 2018 15:20 Surgery: HAMPSHIRE, Ann (Miss) (Nurse Access Role) Entered at: HMYOI Portland

02 Sep 2018 Surgery: RIMELL, Lynne (Mrs) (Clerical Access Role) Entered at: Entered: 07 Sep 2018 12:51

HMYOI Portland

F213 - Report of injury to inmate to Healthcare, HMP YOI Portland

02 Sep 2018 Surgery: RIMELL, Lynne (Mrs) (Clerical Access Role) Entered at: Entered: 07 Sep 2018 12:51

HMYOI Portland

F213

F213 report of injury to inmate completed (XaYgE)

02 Sep 2018 12:09 Surgery: HAMPSHIRE, Ann (Miss) (Nurse Access Role) Entered at: HMYOI Portland

Segregation unit referral for pending investigation (XaPmg)

Admission to segregation unit (XaPma) (New Episode)

Prison segregation unit risk assessment (XaQii)



Medically fit to be held in the segregation unit (Y0d06) - Yes

03 Sep 2018 08:45 Surgery: RIMELL, Lynne (Mrs) (Clerical Access Role) Entered at: HMYOI Portland

04 Sep 2018 13:35 Surgery: SMITH, Lynda (Mrs) (Nurse Access Role) Entered at: HMYOI Portland


Review of admission to segregation unit (XaPmi) - Seen in segregation unit, nil healthcare concerns raised.



06 Sep 2018 08:03 Surgery: RIMELL, Lynne (Mrs) (Clerical Access Role) Entered at: HMYOI Portland

06 Sep 2018 13:43 Surgery: NOONAN, Marie (Nurse Access Role) Entered at: HMYOI Portland




seen in csu.

Nil issues for Healthcare




Medically fit to be held in the segregation unit (Y0d06) - yes


History: Seen in segregation unit (Y0ce3)Seen by nurse (XaATp)


Review of admission to segregation unit (XaPmi) - Seen in segregation unit, nil healthcare concerns raised.





Review of admission to segregation unit (XaPmi) - Seen in segregation on daily healthcare round. Nil healthcare

concerns raised.




Segregation unit referral for cellular confinement (XaPmd)







Review of admission to segregation unit (XaPmi) - Seen in segregation on daily healthcare round. Dry skin evident

to arms Plan: aqueous cream to be issued through PGD. Nil other healthcare concerns raised.



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(From PGD or Homely Remedy) Aqueous cream - 1 pack of 100 gram(s) - 1-5 application - Once only (Topical)

Stopped 10 Sep 2018 Medication has been administered by SMITH, Lynda (Mrs)

12 Sep 2018 08:09 Surgery: SMITH, Zoe (Nurse Access Role) Entered at: HMYOI Portland

Review of admission to segregation unit (XaPmi) - No issues raised today.








Review of admission to segregation unit (XaPmi) - Seen in segregation unit on daily nurse round, no concerns raised

for healthcare.







concerns raised.







17 Sep 2018 11:42 Surgery: NOONAN, Marie (Nurse Access Role) Entered at: HMYOI Entered: 18 Sep 2018 07:42

Portland




Seen in CSU - He requests like "spot " cream - reports skin irritaion on trunk area

tasked nurse prescriber




17 Sep 2018 13:59 Automatically updated from PAS interface: Unknown Staff Member Entered at: Dorset County

Hospital NHS Foundation Trust EPR Core

Previous Home Address: Hmp Yoi, Grove Road, Portland DT5 1DL

Hospital Number: D706036 (Primary PAS ID) at Dorset County Hospital EPR Core Trust

SystmOne Outgoing Record Sharing consent changed to: Not asked - Record shared - Automatically generated by

SystmOne

SystmOne Incoming Record Sharing consent changed to: Not asked - Record shared - Automatically generated by

SystmOne

Home telephone number: 01305 715600




concerns raised.








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concerns raised.










concerns raised.










concerns raised.











Seen In csu cell .

No concerns re Helathcare when asked





Review of admission to segregation unit (XaPmi) - Seen in segregation on daily healthcare round. Requesting 1

gram of paracetamol for a headache. Issued through nurses PGD. Advised to increase fluid intake. Nil other

healthcare concerns raised.








25 Sep 2018 12:05 Surgery: ROBSON, Bryan (Nurse Access Role) Entered at: HMYOI Portland


Admission to segregation unit (XaPma) (Ongoing Episode)

Review of admission to segregation unit (XaPmi) - Seen , no requests for any healthcare needs at time seen.






Review of admission to segregation unit (XaPmi) - Seen in csu - lying on bed reading a book this morning . Denied

any issues for Healthcare . Stable at time of consultation


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27 Sep 2018 11:37 Surgery: THOMPSON, Nicola (Nurse Access Role) Entered at: HMYOI Portland


Review of admission to segregation unit (XaPmi) - seen in CSU no concerns raised at time, appears fit and well at

time.








concerns raised.








Review of admission to segregation unit (XaPmi) - Seen in segregation on daily healthcare round. Mr Turner

requested cream which he believed the doctor was going to prescribe following previous segregation round. Looked

under patient notes noted no cream has been prescribed. Will inform Mr Turner. Nil further healthcare concerns

raised.










Review of admission to segregation unit (XaPmi) - Seen by healthcare no concerns raised this morning.




01 Oct 2018 13:55 Surgery: NOONAN, Marie (Nurse Access Role) Entered at: HMYOI Portland



Review of admission to segregation unit (XaPmi) - seen in csu . paracetamol given for headache -otherwise well





02 Oct 2018 HMP Prison: MUNDY, Caroline (Mrs) (Clerical Access Role) Entered: 03 Oct 2018 13:35

Entered at: HMP Guys Marsh

Medication Compact to HMP Guys Marsh

02 Oct 2018 Surgery: MUNDY, Caroline (Mrs) (Clerical Access Role) Entered Entered: 03 Oct 2018 13:36

at: HMP Guys Marsh

Medical Compact


Accepted (Ub1mG)

02 Oct 2018 08:22 Surgery: GOULD, Holly (Miss) (Clerical Access Role) Entered at: HMYOI Portland

Transfer moved out (Y3425)




02 Oct 2018 11:11 Surgery: SMITH, Lynda (Mrs) (Nurse Access Role) Entered at: HMYOI Portland


Thu 23 Apr 2020 15:02



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concerns raised.





02 Oct 2018 13:34 Surgery: DAYMAN, James (Mr) (Clerical Access Role) Entered at: HMP Guys Marsh





02 Oct 2018 13:34 Surgery: Unknown Staff Member Entered at: HMP Guys Marsh









Are you taking any medicines that have been prescribed for you on prescription or do you take any medicines that

you buy yourself? - Yes

Before coming here, for example at home, did you look after your medicines yourself? - Yes

Before coming here, for example at home, did you take your medicines yourself? - Yes

Do you have any problems understanding how to take your medicines? - No

- difficulties with reading the label

- language issues

- confusing intructions on when to take them

- other issues (please specify)

Does the patient have a problem with alcohol or using drugs? - No

Has the patient had any problems in the last 12 months with bullying or trading medicines? - No

Has the patient had any problems in the last 12 months with not taking, or not remembering to take their medicines

as prescribed? - No

Has the patient had any problems in the last 12 months with not being able to collect their medicines? - No

Has the patient had any problems in the last 12 months with not being able to get their medicines out of their

containers? - No

Has the patient self-harmed or attempted suicide in the last 12 months? - No

Has the patient overdosed with medicines in the last 12 months? - No

Does the patient have an open ACCT document? - No

Is the patient confused or disorrientated? - No

Is it the patient's first time in prison? - No

Has there been a change in their custodial status? (e.g. licence recall; long sentence to serve; manslaughter or

murder charge) - No

Other recent life changing event? - No

Assessment Outcome:

IP Status: Full In Possession

Low Risk Score: 0-9


Not known if prisoner has received medication for mental health problems (Y08fd)




Impressions of the prisoners behaviour and mental state (YX023) - DECLINED REFERRAL

Urine not tested: unable to obtain sample (Y2336)




No (Y0428)

No (Y0428)

No (Y0428)

Thu 23 Apr 2020 15:02



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No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)

Diet notes (Y1310) - NORMAL

No (Y0428)

No (Y0428)

No (Y0428)

Unknown (X90UG)


Assessment of risk of prisoner in-possession medication (Xab5S)

N/A (Y0426)


Interpreter needed (XaI8X)

No (Y0428)


Medical condition comments (Y2578) - N/A



Relevant medical information (XaYmG) - N/A (Ongoing Episode)


No (Y0428)


N/A (Y0426)

No (Y0428)

Medication changed (8B316) - NIL

Other medication management (XaJr2) - NIL

Advice to continue with drug treatment (XaAsN) - NIL

Further background information (Y2299) - NIL

Advice to stop drug treatment (XaA02) - NIL

Sources of information (XaIKS) - PATIENT


Over the counter medication (YA459) - NIL

H/O: high risk medication (14P..) - NIL

Herbal medicine (x00yv) - NIL


User of electronic cigarette (XaaNL)

Comment note (XaIg6)

Alcohol screen - AUDIT PC completed (XaMyj) 0



Medication reconciliation (XaXfG)


Smoker (137R.)


No (Y0428)

No (Y0428)




No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)

No (Y0428)






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Is informed (Ua29U)

Current medication as reported by patient (XaQnH) - N/A






SEEN ON RECEPTION, task sent to trevor barnes, re his referral for pt , when seen at hmp portland, 20th august.

Toothache (1912.)



03 Oct 2018 08:14 Surgery: TRIM, Zara (Miss) (Health Professional Access Role) Entered at: HMP Guys Marsh

Drug addiction therapy (XE0hi) - Risk review - none noted - to be seen by DW.

03 Oct 2018 08:21 Surgery: MUNDY, Caroline (Mrs) (Clerical Access Role) Entered at: HMP Guys Marsh

03 Oct 2018 10:23 Surgery: HEWETT, Francis (Mr) (Health Professional Access Role) Entered at: HMP Guys Marsh

Drug addiction therapy (XE0hi) - Intervention offered and refused. Harm min and P-S sheet given and signed. ISMS

non-engaement disclamimer signed. stated drug use not problematic.

03 Oct 2018 11:33 Surgery: TAYLOR, Diane (Mrs) (Clerical Access Role) Entered at: HMP Guys Marsh


05 Oct 2018 20:48 Acute Hospital: Unknown Staff Member Entered at: Dorset County Hospital NHS Foundation

Trust EPR Core


05 Oct 2018 20:48 Surgery: Unknown Staff Member Entered at: HMP Guys Marsh


09 Oct 2018 15:30 Surgery: BARNES, Trevor (Mr) Entered at: HMP Guys Marsh Entered: 09 Oct 2018 16:29

Did not attend for DENTIST appointment with Mr Trevor Barnes.


09 Oct 2018 15:31 Dentist: BARNES, Trevor (Mr) (Health Professional Access Role) Entered at: HMP Guys Marsh

History: Dental,

We rang the wing 3 x to get him over ,& each time they said they would get him over.

26 Oct 2018 Surgery: SOPER, Irena (Mrs) (Health Professional Access Role) Entered: 27 Oct 2018 13:46

Entered at: HMP Guys Marsh

Open ACCT (YA213) (Ongoing Episode)

27 Oct 2018 11:20 Surgery: SOPER, Irena (Mrs) (Health Professional Access Role) Entered at: HMP Guys Marsh

Plan: Referral to primary care mental health team (XaMhM)Saul was seen as part of the ACCT review. He made a

suicide attempts last night and he stated tyhat this was not his first one. He suffers from depression, and he said that

he has received medications for it in the past.

No (Y0428)

No (Y0428)

Mental symptom findings (XaBfp) - feeling low, and depressed

Family history of mental disorder (128..) - none

H/O: mental health problem (YA741) - has been on medications for depression, he has made several suicide

attempts in the past

No (Y0428)

Attended Assessment, Care in Custody and Teamwork review (XaQfl) - officer Parker, and MH Practitioner (Ongoing

Episode)

Attended Assessment, Care in Custody and Teamwork review (XaQfl)

Review status (Y04d8)

Issues discussd during the ACCT review was Saul's recent heavy SPICE use. He said that he does not have an

outstanding debt as a result of this and he justified his cell isolation as 'like being by myself'. He is cell isolating at

the mement because he does not want to use any more SPICE and the only way to avoid it is to stay way from

everybody according to him. Officer Parker has offered a move to Cambria as a way of giving him more opportunities

to engage with the regime.

Saul said that he suffers from sever depression, which when treated is well managed but he does not take any

medications for it at the moment. A GP appointmnet will be booked for him in order to discuss medications. Also his

case will be discussed on a team meeting to see who will be more suitable to take his case forward as he is willing to

give talking therapies a go.

Saul has made several serious suicide atempts in the past the last one being in 2011. He has made only one attempt

at self-harm and he does not define hilself as a self-harmer.

Althoug he has been using SPICE heavily he does not want to engage with ISMS. He has experince with meetings

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due to his compulsive gambling and he does not beleive that ISMS can help. He has been tald he was allowed to

change his mind, should he wish to give ISMS a go he can do this at a later date.

Saul stated that he got a good night sleep, and did not feel suicidal at the time of the review. His observations have

been lowered to an hourly one, and he has been adviced to try and speak to staff if he felt low.

Yes (Y0427)

Impressions of the prisoners behaviour and mental state (YX023) - He engaged well, and maintained good eye

contact during the ACCT review. His tone, and speach rate were normal. There were no sighns of perceptual or

thought disorder

Yes (Y0427)

Under care of mental health team (XaIvk)

Referred to doctor (XaBhV)

Seen by mental health triage nurse (XaL0u)


Outcome (XaIXy)

Saul has made a suicide attempt last night and he was placed on an ACCT document. He was seens as part of the

ACCT review (see my notes). He said that he suffers from depression, which has been treated in the past but not at

the moment. He also has been using SPICE whilst in prison but does not want to engage with ISMS.

PLAN: he has been referred to the GP, and he will be discussed on the next team meeting for allocation.

Prisoner has received medication for mental health problems (YX019) - He has been on antidepressants in the past


Substance misuse behaviour (XaJz5) - He has uses cannabis when not in prison but has been using SPICE whilst in

custody



28 Oct 2018 14:52 Surgery: EDWARDS, Sharon (Mrs) (Health Professional Access Role) Entered at: HMP Guys

Marsh

Did not attend - no reason (XE2NM) - mr turner is not leaving his cell, he does not even go out to get his food or

shower, he refused to come and see the GP TODAY, he is in a viciouse circle, not seeing GP for a perscription and

not leaving his cell due to his angxiety, he will not az\ttend health care for his medication even if it is perscribed,

28 Oct 2018 15:01 Surgery: EDWARDS, Sharon (Mrs) (Health Professional Access Role) Entered at: HMP Guys

Marsh

28 Oct 2018 15:10 Surgery: SPRING, Mark (Dr) Entered at: HMP Guys Marsh

Did not attend for Doctor appointment with Dr Mark Spring.


29 Oct 2018 08:04 Surgery: MUNDY, Caroline (Mrs) (Clerical Access Role) Entered at: HMP Guys Marsh

29 Oct 2018 13:21 Surgery: LEITCH, Yvonne (Miss) (Clerical Access Role) Entered at: HMP Guys Marsh

Mental health review (XaIyU)

Other relevant information (Y4331) - went to see Saul as Nurse Blackmore concerned that there seemed to be no

reason for Saul self isolating and being depressed. Saul on acct and review previously attended by mh. acct

assessment indicates that Saul has been a spice user and does not want to use again. He has been self isolating.

When I went to see him he asked could I come back another time. Discussed at mh team meeting today- Lisa will

see with ISMS tomorrow

Review status (Y04d8) - went to see Saul as Nurse Blackmore concerned that there seemed to be no reason for

Saul self isolating and being depressed. Saul on acct and review previously attended by mh. acct assessment

indicates that Saul has been a spice user and does not want to use again. He has been self isolating. When I went to

see him he asked could I come back another time. Discussed at mh team meeting today- Lisa will see with ISMS

tomorrow


Seen by primary care mental health team (XaZrh)


30 Oct 2018 10:35 Surgery: HUDSON, Lisa (Ms) (Nurse Access Role) Entered at: HMP Guys Marsh

Other relevant information (Y4331)

Seen in his cell due to concerns about low mood, depression and spice use. Saul was led on his bed, appeared

unkempt with the curtains drawn. He stated just wanting to be left alone, denied any current thoughts of suicide or

self harm. Saul admitted previous spice use but denied using anything currently, not keen to work with ISMS but

referred anyway and will request they attend with me again later.

Saul reported some paranoia but denied any voices or hallucinations, there was no evidence of severe mental illness

or formal thought disorder. He reports periods of depression but is unwilling to attend healthcare to see the doctor

or pick up medication, I will visit him again in a few days to review.



Yes (Y0427)

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30 Oct 2018 11:28 Surgery: HUDSON, Lisa (Ms) (Nurse Access Role) Entered at: HMP Guys Marsh

Referral In to HMP Highdown for Long Term Conditions Case Management Service: Ended on 17 Dec 2018 12:05


No appropriate treatment available

Status Update for Long Term Conditions Case Management Service Referral In: Care ongoing

31 Oct 2018 10:42 HMP Prison: CHEESEMAN, Emma (Miss) (Health Professional Access Role) Entered at: HMP

Guys Marsh

One to one communication with the client (Ua1FW)

Drug addiction therapy (XE0hi)

Initial assessment complete and Saul declined to engage with ISMS. He said that he used PS regularly and that he

had no plans to stop as it helps with the boredom of prison. He smokes pipes and spliffs and we discussed the

dangers of pipe use particularly, we discuss the unknown chemicals in PS. He stated that he wasn't on any

medication.

Harm min given and PS information given and discussed.

31 Oct 2018 10:53 Surgery: LEITCH, Yvonne (Miss) (Clerical Access Role) Entered at: HMP Guys Marsh

Review status (Y04d8) - SO bartholemew attended saying he had spoken to Saul encouraging him to attend acct

review, Saul said that he gets anxious as soon as cell door opens and whille he was happy to speak to SO

Barholemew he didnt want. He spoke to Mr Bartholemew for about 10 mins saying he just wanted left alone and had

no thoughts of self harm. Said he didnt want to end things and would be ok if acct closed.Mr Bartholemew came to

speak to me to advise me of this and that currently Saul on 3 obs per hr but this seemed unnecessary- Saul staed

recently to Lisa that he had no thoughts of self arm and has not made further attempts at self harm since acct

opened. We agreed obs could be reduced to one per hr but meaningful conversations must be strongly reminded to

staff to encourage. Also for Saul to be encouraged to shower and take part in self isolator regime. I have said it is ok

at present he can be only one out at a time to encourage Saul to shower. Lisa has further appt with Saul. He also

has been accepted by Cambria where he may be more comfortable to come out.

Other relevant information (Y4331) - SO bartholemew attended saying he had spoken to Saul encouraging him to

attend acct review, Saul said that he gets anxious as soon as cell door opens and whille he was happy to speak to

SO Barholemew he didnt want. He spoke to Mr Bartholemew for about 10 mins saying he just wanted left alone and

had no thoughts of self harm. Said he didnt want to end things and would be ok if acct closed.Mr Bartholemew came

to speak to me to advise me of this and that currently Saul on 3 obs per hr but this seemed unnecessary- Saul staed

recently to Lisa that he had no thoughts of self arm and has not made further attempts at self harm since acct

opened. We agreed obs could be reduced to one per hr but meaningful conversations must be strongly reminded to

staff to encourage. Also for Saul to be encouraged to shower and take part in self isolator regime. I have said it is ok

at present he can be only one out at a time to encourage Saul to shower. Lisa has further appt with Saul. He also

has been accepted by Cambria where he may be more comfortable to come out.

Attended Assessment, Care in Custody and Teamwork review (XaQfl) (Ongoing Episode)

Attended Assessment, Care in Custody and Teamwork review (XaQfl)

SO Bartholomew

Yvonne mh (Ongoing Episode)


Multi-disciplinary team meeting (Y04c6)





02 Nov 2018 14:30 Surgery: POELVOORDE, Maria (Mrs) Entered at: HMP Guys Entered: 30 Nov 2018 12:34

Marsh

Did not attend for Nurse Clinic appointment with Mrs Maria Louise Poelvoorde.


04 Nov 2018 13:58 Surgery: DAYMAN, James (Mr) (Health Professional Access Role) Entered at: HMP Guys Marsh

Examination: Appointment For Doctor (Y1307)

Plan: declined to see dr today, when called, no reason given

06 Nov 2018 11:49 Surgery: HUDSON, Lisa (Ms) (Nurse Access Role) Entered at: HMP Guys Marsh


Visited on the wing due to self isolating, Saul was up and about in his cell. Engaged with good eye contact, normal

speech rhythm tone & pace. He reported feeling better in himself, visibly cleaner, reports no spice use for over a

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week which he identifies has helped with mood.

Saul denied any thoughts of deliberate self harm or suicide and reported the ACCT is becoming annoying, this was

fed back to the wing and added to to the ACCT document.



Yes (Y0427)






07 Nov 2018 08:43 Surgery: MUNDY, Caroline (Mrs) (Clerical Access Role) Entered at: HMP Guys Marsh

09 Nov 2018 17:04 Surgery: LAZENBURY, Michelle (Mrs) (Health Professional Access Role) Entered at: HMP Guys

Marsh

History: Wing visit as Cell isolating - No issues at present - declined Healthcare

10 Nov 2018 17:08 Surgery: LEITCH, Yvonne (Miss) (Clerical Access Role) Entered at: HMP Guys Marsh

Yes (Y0427)


Saul has been a cause for concern as self isolating and not getting out of bed. He has been accepting food and

saying he wants to stay off spice. Today a space was available on Cambria and he was moved there. Saul attended

acct rreview in SO office and engaged really well. Wasnt a spice user till previous sentence - says he spent

thousands and had to self isolate for two months at Portland to stay off it. When he got here he smoked it straight

away - increased use and lots of debt. he wasnt going to pay it back but got lots of hassle and couldnt be bothered

with it so paid it all. Says it was a lot of money. Others know he has money so he is a target for others to sell to. He

said he does get depressed but doesnt want meds. He had traumatic thing when young and partner left him and took

his child many years ago. He feels he has mental health related issues but his way of dealing with them is taking to

bed for lengthy period. he says we will know if he is depressed again as this is what he does. He says we dont have

to worry = he wont kill himself or self harm. Says he self harmed once cutting wrist and told us its not as easy as

people think. He showed me a well healed and faded scar across inside of right wrist. He said when moved to Saxon

from Anglia he had just stopped spice, was starting to withdraw, he was given no food , had no mattress etc and he

lost it and wrote note to ex that is mother of child saying he would kill himself. He said he had no intention of killing

himself and never will. Prison staff believe this was his sister but he says no it was ex and he doesnt even know

where she is. He is happy for acct to be closed. He doesnt know how it will go on Cambria but he will request wing

work or workshop 10 to be co-operative. After review he was having a look around Cambria and later I saw him

collecting his food and he pulled a comical face when he saw me.

No signs of perceptual or thought disorder. Would benefit from CBT or similar but not keen but Lisa reviewing him

soon so she may persuade him but he clearly has capacity to make decisions and manage his issues / life his

way.All agreed acct could be closed

In Assessmnt Care in Custody and Teamwork post-closure phase (XaYXJ) - yes

Close ACCT (Y0804) (New Episode)

Close ACCT (Y0804)

CM Bartholemew

SO Hoskins

Saul

Yvonne mh

Saul has been a cause for concern as self isolating and not getting out of bed. He has been accepting food and

saying he wants to stay off spice. Today a space was available on Cambria nd he was moved there. Saul attended

acct rreview in SO office and engaged really well. Wasnt a spice user till previous sentence - says he spent

thousands and had to self isolate for two months at Portland to stay off it. When he got here he smoked it straight

away - increased use and lots of debt. he wasnt going to pay it back but got lots of hassle and couldnt be bothered

with it so paid it all. Says it was a lot of money. Others know he has money so he is a target for others to sell to. He

said he does get depressed but doesnt want meds. He had traumatic thing when young and partner left him and took

his child many years ago. He feels he has mental health related issues but his way of dealing with them is taking to

bed for lengthy period. he says we will know if he is depressed again as this is what he does. He says we donr have

to worry = he wont kill himself or self harm. Says he self harmed once cutting wrist and told us its not as easy as

people think. He showed me a well healed and faded scar across inside of right wrist. He said when moved to Saxon

from Anglia he had just stopped spice, was starting to withdraw, he was given no food , had no mattress etc and he

lost it and wrote note to ex that is mother of child and said he would kill himself. He said he had no intention of killing

himself and never will. Prison staff believe this was his sister but he says no it was ex and he doesnt even know

where she is. He is happy for acct to be closed. He doesnt know how it will go on Cambria but he will request wing

work or workshop 10 to be co-operative. After review he was having a look around Cambria and later I saw him

collecting his food and he pulled a comical face when he saw me.

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No signs of perceptual or thought disorder. Would benefit from CBT or similar but not keen but Lisa reviewing him

soon so she may persuade him but he clearly has capacity to make decisions and manage his issues / life his

way.All agreed acct could be closed (Ongoing Episode)







12 Nov 2018 08:04 Surgery: MUNDY, Caroline (Mrs) (Clerical Access Role) Entered at: HMP Guys Marsh

22 Nov 2018 11:52 Surgery: HUDSON, Lisa (Ms) (Nurse Access Role) Entered at: HMP Guys Marsh


Close ACCT (Y0804) (Ongoing Episode)


Seen on the wing with OM Hoskins, Saul continues to self isolate due to feeling at risk. Reporting still being given

"grief", he refuses to leave the cell even when the self isolators are out. Saul would like a ship out to another prison

where he would feel safe, Miss Hoskins discussed this with him and assured his safety if he comes out with the other

isolators. He currently looks unkempt and hasn't had a shower since moving to Cambria.

He reported his mental health as good denying any thoughts of self harm or suicide, there was no evidence of

severe mental illness or formal thought disorder, Soul denies and psychotic symptoms and believes thoughts about

being under threat are totally founded.

I will continue to monitor his mental health presentation.





Close ACCT (Y0804) - ACCT was closed when Saul was moved to Cambria. (Ongoing Episode)


30 Nov 2018 16:39 Surgery: LAZENBURY, Michelle (Mrs) (Admin/Clinical Support Access Role) Entered at: HMP

Guys Marsh

Cell visit as Mr Turner is Cell isolating, No issues at present

06 Dec 2018 08:59 Surgery: HUDSON, Lisa (Ms) (Nurse Access Role) Entered at: HMP Guys Marsh




Yes (Y0427)

Close ACCT (Y0804) - . (Ongoing Episode)

Close ACCT (Y0804)


Other relevant information (Y4331) - Seen on the wing, Saul continues to self isolate. He was asleep in bed when I

attended and not pleased to see me, stating that he's fine and doesn't need any mental health support. The ACCT

has been closed.


Yes (Y0427)


Responsible to (XaIjx) - Everyone



Other relevant information (Y4331) - Risk assessment

Summary report (XaX2s) - Low risk: Saul is currently low risk, he denies any thoughts of deliberate self harm or

suicide. He is at risk of self neglect due to self isolating and being unable to meet his needs.

Unable to summon help (Y4904)

Misuses drugs (Ub0mt)

Multi-agency action plan (XaXHL)

The establishment to help Saul meet his needs ensuring he has sufficient food, drink and access to facilities.

Contact healthcare with any concerns and open an ACCT if appropriate.

Responsible to (XaIjx) - Mental health team

Multi-agency action plan (XaXHL) - Mental health to continue monitoring.

Risk of self neglect (XaIv1)

Overview Notes (Y0028) - Denies any current thoughts of deliberate self harm or suicide. But at risk of self neglect

due to long term self isolation

No (Y0428)

Thu 23 Apr 2020 15:02



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Unknown (X90UG)

No (Y0428)

In prison (XE0pK)

Unknown (X90UG)

Clinic note (XaIgp) - Saul has minimalised risk from others by self isolating.


Unknown risk of deliberate self harm (XaIv0)

Suicidal intent (XaA1G)

H/O: deliberate self harm (XaF9U)


Risk of self neglect (XaIv1)

Overview Notes (Y0028) - History of deliberate self harm and suicidal thoughts

Unknown (X90UG)

Unknown (X90UG)

Self inflicted injury (Xa0EN)

No (Y0428)

11 Dec 2018 16:40 Surgery: LAZENBURY, Michelle (Mrs) (Admin/Clinical Support Access Role) Entered at: HMP

Guys Marsh

Note Marked in Error: Entered on wrong patient

Wrong Name of patient documented, however notes are correct

30 Nov 2018 16:39, History: Wing/Cell visit as cell isolating

Examination: Mr Dicks has no issues at present




Other relevant information (Y4331) - Visited on the wing, Saul reports his mental health is absolutely fine & asked to

be discharged from the service. He was made of how to re refer if needed.



Discharged from primary care mental health team (XaXH8)


General Letter to Mr Saul Turner

12 Dec 2018 16:28 Surgery: EDWARDS, Sharon (Mrs) (Health Professional Access Role) Entered at: HMP Guys

Marsh

Clinical history and observations (X76sV) - well fare check completed on mr turner, he claims he is perfectly okay

and does not need anything from health care at this time, his cell was very clean and tidy, the officers says that hye

does not come out of his cell very often if ever, he does not get much exercise

Cell (XS1CR)

Plan (XaIVg) - to review in 1 weeks time


Status Update for Long Term Conditions Case Management Service Referral In: Discharged From Care

18 Dec 2018 13:35 Hospital: THOMAS, Eleanor (Mrs) (Clerical Access Role) Entered at: HMP Guys Marsh

Address Changed From: 'ZZ99 3VZ'

Previous Home Address: HMP Guys Marsh, Guys Marsh, Shaftesbury SP7 0AH


28 Mar 2019 14:45 Surgery: SOPER, Irena (Mrs) Entered at: HMP Guys Marsh Entered: 28 Mar 2019 15:43

Did not attend for MENTAL HEALTH appointment with Mrs Irena Soper.


28 Mar 2019 15:45 Surgery: SOPER, Irena (Mrs) (Health Professional Access Role) Entered at: HMP Guys Marsh

Procedure declined (8I3..) - Refused to attend despite making several calls to the wing. A task sent to the psychiatrist

for a review.

28 Apr 2019 14:53 Surgery: HOLLAND, Gillian (Miss) (Nurse Access Role) Entered at: HMP Guys Marsh

Blood oxygen saturation (X7708) 98 %

Other professionals involved (Y3076) - G. Holland.

Novel psychoactive substance misuse (XabbR)

O/E - pulse rate (242..) 115 bpm

Novel psychoactive substance misuse (XabbR)

Treatment given (8BC..)

Monitored oxygen saturations and heart rate, gave advice of the risks associated with illicit drug use.

Officer asked to start Welfare log (reported that was already started).

Thu 23 Apr 2020 15:02



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Left patient alert in his cell.

Informed him that I would be informing ISMS regarding the incident.

History and observations (X76sU)

Called to wing to assess Mr Turner for suspected illicit substance misuse.

On arrival patient was laying on his bed and alert.

Asked him to sit up which he did unaided.

Airway- maintaining independently.

Breathing- No concerns noted maintaining saturations 98-100% on room air.

Cirulcation- no bleeding or vomit.

Disibility- alert, speech slurred but engaged with staff. Pupils equal size 4 and a little sluggish.

29 Apr 2019 08:10 Surgery: TRIM, Zara (Miss) (Health Professional Access Role) Entered at: HMP Guys Marsh

Drug addiction therapy (XE0hi)

PS use suspected

To be seen by RW.

29 Apr 2019 14:30 Surgery: SHIPP, Paul (Mr) (Health Professional Access Role) Entered at: HMP Guys Marsh

Drug addiction therapy (XE0hi) - Met with Mr Turner on Cambria House this morning as ISMS duty worker. ISMS had

received a referral for him ref a recent PS episode. He declined to engage with ISMS at this time saying it was a 'one

off'. I had a discussion with him about the dangers of using PS.

One to one communication with the client (Ua1FW)

03 May 2019 07:52 Surgery: MUNDY, Caroline (Mrs) (Clerical Access Role) Entered at: HMP Guys Marsh

08 May 2019 08:18 Surgery: MUNDY, Caroline (Mrs) (Clerical Access Role) Entered at: HMP Guys Marsh

11 Jun 2019 12:50 Automatically updated from PAS interface: Unknown Staff Member Entered: 11 Jun 2019 13:02

Entered at: Dorset County Hospital NHS Foundation Trust EPR

Core




Outpatient (Ua0WZ)

Discussion about a problem (XaA2r)

Email from Leonard Higgins probation officer asking about information for housing.

Hi Tony

Could you please provide me with information regarding Mr Turners mental health issues to support his Housing

application.

Kind Regards

Leonard Higgins

Case Manager

Hampshire and Isle of Wight Community Rehabilitation Company

C115

Seen by primary care mental health gateway worker (XaM7s)

No (Y0428)

Outcome (XaIXy)

Thank you for your email, I can confirm that Mr Saul Turner was diagnosed with

Double depression (recurrent depressive disorder on a background of dysthymia) with co-morbid cannabis/spice

misuse.

This was diagnosed by Dr Singh Consultant forensic psychiatrist on 20th December 2017.

In my view this would meet the criteria for priority housing due to his mental health.

Kind regards

Tony Dean


Thu 23 Apr 2020 15:02



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Acrobat Document: Consent to share Saul Turner.pdf

08 Jan 2020 HMP Prison: MARTIN, Ruby (Miss) (Clerical Access Role) Entered: 09 Jan 2020 10:52

Consent Form to HMP Highdown

08 Jan 2020 20:53 Surgery: FUGILL, Niamh (Miss) (Health Professional Access Role)

Address Changed From: 'ZZ99 3VZ', Dispensing Flag Turned Off

Previous Home Address: HMP Guys Marsh, Guys Marsh, Shaftesbury SP7 0AH

08 Jan 2020 20:53 Surgery: Unknown Staff Member








Eating normal (Xa4O0)

Normal diet (Ub04n)

Memory function normal (X75xR)

Able to mobilise indoors (Xa7zW)

No (Y0428)

not required (Y1471)

Able to dress (Xa2xE)

Able to wash self (Xa2uI)



Prisoner assessment for in-possession medication completed (XaPim)


General practice premises (XC0SY) - n/a

No (Y0428)








Syphilis screening declined (XaLNB)



Able to communicate about self (Xa4Fa)


Safe to be left unattended (Ua2Ah)

No (Y0428)

not required (Y1471)

Health assessment questionnaire (XM0e6) 1 - 1. Can the prisoner tell the time?: Yes

2. Can the prisoner read?: Yes

3. Can the prisoner write?: Yes

4. Does the prisoner live independently?: Yes

5. Does the prisoner have a job?: No

6. Has the prisoner had previous contact with LD Services?: No

7. Has the client had special schooling?: No

No (Y0428)

No (Y0428)

Admission to establishment (XaAMo)

Ex-drinker (Ub0lI)


Has never injected drugs (Ub0nF)

Patient has previously used drugs (Y2479)

O/E - mental state (225..) - Low in mood, compliant with screening, states he does not hae any thoughts of self hamr

or suicide but feels as if hes going to have a nervous breakdown.


Thu 23 Apr 2020 15:02



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Printed







Syphilis screening offered (XaLN9)



Never smoked tobacco (XE0oh)


No injuries apparent (Ua15i)



Interpreter not present (XaF47)



O/E - height (229..) 1.7 m (5 ' 7 ")


Feeling hopeless (XaAyM)

Prisoner has tried to harm themselves (outside prison) (YX021)


Has not been homeless in the past year (Y08db) - currently

Respiratory rate (X774f) 18 breaths/min

History/symptoms (1....) - Chronic depression, dysoman nervous breakdown 2011

Homeless single person (13D2.)

124 / 69 mmHg

Medication In Possession Status: Not in possession




seen patient in reception, pt informed me he spoke with a MH team this AM in police custody, who recommened he

goes to HC, he states they informed him that they would fax over his documents- unable to loacte. he states he is

feeling very low in mood and the reason he is in prison is because 'it was prison or kill himself', he informed me he

had a nervous break down in 2011 and feels as if hes going to have another one. He states he is very depressed at

them minute but does not have any thoughts of self harm or suicidal ideation at present. When speaking with Mr

Turner he was reluctant to disclose any information on his current MH state and MH HX, he got very frustated as he

said "everyone is asking the same questions and doing nothing about it". He expressed that he thinks he should be

in HC as he is very concerned about his MH but would not further discuss this. Pt sent to HC for review. ACCT not

opened as not at immediate risk to himself, and denies any thoughts of self harm or suicidal ideation, pt states he

does not want an ACCT to be opened


Admission avoidance care ended (XaYD2) - attempted to loacte referral documents from MH team in police custodyunable

to loacte

Primary Care Group (XaIgz)

Mental health disorder (E....)

Referral to acute medical assessment unit (XaQsi)

No smokers in the household (XaIn9)

Outcome of delivery (XE1SI) - Pt to be assessed by MH and to see Dr regarding meds

09 Jan 2020 06:18 HMP Prison: VICTOIRE, Francois (Nurse Access Role)

Clinical management plan to date (Y0fd8)

Admission to ward (XaAMw)

O/E - weight (22A..) 0 Kg

Informed consent for procedure (892..)


Saul was admitted from reception, He was not engaging and refusing to cooperate with assessment and c/o low in

mood.

He has a hx of dysthemia ( persistant depressive disorder ) psychiatric letter 17 April 2018

He has a hx of insisting in staying in Health Care in other prison.

He has been on Na Valproate and Mirtazapine whenever he is in prison.

Spice (Xa4eZ)

Hx of using Cannabis and Spice when he is outside.

Thu 23 Apr 2020 15:02



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General observation of patient (Xa1bt)

Inpatient treatment (Y0714)

Shared care: other agency and GP (66SY.)

Patient held care plan (XaQxa)


Hx of Persistant depressive disorder, he has been on Mirtazapine and Na Valproate whilst in prison in the past.

Goal identification (Ua1LR) - Stabilise mental health then transfer to the houseblock.

Record of Needs (XaItR) - Mental health problem with persistant depressive disorder.

Intervention (XaIja)

Seek medical info from gp and local CHMT and previous prison Inreach.

Refer to psychiatrist for assessment.

Provide One to One support to One to gather as much background history.

Provide access to Samaritans, Listeners and Chaplaincy as needed


Saul was admitted and located. He was looking somewhat confused, appeared to be under substance influence.

He got agitated he could not tell me if he wanted hot water or cup of tea. He started to be verbally abusive.

He later settled and slept.

He was kept on general obs.

09 Jan 2020 11:24 Surgery: ASIEDU, Marian (Mrs) (Health Professional Access Role)

Sources of information (XaIKS)

MAR Chart / Transfer Records -

Verbal report from - Patient

Other Source - FirstScreening

Further background information (Y2299) - Patient was prescribed sodium valporate and mirtazapine when last in

prison (2018). Patient is current not on regular prescribed meds

Medicines reconciliation performed (XaRF0)

09 Jan 2020 14:25 HMP Prison: NELSON, Brenda (Mrs) (Information Officer Access Role)

09 Jan 2020 16:50 HMP Prison: RUSE, Gareth (Dr) (Clinical Practitioner Access Role)

History: he may need zopiclone tonight soi nurse asking for him to have help. see me tomorrow

Zopiclone 7.5mg tablets - 3 tablets - 1 tablet - admin times: 20:00

Custom script: Printed On Thu 09 Jan 2020 16:51 By Dr Gareth Ruse

09 Jan 2020 19:43 Surgery: HILL, Paula (Mrs) (Admin/Clinical Support Access Role)

Personal Care

Mr Turner washed and dressed in his cell this morning.

Mood & Mental State

He is feeling a bit low mood today.

Physical

He is physically capable of doing everyday tasks if he wanted too.

Dietary Intake

Has been observed eating and drinking.

Activities & Social Interaction

Mr Turner came out for association and sat in the Day room. He interacted with other patients. He is now in his cell,

hourly observations maintained.

09 Jan 2020 19:48 HMP Prison: TAFIRENYIKA, Stellah (Health Professional Access Role)

History: Saul said he came to prison to seek help

Did not get any form of help when released from prison

Had no accommodation, was financially unstable and relationship broke down

Feeling very low in mood, hopeless, unable to sleep at night, emotional

Family

Reported is the only child, mum was a prostitute never met his father

Left home when he was 12 yrs was on the street for a year then went to stay with nan

Nan died in 2007 when he was in prison and does not have contact with mum

No proper education was arrested at 15 and has been in and out of prison

Said he was staying with a girlfriend was had a miscarriage of their twin babies during a short time when he was out

of prison. This caused tension with their relationship due to his depression and the relationship broke down. He left

girlfriend and has since been homeless.

Main index offence burglary and theft and arson once

Substance misuse

Denied using any illicit drugs nor alcohol but records from previous records suggest so

Thu 23 Apr 2020 15:02



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Said has a diagnosis of chronic Depression and has been on Mirtazapine and Sodium Valproate before but did not

work for him.

Reports hearing voices ‘from mu head’ for the past six months one male and female

Voices are distressing as they are always arguing, not commanding

Denied any thoughts nor plans of DSH

Plan: Will be seen by psychiatrist



O/E - temperature (XaBzA) 37.2 degC

Family history unknown (XaJ2K)

Meningitis C vaccination offered (XaQGB)

Meningitis ACW & Y vacc given by other healthcare provider (XacK5)

Family history (12...) - Saul stated that he does not have family and no very little about his father's side


Referral to smoking cessation service (XaaDy)

User of electronic cigarette (XaaNL)

Smoker (137R.)


O/E - height (229..) 1.7 m (5 ' 7 ")

Dietary advice (8CA4.)

Advice about exercise (Xa9zF)

Patient given advice NOS (8CAZ.)

Advice on effects of smoking on health (Ua1O0)


Other medication management (XaJr2)

Sexual advice (X71FD)

Advice on alcohol consumption (Xa1dA)

Seasonal influenza vaccin given by other healthcare provider (XaZ0e)


History of measles, mumps and rubella vaccination (XaQe5)


Patient given advice (8CA..)

Referral to mental health team (XaIPw) - patient already referred and in inpatient


116 / 63 mmHg


09 Jan 2020 20:54 HMP Prison: BOSU, Kwaku (Mr) (Nurse Access Role)

09 Jan 2020 20:55 Surgery: BOSU, Kwaku (Mr) (Nurse Access Role)


History: Night Report:

Saul had a quite night, he was observed to have slept well during the shift.

No psychotic symptoms observed or reported

He was monitored by general nursing observations.

10 Jan 2020 08:51 Surgery: ASIEDU, Marian (Mrs) (Health Professional Access Role)

10 Jan 2020 17:49 HMP Prison: BROWN, Beverly (Mrs) (Nurse Access Role)

History: Mr Turner came out on association this morning and took care of his personal hygiene (shower).

He also went to the Dayroom and spent sometime there and was observed talking to other inmates. He ate and

drank

adequately and at present there are no concern in regards to his physical wellbeing. He was observed dancing

around

in his cell earlier. He did not clean his cell today however, it is fairly clean and at present he appears to be watching

television.





Mr Turner was stable in mood and behaviour during the shift, he adhered to his medication, and appeared to have

slept well

No concerns raised or observed

He was nursed on hourly observations


Thu 23 Apr 2020 15:02



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History: Saul came out on association this morning and went to the Dayroom however, he was not observed

interacting with

any other inmate. He was sitting in his cell watching television and whilst I was doing the hourly checks I asked

him

if he was ok. He asked me when he was going to see the psychatrist and I have explained to him that it might be on

Tuesday. He said ok because he was told that he would be seeing one.

Saul took care of his personal hygiene whilst he was out on association (shower). He ate and drank adequately

throughout the day and at present there are no concern in regards to his physical wellbeing.




History: Night Entry:

Saul appeared to have slept well throughout the night, and was monitored by general nursing observations

No concerns verbalised or observed

12 Jan 2020 14:14 Surgery: OGUNMODEDE, Folasade (Mrs) (Nurse Access Role)

History: Mr Turner came out for his association.

Minimal interaction with staff.

He attended to his personal care(shower)

He did not clean his cell but hs cell is habitable.

He was given all meals.

Observed to have had good dietary intake and fluid intake.

Nursing hourly observation maintained.



Mr Turner was observed to have slept well during the night.and was nursed on hourly observations.

No psychotic features noted

No issues raised



He spent time in day room.

Used the kiosk.


He did not attend to his personal care(shower)

He did not clean his cell but his cell is habitable.





Saul was in bed on taking over, he appeared to have slept.

He did not wake up during the night. Hourly obs maintaied.



History: Mood and Mental State

Had been fairly settled part of the morning

Requested to see psychiatrist and became agitated, angry and threatened to put in a compliant

Stating that he has not been seen by anyone, reminded him that he has was seen by the nurse when he came and

he will be seen by psychiatrist.

When he was informed that he was not going to be seen today he became very agitated ‘I did not sleep last night

can l have something for tonight’

It would not encourage any more Zopiclone for this patient.

Personal Care & Immediate Environment

He did not take a shower though he was out for association. His cell is fairly clean.

Physical Health

Complained of fatigue stating that he has not slept at all last night

Nutritional Intake

He collected all his meals and appears to be drinking and eating well.

Therapeutic Activity & Social Interaction

Spend most of his time in dayroom watched television appeared relaxed

Medication

Not on any current medication but would like to be prescribed a mood stabiliser

Said he was on Sodium Valproate and did not work so does not want to go back on it

ACCT/Risk to Self

Thu 23 Apr 2020 15:02



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He did not express any thoughts or plans to DSH express future plans of wanting to put in a complaint tomorrow if

not seen by a doctor


Saul was in bed on taking over, he appeared to have slept the whole night.

Hourly checks carried out.

15 Jan 2020 08:28 HMP Prison: FEENEY, Adrian (Health Professional Access Role)

History: review of notes

significant docs

liaison referral in rec attachments 2012

journal entries: 5.7.17 and 6.1.18

He reports his mother was a high class prostitute and his father was one of her clients and a drugs baron.

he dislikes his mother

int he entry on 6.1.18 he alleges that his mother paid bribes to social workers to ensure that she got custody of his

daughter (now aged late teens)

history of NPS use in prison

Assessment in April 18 that he had

recurrent depression

dysthymia

hx of cannabis and NPS

the doctor initially concluded that he hadn't responded much to antidepressants and didn't offer then, suggesting

counselling instead

later he did prescribe mirtazapine 30m g PM

(had previously been prescribed fluoxetine.

in March 18 was on

mirtazapine 30mg OD

valproate 500mg BD

There is a record in December 17 that the valproate was a prophylaxis for recurrent depression

he had stopped taking the medication when out of prison.

S1 entry in Nov18 states had been self isolating, had been using NPS

previous entry stated at times he engages and wants to do the right thing and at other times doesnt' engage.

He has had multiple short spells in prison (recorded on S1) since 2012.

last released in May 19



Inpatient stay (XaBV3)

Imported notes (Y0529)

See summary above

he was prescribed zopiclone on 9th for 3 days: he was quite rude to a nurse yesterday demanding to see the

psychiatrist and complaining of insomnia

remand

Charged with Burglary

Pmth CC

says not sure when next in court

not entered a plea

irritable when I asked about this at the beginning of the interview

not very forthcoming

He told me that he had been diagnosed with

dysthymia

chronic depression

He confirmed he had been released in May 19 and stayed on tag at a hostel: Bass House.

says he used cannabis about 6 months ago

denied using drugs or alcohol since

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Thu 23 Apr 2020 15:02



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Printed



says hasn't been working: vague about work history: some agency work in the past

no relationship

says he has been living on the streets in Portsmouth: wouldn't be more specific

wouldn't tell me what he does with his time.

he claims no alcohol or drugs including NPS in the recent past

m state

irritable

not very forthcoming

mood dysthymic

denied thoughts of DSH or suicide

thoughts

difficult to probe since he is not very cooperative

I asked if anything strange was going on

he said "What you mean paranoia?"

Yes slightly

he recounted that he had perfume confiscated in reception and later thought that he could smell the same scent on

the officers.

nil else: no abnormality of form, possession or content

perception

at the end of the interview I asked him if he had anything else to say

he said

I have been hearing 2 voices (1 male the other female) arguing in my head for the last 6 months.

says they argue between themselves: no references to him.

not likely to be a true hallucinations

hx in notes

July 2011 took OD, has taken another OD, on one occasion cut wrists

meds in prison

was prescribed mirtazapine 30mg and valproate in March/ April 19 in Guys Marsh: last regularly took meds in March

19

impression

not clearly depressed

it is possible that he is depressed or this is part of dysthymia.

He is very irritable

We discussed his problems and I offered mirtazapine: he said that meds hadn't worked for him in the past.

I suggested that given his presentation it seemed sensible to restart

I suggest he stays in HCU for next week and I will assess on the 21.1.20

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He is likely to need support from the MHT on discharge from HCU

discuss in MHT meeting today


(R) Mirtazapine 30mg tablets - 28 tablets - 1 tablet - admin times: 16:00 (Oral)

Mirtazapine 30mg tablets - 28 tablets - 1 tablet

Ended 12 Feb 2020 Patient Deducted (Sentence Ended)

Custom script: Printed On Wed 15 Jan 2020 09:24 By Adrian Feeney

15 Jan 2020 09:25 Surgery: MURRAY, Louise (Miss) Entered: 15 Jan 2020 11:31

Did not attend for Second-stage health assessment appointment with Miss Louise Murray.



15 Jan 2020 11:31 HMP Prison: MURRAY, Louise (Admin/Clinical Support Access Role)

Thu 23 Apr 2020 15:02



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Printed



Screening declined (XaZ1n) - dna 15/01/2020

15 Jan 2020 15:39 Surgery: ATHWAL, Amrita (Miss) (Health Professional Access Role)

Referral by person (XaBFi) - Dr Adrian Feeney

Reason for referral (XaIpS) - For long term low mood / depression

Referral to mental health in-reach team (XaWzW)

Referral to mental health team (XaIPw)

Referral In to HMP Highdown for In Reach: Ended on 06 Feb 2020 09:35

Patient is deceased

Status Update for In Reach Referral In: Waiting For Assessment


History: Saul was assessed by Dr Feeney this morning during Ward Round (see notes above).

He was out on association however, he was not observed taking care of his personal hygiene.

He did not clean his cell today but it is fairly clean and tidy at present. He is eating and drinking adequately

and there are no concern in regards to his physical wellbeing. He is lying in bd awake at present and appears

to be watching television.


Is this medicine supervised (NIP)? - Yes

Depression Questionaire: No action required.

Depression monitoring administration (XaMGL)



Saul settled around 23:00hrs and slept. No concern, hourly checks carried out.



Address Changed From: 'HMP Guys Marsh, Guys Marsh, Shaftesbury SP7 0AH'

Current Home Address: HMP Highdown, Highdown, Highdown Lane, Sutton SM2 5PJ

Current Temporary Address: HMP Highdown, Highdown, Highdown Lane, Sutton SM2 5PJ


History: Saul came out on association and took care of his personal hygiene (shower). He went to the Dayroom and

was also walking around on the unit however, he was not observed interacting with the other inmates. He

ate and drank adequately throughout the day and there are no concern in regards to his physical wellbeing.

He leaned his cell and at present he is lying in bed awake.





16 Jan 2020 17:40 Surgery: BROWN, Beverly (Mrs) (Nurse Access Role)



Mr Turner had a quite shift, he was observed to have slept well during the shift and was nursed on hourly

observations.

No physical or mental health issues observed or reported


Heart rate (X773r) 93 BPM


No (Y0428)


Response to voice (X75q0)

Response to pain (X769v)

Informed consent given (XaLQR)

Regular (X78xd)

National Early Warning Score - Royal College of Physicians (XaaPo) 1 - Respiratory rate: 12 - 20

SpO2: N/A

Supplemented Oxygen?: No

Temperature: 36.1 - 38

Blood Pressure - systolic: 111 - 219

Heart Rate: 91-110

Conscious Level: Alert

Mentally alert (X769o)

122 / 76 mmHg

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Thu 23 Apr 2020 15:02



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Printed



17 Jan 2020 12:15 Surgery: HUNNINGS, Julie (Admin/Clinical Support Access Role)

Custom script: Re-printed On Fri 17 Jan 2020 12:17 By Julie Hunnings

17 Jan 2020 13:47 Surgery: SARAN, Mandeep (Health Professional Access Role)






17 Jan 2020 18:25 Surgery: CROUCHER, Carolynne (Miss) (Nurse Access Role)

History: MR Turner came out on association today and used the day room. He ate and drank well. He complied with

his prescribed medications. Hourly checks carried out.



Saul was abusive to SN Bosu saying ''fuck off'' because I was switching on the lights every hour to check on him,

tried to explain but he was still abusive so I walked away. He appeared to have slept well during the shift and was

monitored by general nursing observations



18 Jan 2020 17:01 Surgery: ROBERTS, Carleen (Miss) (Health Professional Access Role)






Personal hygiene activities (Xa3bU) - Did not shower today. Room habitable.

Health related observations about the prisoners physical appearance (YX010) - Very little interaction with staff or

peers. Came out to day room but did not socialise.

Nutritional observation (Xa7k6) - Given hot meal at lunchtime - has not eaten remaining food as yet.



Saul had a calm shift, he was observed to have slept well during the shift and was nursed by hourly observations.

No issues raised or observed







Health related observations about the prisoners physical appearance (YX010) - Minimal engagement with staff and

peers. Was concordant with prescribed medication.

Personal hygiene activities (Xa3bU) - Attended to his own personal hygiene and had a shower in the afternoon.

Nutritional observation (Xa7k6) - Food / fluid intake observed



Mr Turner had a stable shift, he appeared to have slept well during the night and was nursed by general

observations

No physical health issues observed or reported









He used the mirror.

He spent time in the day room.



He complied with his prescribed medication.


Thu 23 Apr 2020 15:02



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Printed




Saul was in bed on taking over, he appeaed to have slept the whole night.

Hourly checks carried out.





hand over from staff

self isolating

spends time in his cell watching TV

m state

rapport slightly better

less brittle than last week

after about 10 minutes did start confiding in me

mood low he rates 3/10

he said he had thought about suicide in the community but not since being in prison

C125

he has been taking mirtazapine again for about a week

he reports no improvement in his mood yet

thoughts

no abnormality of form, possession or content

very negative theme

What's the point of you offering me help: I will never get better.,

Says he intentionally got arrested because he was falling apart and needed help with his mental health

he told me that he had had one positive relationship with a nurse in prison: Tony Dean in Rochester. See Feb 18

entry shows that on the 9th he had reported he was feeling as good as he had done, he was in HCU attending stone

masonary and doing well on mirtazapine and valproate, However just two weeks later he had lost his place on the

HCU for using NPS and there is a comment that he had sabotaged his progress.

perception no abnormality

he says he is unconcerned about the legal process, had been homeless, seems not to care about lost of his liberty at

present.

impression

a slight improvement in his rapport with me.

he did explain how low he is and his very negative view of his circumstances.

plan

to remain in HCU for at least another week

I will ask the MHT to asign someone to work with him and ask them to come to engage with him soon to build a

relationship with him to prepare him for discharge to the HB.






21 Jan 2020 16:48 Surgery: TAFIRENYIKA, Stellah (Health Professional Access Role) Entered: 21 Jan 2020 16:53


History: Reports feeling low in mood feels hopelessness

Spend day in his cell will come out to collect his meals , take showers

He has not been interacting with any peers but is stating to approach staff

He takes all his meals and call staff for hot water

He had his medication

He was reviewed by Dr Feeney

Thu 23 Apr 2020 15:02



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Saul was in bed on taking over, he got up once for toilet paper. He appeared to have slept well.

Hourly obs carried out.







History: Saul came out on association and went to the Dayroom. He was not observed interacting with any other

inmates.

Later he went back to his cell and was observed watching television. He ate and drank adequately throughout

the day and was compliant with his prescribed medication. He was not observed taking care of his personal

hygiene or cleaning his cell today.


Saul was in bed by 22:00hr, he appeared to have slept.

Hourly obs maintained.



History: Mr Turner complied with his prescribed medication.

He was given all his meals.










Saul had a settled shift, he was observed to have slept well during the shift and was monitored by general nursing

observations.

No bizarre behaviour observed or reported.




He attended to his personal care(shower).

He spent time in the day room, used the kiosk.


His mental state appears stable.








24 Jan 2020 16:35 Surgery: TAFIRENYIKA, Stellah (Health Professional Access Role) Entered: 24 Jan 2020 16:39



Saul appeared to have slept well throughout the shift and was nursed on hourly observations.

No concerns verbalised




Baseline SpO2 (oxygen saturation at periphery) (Xabhv) 98 %

No (Y0428)

Heart rate (X773r) 76 BPM

Response to voice (X75q0)

Response to pain (X769v)

Informed consent given (XaLQR)

Thu 23 Apr 2020 15:02



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Printed



Regular (X78xd)

National Early Warning Score - Royal College of Physicians (XaaPo) 0 - Respiratory rate: 12 - 20

SpO2: >=96

Supplemented Oxygen?: No

Temperature: 36.1 - 38

Blood Pressure - systolic: 111 - 219

Heart Rate: 51 - 90

Conscious Level: Alert

Mentally alert (X769o)

111 / 75 mmHg


History: Mr Turner came out for association.



He spent some time in the day room.


He complied with his prescribed medication and his general physical observation.

No concerns about his physical health condition.











Mr Turner had a stable shift, he was observed writting a letter before he retired to bed, he slept well throughout the

night.

No physical health issues observed or reported

He was nursed by general observationms.


History: Mr Turner came out for association.

Minimal interaction with staff and his other inmates.



He spent time in the day room, used the kiosk.











Mini mental state score (XaJx9) 1 - Sexual Abuse: No Evidence Found

Physical Abuse: No Evidence Found

Emotional Abuse: No Evidence Found

Neglect: Not Known

Bullying: No Evidence Found

Exploitation. Financial Abuse: No Evidence Found

No (Y0428)

No (Y0428)

No safeguarding issues identified (XaZwt)

Carers concerns about patient (Y4330) - Unpredictable in mood and behaviour

Mini mental state score (XaJx9) 0 - Absconsion: No Evidence Found

Escape from Institutions: No Evidence Found

Thu 23 Apr 2020 15:02



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Printed



No safeguarding issues identified (XaZwt)

H/O: mental health problem (YA741)

No (Y0428)

Risk assessment completed (Y3403)

Patients and carer referral concerns wishes and goals (Y0fd7) - None disclosed currently

Presenting complaint (XaIm8)

It was reported that Mr Turner attempted Overdose in 2011 according to Sys 1 entry.

- He also reported that he has self harmed few times by cutting himself when he is depressed.

Mini mental state score (XaJx9) 4 - Suicidal Thoughts: No Evidence Found

Attempted Suicide: No Evidence Found

Thoughts of self-harm: Evidence of Historical Risk

Acts of Self Harm: Evidence of Historical Risk

Self-neglect: No Evidence Found

Substance misuse: No Evidence Found

Assessment for risk of harm to others (Xad5d) - - Mr Turner was aggressive and verbally abusive to staff on 18/01/20

by telling staff to 'fuck off''

No (Y0428)

No (Y0428)

Mini mental state score (XaJx9) 6 - Aggression/ Irritability: Evidence of Current Risk (last 6 months)

Violence to others: No Evidence Found

Use of weapons: No Evidence Found

Arson: No Evidence Found

Concerns about terrorism/ extremism: No Evidence Found

Sexual harm: No Evidence Found

Harm to children: No Evidence Found

Risk to staff - violence: Evidence of Current Risk (last 6 months)

Risk to staff - allegations: No Evidence Found

Subject to Mappa: No Evidence Found






Care plan (Xa0jb) - Care Plan to be immediately reviewed should he engage in any risk taking behaviour


Goal identification (Ua1LR)

- For Saul to maintain good standard of personal hygiene

Record of Needs (XaItR)

Care Plan 1

Personal Care

Saul is self caring but needs a lot of promptings and reassurance to maintain good personal hygiene


- Saul will need to be offered his daily regime to enable him to take showers

- Staff to offer Saul toiletries and clean sets of clothes and bedding

- Saul to have easy access to cleaning material for his cell

- He will hoover and mop his cell when needed to keep it clean

- He will take his rubbish out of his cell when needed

Note Marked in Error: Wrong data entered

26 Jan 2020 22:32, - For Junior to continue taking his medication as prescribed

Template Entry Marked in Error: Wrong data entered


Diagnosis Marked in Error: Wrong data entered

26 Jan 2020 22:32, Goal identification (Ua1LR),


26 Jan 2020 22:32, Record of Needs (XaItR),

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Thu 23 Apr 2020 15:02



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Printed





26 Jan 2020 22:37, Inpatient treatment (Y0714),


26 Jan 2020 22:37, Care plan (Xa0jb),


26 Jan 2020 22:37, As Required


26 Jan 2020 22:05, Care Plan to be reviewed immediately should he engage in any risk taking behaviour









26 Jan 2020 22:32, Mental health disorder (E....),



26 Jan 2020 22:32, Patient held care plan (XaQxa),


26 Jan 2020 22:37, Intervention (XaIja),


26 Jan 2020 22:37, - Staff to ensure that Saul is offered his daily regime to enable him to socialise with peers.

- For Saul to utilise the court yard and day room and encouraged to interact with others

- For Saul to maintain good communication with his family/friends outside

- Staff to encourage him to attend ward groups and activities.


26 Jan 2020 22:37, Care Plan 5

Social interaction

Saul appears to have good social skills and needs to be encouraged to maintain these skills


















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Thu 23 Apr 2020 15:02



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Printed







26 Jan 2020 22:37, - For Saul to maintain good social skills


26 Jan 2020 22:05, For Junior to maintain good personal hygiene



26 Jan 2020 22:28, - Junior's vital signs to be taken every Friday

- For Junior to be referred to a GP if he experience physical health issues which needs referring

- For Junior to have good dietary intake and exercise regularly














26 Jan 2020 22:28, - For Junior to maintain good physical health.

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26 Jan 2020 22:28, Care Plan 3

Physical Health

JUnior reported to be in good physical health. He needs his vital observation monitoring as on going and for him to

be referred to the GP if he happened to experience any concerns with physical health.



26 Jan 2020 22:32, Care Plan 4

Medication

-Junior is currently on Mirtazepine and is compliant with his prescribed medication




Thu 23 Apr 2020 15:02



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Printed



26 Jan 2020 22:05, Needs: Needs: Care Plan 1

Personal Care

Saul is self caring but needs a lot of promptings and reassurance to maintain good personal hygiene

He needs to maintain good standard of personal hygiene








26 Jan 2020 22:32, -Vital signs to be monitored

-Staff to monitor signs of side effect

-More information to be given to Junior about his medication.










26 Jan 2020 22:05, - Junior will need to be offered his daily regime to enable him to take showers

- Staff to offer Junior toiletries and clean sets of clothes and bedding

- Junior to have easy access to cleaning material for his cell

- He will hoover and mop his cell when needed to keep it clean

- He will take his rubbish out of his cell when needed







Care Plan 3

Physical Health

Saul reported to be in good physical health. He needs his vital observation monitoring as on going and for him to be

referred to the GP if he happened to experience any concerns with physical health.


- Saul's vital signs to be taken every Friday

- For Saul to be referred to a GP if he experience physical health issues which needs referring

- For Saul to have good dietary intake and exercise regularly



- For Saul to maintain good physical health.

Care plan (Xa0jb) - As Required







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Thu 23 Apr 2020 15:02



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- To continue taking his medication as prescribed


Care Plan 4

Medication

-Saul is currently on Mirtazepine and is compliant with his prescribed medication


-Vital signs to be monitored

-Staff to monitor signs of side effect

-More information to be given to Saul about his medication







- For Saul to maintain good social skills


Care Plan 5

Social interaction

Saul appears to have good social skills and needs to be encouraged to maintain these skills.


- Staff to ensure that Saul is offered his daily regime to enable him to socialise with peers.

- For Saul to utilise the court yard and day room and encouraged to interact with others

- For Saul to maintain good communication with his family/friends outside

- Staff to encourage him to attend ward groups and activities.


History: Night Report

Saul was calm in presentation during the shift, he was observed to have slept well during the night.

He was monitored by general nursing observations.

No issues raised



He spent time in his cell watching his TV.

Interacts with staff appropriately.

He came out for association.


He spent some time in the day room.

His mental state appears stable.











Saul watched tv, he was in bed by 23:00 hr and appeared to have slept.

Hourly oobs maintained.


Surname Changed From 'Turner', Date Of Birth Changed From '08 Dec 1983', Former Surname Entered




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Thu 23 Apr 2020 15:02



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History: Mr Turner came on association this afternoon and went to the Dayroom. He is presenting as much

brighter in his mood however, he was not observed interacting with other inmates whilst he was in the Dayroom.

He took care of his personal hygiene (shower) before returning to his cell. He is eating and drinking adequately

and there are no concern in regards to his physical wellbeing. At present he is sitting in his cell watching television.

29 Jan 2020 01:00 Surgery: Unknown Staff Member Entered at: HMP Elmley


29 Jan 2020 01:00 Surgery: Unknown Staff Member


29 Jan 2020 01:00 Acute Hospital: Unknown Staff Member Entered at: Dorset County Hospital NHS Foundation

Trust EPR Core



Saul was asleep on taking over, he slept the whole night.





Depressive disorder (X00SO)



reviewed with Fola

not on ACCT

m state

rapport good

good eye contact and relaxed posture

mood euthymic

he says his mood lifter a couple of days ago

denies thoughts of DSH or suicide

said felt anxious on going to video link recently

C133

no abnormality of thought or perception suggestive of psychosis.

legal,

says made an admission in cells

yet to plea

will plea guilty to burglary

in court after 10.2.20: Pth

this is 7th burglary conviction

last got 3 yr 9 month

he is claiming mititagation

didn't steal much and it was a cry for help: says it was the quickest way he knew he could access help

Says wasn't getting adequate support from OM

impression

mood improved

no risk statement

I will discharge today

Kumar has kindly agreed to pop down to see him today and to engage and follow up

he does better if feels supported

he has asked for a single cell

I cannot justify recommending a medical single, among other things he has a history of DSH and this will be easier to

manage if he is in a double.

Thu 23 Apr 2020 15:02



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Printed



Discharge today


Depressive disorder (X00SO)


History: Mr Tuner was seen by Dr Feeney today.

He presented as brighter in mood.

He interacted appropriately during this review.

He maintained good eye contact throughout the interview.

No concerns was raised.



His cell is habitable.




29 Jan 2020 16:15 HMP Prison: TRIPTREE, Simon (Mr) (Admin/Clinical Support Access Role)




29 Jan 2020 16:17 Surgery: TRIPTREE, Simon (Mr) (Admin/Clinical Support Access Role)

29 Jan 2020 16:49 HMP Prison: NAGHEE, Reddy (Mr) (Health Professional Access Role)

Presenting complaint (XaIm8) - Introduced myself to saul that I will be his care co ordinator when he is discharged

from HCU. He was in the process of having a shower.



Planned intervention (Y01be)


Saul was asleep on taking over, he slept the whole night. No concern raised.



Surname Changed From 'Altel', Former Surname Entered



Interacted with staff.

His mood appeared lifted.














Saul had a quite shift, he appeared to have slept well throughout the night and was nursed by general observations

No concerns raised







History: Saul came out on association this afternoon and went to the Dayroom for sometime.

He also took care of his personal hygiene (shower) and cleaned his cell. He collected his evening

meal from the hotplate before returning to his cell. He remains compliant with his prescribed medication

and at present there are no concern in regards to his physical or mental wellbeing. At present he is lying

in bed watching television.

Thu 23 Apr 2020 15:02



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01 Feb 2020 05:25 HMP Prison: BOSU, Kwaku (Mr) (Nurse Access Role)


Mr Turner was observed to have slept well throughout the night and was monitored by general nursing observations.

No issues raised

01 Feb 2020 16:38 HMP Prison: TAFIRENYIKA, Stellah (Health Professional Access Role)




01 Feb 2020 16:41 Surgery: TAFIRENYIKA, Stellah (Health Professional Access Role)

01 Feb 2020 18:05 Surgery: ROBERTS, Carleen (Miss) (Health Professional Access Role)

Personal hygiene activities (Xa3bU) - Mr Turner had a shower and attended to his personal hygiene independently

Health related observations about the prisoners physical appearance (YX010) - calm and appropriate, although

engaged minimally with staff and peers. Was concordant with medication as prescribed.

Nutritional observation (Xa7k6) - Had hot meal at lunch time and was given supper / breakfast packs. Requested hot

water on a few occasions.



Mr Turner had a fairly settled shift, he watched tv briefly before he retired to bed. He was upset that the lights were

switched on every hour to check on him

Reassurance given

He appeared to have slept during the night and was nursed on hourly observations

No issues raised or observed






02 Feb 2020 19:21 Surgery: ROBERTS, Carleen (Miss) (Health Professional Access Role)

Personal hygiene activities (Xa3bU) - Attended to his own personal hygiene independently

Nutritional observation (Xa7k6) - Had hot meal at lunch time and was given supper and breakfast packs

Health related observations about the prisoners physical appearance (YX010) - Concordant with medication as

prescribed. Little interaction with staff or peers. Asleep at 7pm.



Saul was settled in presentation during the shift, he was observed to have slept well during the shift and was nursed

on general observations

No physical health issues raised or observed

03 Feb 2020 16:30 HMP Prison: TRIPTREE, Simon (Mr) (Admin/Clinical Support Access Role)




03 Feb 2020 16:32 Surgery: TRIPTREE, Simon (Mr) (Admin/Clinical Support Access Role)

03 Feb 2020 18:47 HMP Prison: BROWN, Beverly (Mrs) (Nurse Access Role)

History: Saul came out on association and went to Dayroom where it was observed using the Kiosk.

He had minimal interaction with the other inmates whilst he was in the Dayroom. He took care of his

personal hygiene (shower) before returning to his cell. He is eating and drinking adequately and is

presenting as much brighter in mood. There are no immediate concern in regards to his physical

or mental wellbeing. He remains compliant with his prescribed medication and is sitting in his cell

watching television at present.

04 Feb 2020 06:05 HMP Prison: VICTOIRE, Francois (Nurse Access Role)

Saul was in bed on taking over, he appeared to have slept the whole night.



History: Saul came out on his regime this morning

He had a shower and spent time within the day room

He also used the kiosk whilst spending time within the day room

His mood is lifting up and is now interacting and communicating with staff

His mood has improved from when he first came into the prison

He is eating and drinking adequately

He is still compliant with his medication

No concerns in regards to his physical or mental wellbeing.

Thu 23 Apr 2020 15:02



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05 Feb 2020 06:22 HMP Prison: VICTOIRE, Francois (Nurse Access Role)

Saul was in bed by 23:00hrs and slept, hourly checks carried out.

05 Feb 2020 10:57 HMP Prison: FEENEY, Adrian (Health Professional Access Role)

History: I discharged him from HCU on the 28th and he is still here

no concerns raised in Hand over this morning

POs to look for cell on the HB

he is requesting a single cell but there aren't medical grounds for this

Kumar to engage on the HB

as a discharged pt I will not review in person today.

05 Feb 2020 11:57 Surgery: OGUNMODEDE, Folasade (Mrs) (Nurse Access Role)



Interacted with staff.


His cell is clean and tidy.

His mental state is stable.




05 Feb 2020 16:33 HMP Prison: TRIPTREE, Simon (Mr) (Admin/Clinical Support Access Role)




05 Feb 2020 16:35 Surgery: TRIPTREE, Simon (Mr) (Admin/Clinical Support Access Role)

05 Feb 2020 16:44 Surgery: OGUNMODEDE, Folasade (Mrs) (Nurse Access Role)


Action taken (YA794) - Saul was reviewed by Dr Feeney.

Discharged from inpatient care (8HE2.)

In prison (XE0pK)

Duration of inpatient stay (8HN..) 26 Days

Outcome of action (XaIVO)

His medication to be taken to the houseblock.

Send task to Inreach for follow up.

06 Feb 2020 08:26 HMP Prison: NELSON, Brenda (Mrs) (Information Officer Access Role)

06 Feb 2020 09:56 HMP Prison: RUSE, Gareth (Dr) (Clinical Practitioner Access Role)

History: Asked to see on wing at 0910 hours. He was found dead in his bed in the upper bunk. He is a 37 year old

discharged from healthcare yesterday.

He has a history of alleged NPS use , and has been suicidal in the past.

He is sharing with a cell mate. Offidcers attended and pulled the mattress to the gorund determining rigormortice.

Asystolic on AEDifibrillator. I understand cpr was commenced, andthe prison paramedic discontinued it as futile..

Examination: congestion of the back , mild patches onthe abdomen, severe rigorortice-yung and muscular -of the

arms which are contracted firmly, so death more than 6 hours ago.

He has no arcus inthe eyes so less than 24hours.

no thermometer available.for low readings.

He does have congestion of the upper chest neck and head. no ligautre marking is seen in the thraot. possible

petechiae besicde the right eye and some purpuric haemorrhagfes appear present in both sclera on each side of the

pupil.

Diagnosis: Death declared at 0920 hours. possible a cardiac arrhythmia, respiratory arrest due ot natural causes or

drug use and over sedation , and a possible suspicious element inthe congestion of the upper chest and face and

bilateral ocular purpuric haemorrghfes or staining /pigmentiona ?

Plan: Rigor mortice is more pround in young muscular men, ocmse on quicker with severe exertion.

It is possible if the eyes have purpuric haemorhages to consider coughing/vomiting (none present) or suggocation or

soft ligauting as the cause.

Officers advised this could be a suspicious death, and should proceed witht he police accordingly until the pathology

investigation . Inpatinets asked to clarify if he had purpuric haemorrhages or chronic staining of both eyeballs when

he left.

Thu 23 Apr 2020 15:02



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Added after 5 minutes ..spoke officer Stavert who saw him yesterday morning and he did not have any eye

discoloruation that she noticed, so this does appear to be fresh.


06 Feb 2020 10:55 HMP Prison: WEBSTER, Jacqueline (Ms) (Clerical Access Role)

Fw: 070120/005 Re: Saul Turner - DOB 08.12.1982

REPLY REPLY ALL FORWARD

Mark as read

YADALLEE, Zeiyad (CENTRAL AND NORTH WEST LONDON NHS FOUNDATION TRUST)

Thu 06/02/2020 10:48

Inbox

To:

WEBSTER, Jacqueline (CENTRAL AND NORTH WEST LONDON NHS FOUNDATION TRUST);

...

Cc:

KING, Kirk (CENTRAL AND NORTH WEST LONDON NHS FOUNDATION TRUST);

...

1 attachment

S36BW-42002~.pdf

281 KB Open in browser

Can you share Dr Feeney's assessment with them please.

Thank you

Zeiyad Yadallee

MH Practitioner/Non-Medical Nurse Prescriber/Acting MH Service Lead

Mental Health In Reach

HMP HighDown

Central and North West London NHS Foundation Trust

Telephone: 02071476552

Fax: 02071476611

Web: www.cnwl.nhs.uk

Follow us on Twitter: @CNWLNHS

Like us on Facebook: www.facebook.com/CNWLNHSFT

C137

Central and North West London NHS Foundation Trust (CNWL) is one of the largest trusts in the UK, caring for

people with a wide range of physical and mental health needs. We have approximately 7,000 staff who provide

healthcare to a third of London's population and across wider geographical areas, including Milton Keynes, Kent,

Surrey and Hampshire.

As a Foundation Trust we involve service users, carers, the public, staff and partner organisations in the way that we

are run and our future development. If you are interested in becoming a member of our Foundation Trust please visit:

www.cnwl.nhs.uk/get-involved

Compassion | Respect | Empowerment | Partnership

________________________________________

From: Enquiries <enquiries@tbj-solicitors.co.uk>

Sent: 06 February 2020 10:40

To: YADALLEE, Zeiyad (CENTRAL AND NORTH WEST LONDON NHS FOUNDATION TRUST)

Subject: RE: 070120/005 Re: Saul Turner - DOB 08.12.1982

Thank you for your email of which I acknowledge the content.

It would be helpful if you could provide Dr Feeney_s assessment of Mr Turner and I attach with this email the signed

authority from our client for ease of reference.

Yours sincerely

Daniel Reilly

Tang, Bentley & Jackson Solicitors Limited

CRIMINAL DEFENCE SPECIALISTS

Thu 23 Apr 2020 15:02



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Printed



Email: enquiries@tbj-solicitors.co.uk

151 West Street, Fareham, Hampshire PO16 0DZ

Telephone 01329 220 401 Fax 01329 828 347 DX 40801 Fareham

Emergency Police Station Out of Hours Phone 07765 331 590

Portchester Business Centre, 1 Castle Street, Portchester, Hampshire PO16 9QD

Telephone 02392 272 720

www.tbjsolicitorsfareham.co.uk

C138

Re: 070120/005 Re: Saul Turner - DOB 08.12.1982

REPLY REPLY ALL FORWARD

Mark as unread

WEBSTER, Jacqueline (CENTRAL AND NORTH WEST LONDON NHS FOUNDATION TRUST)

Thu 06/02/2020 11:12

Sent Items

To:

enquiries@tbj-solicitors.co.uk;

...

Cc:

YADALLEE, Zeiyad (CENTRAL AND NORTH WEST LONDON NHS FOUNDATION TRUST);

...

1 attachment

S Turner - ~.pdf

703 KB Open in browser

FAO: Daniel Reilly - TBJ Solicitors

Dear Mr. Reilly,

Please find attached a copy of Dr. Feeney's assessments as requested, with your client's signed consent.

The assessment is encrypted. I will send the password with my next email.

With kind regards,

Jacqueline

Jacqueline Webster

Transfer and Discharge Officer - Surrey Prisons

Mental Health InReach Team

Central & North West London NHS Foundation Trust

HMP High Down, Sutton Lane, Sutton, Surrey, SM2 5PJ

For patients record only - Please note: I sent a further email to Solicitors with the encrypted password for Dr.

Feeney's assessment (nreach).

Acrobat Document: S Turner - Signed Consent from Solicitors - 08.01.2020.pdf

Acrobat Document: S Turner - Assessment by Dr. A. Feeney - HMP High Down.pdf


History: retrospective entry relating to yesterday.

I spoke briefly to him as I left the inpatient unit at about 1150 yesterday morning.

he was standing in the open door way of his cell.

I asked him how he was and he said he was ok

I told him that he would be discharged from the HCU soon.

Thu 23 Apr 2020 15:02



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I then briefly mentioned him in the MHT weekly meeting when discussing the prisoners in the HCU

I explained he had been discharged from the caseload last week and the plan was to transfer him to a double cell on

normal location

I checked in with Kumar that he was aware of this plan since he has already engaged him on the HCU and planned

to follow him up on the HB.

I have this morning recieved an email informing me of his sad death.


06 Feb 2020 11:56 HMP Prison: MILES, Verity (Mrs) (Health Professional Access Role)

History: On 6/2/20 at 09:09 Code blue called. Control room asked for information – came over radio ‘possible death

in custody’. I was in outpatients at the time so started to make my way to HB3. Whilst on route there, a call over the

radio ‘All response staff attend HB4’ then straight after ‘All medical staff attend HB3 and bring red bags’.

Examination: At approximately 09:12, I arrived onto HB3 A spur 3’s landing. On arrival officers were around the door

and Nurse Sawmy standing outside the door. I entered the cell and officers were moving Mr Turner from the top bunk

onto the floor.

Mr Turner was laying on his back, covered in sheets. I observed both arms were fixed in a flexed position. I

attempted to move left arm, confirmed rigor mortis, no response from patient. At my request officers cut clothing from

patient.

Airway and breathing assessment carried out, patient not breathing. I asked officers to get the red bag and CPR

commenced. I asked an officer to carry out chest compressions while I called over the radio ‘Please inform

Ambulance patient is unresponsive and not breathing’. I then took over chest compressions.

Health Care Assistant Simon Triptree arrived on scene and applied defibrillator pads. Defibrillator assessed rhythm

and shock not advised. CPR recommenced by HCA Triptree. At approximately 09:14, Paramedic Ana Bakht arrived

on scene, I handed over information to her and she carried out physical assessment of patient. I also asked that the

on duty GP attend the incident. Assessment from Paramedic, Ana Bakht showed, no breath or heart sounds on

auscultation, pupils fixed and non-responsive and Post mortem staining observed to upper chest and flank of back.

During assessment of breath and heart sounds CPR stopped, defibrillator further assessed rhythm and again shock

not advised.

09:15 following discussion of assessment decision made by Paramedic Ana Bakht and myself that life extinct and to

stop CPR.

09:18 Dr Gareth Ruse attended and confirmed life extinct.

09:22 External paramedics arrived on scene and carried out assessment.

09:35 External paramedics confirmed life extinct.

06 Feb 2020 12:43 HMP Prison: SWAMY, Margarita (Nurse Access Role)

I was doing the medication in HB3 hatch when I heard code blue on the radio. I immediately went to see what

was happening . I saw a few officers on A spur landing on the 3rd landing. and went to see what was going on. I

went up to the cell to see who the prisoner was and what was the emergency of the code. . I stood on a chair to be

able to see as his face appeared half covered. I tried to remove the sheets from his face but was unable to do so

due to the rigidity of the prisoners arms and hands . I then went out of the cell room to get the emergency bag

and other staff had arrived to help. After that I found out that the prisoner in question was Mr. Turner. I then

called the G.P on duty to attend the scene.

06 Feb 2020 12:47 Surgery: BAKHT, Ana (Miss) (Health Professional Access Role)

On Wednesday 6th February 2020 at approximately 09:09 Code Blue heard over radio. Travelled to House Block 3

and directed to Cell by Officers.

On/Arrival: Arrived at approximately 09:14 with Nurse Sophie Marshall. Officers, Nurse Verity Miles and HCA Simon

Triptree present. Patient appears unresponsive lying on back on a mattress on the floor with both arms raised and

fixed in flexed position with visible rigor mortis. Defibrillator pads applied. HCA Simon performing compressions with

Nurse Verity overseeing CPR. Received handover from Nurse Verity, Patient unresponsive and showing no signs

of life following ABC assessment.

On/Examination: Patient displaying visible rigor mortis and on attempting to unsuccessfully move arm rigor mortis

reconfirmed. Evidence of post mortem staining. Patient unresponsive. No breath sounds heard on auscultation. No

heart sounds heard on auscultation. Defibrillator assessed rhythm as shock not advised. Pupils fixed and dilated on

assessment. Unable to obtain 30 second rhythm strip due to absence of ECG machine. No obvious DSH or injuries

observed.

Plan: Patient assessed and displaying rigor mortis , visible post mortem staining around upper chest and flank of

back, with no breath sounds or heart sounds on auscultation and fixed and dilated pupils. Therefore with support

from Nurse Verity declared recognition of life extinct at approximately 09:15 and CPR halted. GP Dr Gareth Ruse

arrived at 09:18 and following assessment confirmed recognition of life extinct.

Ambulance arrived and conducted assessment for recognition of life extinct including obtaining 30 second Asystole

rhythm strip. Ambulance confirmed recognition of life extinct at approximately 09:35.


Thu 23 Apr 2020 15:02



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History: Spke with police officer to give clarity. I note he has been seen and treated by Dr Feeney with mirtazepine

and had been discharged from healthcare. His old photo does not show any scleral pigmentation.

06 Feb 2020 14:35 HMP Prison: NELSON, Brenda (Mrs) (Information Officer Access Role)

Restricted to Staff member MARTIN, Kerry (Miss) (Audit Manager)

Restricted to Staff member TURNER, Steven (Mr) (Analyst)

Restricted to Staff member JONES, Lisa

12 Feb 2020 10:03 HMP Prison: TURNER, Steven (Mr) (Clerical Access Role)

Patient died (XM01Y)

Informant of death - GP - Dr Ruse & Ambulance Crew

Date Of Death Entered

25 Feb 2020 11:58 Surgery: WATERS, Gemma (Mrs) (Information Officer Access Role) Entered at: Hmp Rochester

23 Apr 2020 15:01 HMP Prison: TURNER, Steven (Mr) (Clerical Access Role)

Medication

A = Acute P = Private I = Instalment Dispensed D = Dental H = Hospital O = Other

Paracetamol 500mg tablets 500mg x 2 O

Script notes: Headache

13 Aug 2010

06 Sep 2010

Doxycycline 100mg capsules

Doxycycline 100mg capsules

Noon: 1.0 capsules

Noon: 1.0 capsules

30 capsules

30 capsules

A

13 Sep 2010 Doxycycline 100mg capsules Noon: 1.0 capsules 30 capsules

04 Oct 2010 Doxycycline 100mg capsules Noon: 1.0 capsules 30 capsules

04 Oct 2010 Venlafaxine 150mg modified-release tablets AM: 1.0 tablets 28 tablets

30 Mar 2012

06 Apr 2012

Paracetamol 500mg tablets

Ibuprofen 200mg tablets

take 1 or 2 4 times/day

take one or two 3 times/day

16.0 tablets

24 tablets

A

A

20 Apr 2012

13 Jul 2012


Minocycline 100mg modified-release capsules

take 1 or 2 4 times/day

take one daily

16.0 tablets

56 capsules

A

A

13 Jul 2012 QUINODERM ANTIBACTERIAL wash

[QUINODERM]

bd 100 millilitres A

24 Sep 2012 Minocycline 100mg modified-release capsules take one daily 56 capsules

24 Sep 2012 QUINODERM ANTIBACTERIAL wash

bd

100 millilitres

[QUINODERM]

20 Oct 2012 QUINODERM ANTIBACTERIAL wash

bd

100 millilitres

[QUINODERM]

12 Nov 2012 Minocycline 100mg modified-release capsules take one daily 56 capsules

07 Jan 2013 Minocycline 100mg modified-release capsules take one daily 56 capsules

19 Apr 2013 Minocycline 100mg modified-release capsules take one daily 28 capsules A

15 May 2013

13 Jun 2013



take one daily

take one daily

28 capsules

28 capsules

A

A

18 Mar 2016

31 Mar 2016



1 TDS PRN

1 TDS PRN

21 tablets

21 tablets

A

A

27 Apr 2016 Amoxicillin 500mg capsules [08:00-1][12:00-1][16:00-1] 15 capsules A

27 Apr 2016 Ibuprofen 200mg tablets [08:00-1][12:00-1][16:00-1] 15 tablets A

23 May 2016 Ibuprofen 200mg tablets 1 tablet 1 pack of 16 A

Ended early on 23 May 2016: Medication has been administered by LOGAN, Susan

Administrative notes: " One to two tablets.

" Up to three times a day (4 hours between doses) after food.

" Maximum 6 tablets in 24 hours.

tablet(s)

C140

16 Jun 2016 Paracetamol 500mg tablets 2 tablet 2 tablets A

Ended early on 16 Jun 2016: Medication has been administered by HUNNINGS, Julie

Administrative notes: 2 single tabs given at hatch for cold symptoms

16 Jun 2016 Paracetamol 500mg tablets 2 QDS PRN 1 pack of 32

tablet(s)

A

25 Jul 2016 Ibuprofen 200mg tablets 1 tablet 1 pack of 16 A

Thu 23 Apr 2020 15:02



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tablet(s)

Ended early on 25 Jul 2016: Medication has been administered by NAKAYI, Cynthia (Miss)

Administrative notes: " One to two tablets.

" Up to three times a day (4 hours between doses) after food.

" Maximum 6 tablets in 24 hours.

10 Oct 2016 SUDOCREM (form not specified) O

08 Nov 2016 Paracetamol 500mg tablets 2 qds 16 tablets O

10 Feb 2017 Amitriptyline 25mg tablets 1 tablet 28 tablets A

Ended early on 15 Feb 2017: End of course by HARDING, Tim

16 Feb 2017 Amitriptyline 50mg tablets 1 tablet 28 tablets

16 Feb 2017 Paracetamol 500mg tablets 2 tablet 80 tablets

24 Feb 2017 Ketoconazole 2% shampoo ao 120 millilitres A

10 Mar 2017 E45 cream (Forum Health Products Ltd) ao 500 grams

18 Mar 2017 Amitriptyline 50mg tablets 1 tablet 28 tablets

29 Mar 2017 Promethazine hydrochloride 25mg tablets 25 mg 5 tablets A

15 Apr 2017 Amitriptyline 50mg tablets 1 tablet 28 tablets

13 May 2017 Amitriptyline 50mg tablets 1 tablet 28 tablets

Ended early on 13 May 2017: Sentence Ended by MAULINO, Rogelio (Mr)

06 Nov 2017 Mirtazapine 15mg tablets 1 tablet 28 tablets A

Ended early on 07 Nov 2017: End of course (Change to 7/7 IP) by HOSSAIN, Jahura (Dr)

07 Nov 2017 Benzoyl peroxide 5% / Clindamycin 1% gel Apply ONCE at night 1 pack of 30

gram(s)

A

Administrative notes: BNF:

Dose

"Apply 1_2 times daily preferably after washing with soap and water, start treatment with lower-strength preparations

Note May bleach clothing

07 Nov 2017

14 Nov 2017

Mirtazapine 15mg tablets

Mirtazapine 15mg tablets

[16:00-1 tablet]

[16:00-1 tablet]

7 tablets

28 tablets

A

Ended early on 17 Nov 2017: Other (Ended after on admission medication review) by GONCARAS, Laimonas (Dr)

21 Nov 2017 Mirtazapine 15mg tablets [16:00-1 tablet] 28 tablets

Ended early on 12 Dec 2017: Form, strength, or route change by GONCARAS, Laimonas (Dr)

21 Nov 2017

28 Nov 2017



2 qds

2 qds

16 tablets

16 tablets

O

O

13 Dec 2017 Mirtazapine 15mg tablets 1 tablet 28 tablets

16 Dec 2017 Paracetamol 500mg tablets now 2 tablets O

17 Dec 2017

18 Dec 2017



now

x2 given nip

2 tablets O

O

19 Dec 2017 Paracetamol 500mg tablets now 2 tablets O

20 Dec 2017 Valproic acid 250mg gastro-resistant tablets 250 mg 28 tablets A

22 Dec 2017 Valproic acid 500mg gastro-resistant tablets 500 mg 28 tablets A

Administrative notes: Mania, initially 750 mg daily in 2-3 divided doses, increased according to response, usual dose

1-2 g daily; doses greater than 45 mg/kg daily require careful monitoring; child under 18 years not recommended

Migraine prophylaxis [unlicensed], initially 250 mg twice daily, increased if necessary to 1 g daily in divided doses

10 Jan 2018 Mirtazapine 15mg tablets 1 tablet 28 tablets

Ended early on 15 Jan 2018: Change of Dosage by BONCHEV, Sevdalin (Dr)

16 Jan 2018 Mirtazapine 30mg tablets 1 tablet 28 tablets A

16 Jan 2018 Valproic acid 250mg gastro-resistant tablets 1 tablet 28 tablets

Ended early on 16 Jan 2018: Change of Dosage by SINGH, Sourabh (Dr)




Thu 23 Apr 2020 15:02



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16 Jan 2018 Valproic acid 500mg gastro-resistant tablets 1 tablet 28 tablets

Ended early on 16 Jan 2018: End of course by SINGH, Sourabh (Dr)




16 Jan 2018 Valproic acid 500mg gastro-resistant tablets 500 mg 56 tablets A




17 Jan 2018 Zopiclone 7.5mg tablets 7.5 mg 3 tablets A

13 Feb 2018 Mirtazapine 30mg tablets 1 tablet 28 tablets A

Ended early on 13 Feb 2018: Form, strength, or route change by SINGH, Sourabh (Dr)

13 Feb 2018 Valproic acid 500mg gastro-resistant tablets 1 tablet 55 tablets A

Ended early on 13 Feb 2018: End of course by SINGH, Sourabh (Dr)




14 Feb 2018 Mirtazapine 30mg orodispersible tablets [20:00-1] 28 tablets A

14 Feb 2018 Sodium valproate 500mg gastro-resistant [08:00-1][20:00-1] 56 tablets A

tablets

19 Feb 2018 E45 cream (Forum Health Products Ltd) ao 500 grams

08 Mar 2018 Mirtazapine 30mg orodispersible tablets [21:00-1] 28 tablets A

Ended early on 14 Mar 2018: End of course by KHAN, Joblu (Dr)

08 Mar 2018 Sodium valproate 500mg gastro-resistant

tablets

[08:00-1][18:00-1] 56 tablets A


16 Mar 2018 Mirtazapine 30mg tablets One to be taken daily 1 pack of 28

tablet(s)


16 Mar 2018 Mirtazapine 30mg tablets 1 tablet 1 pack of 28 A

tablet(s)

Administrative notes: CSU

16 Mar 2018 Sodium valproate 500mg gastro-resistant

tablets

To be taken Twice Daily 56 tablets


16 Mar 2018 Sodium valproate 500mg gastro-resistant 1 tablet 1 pack of 100 A

tablets

tablet(s)

Administrative notes: CSU

10 Apr 2018 Mirtazapine 30mg tablets One to be taken daily 1 pack of 28

tablet(s)

Ended early on 13 Apr 2018: Other (CSU) by FRANKE, Theodorus

10 Apr 2018 Sodium valproate 500mg gastro-resistant

tablets

To be taken Twice Daily 56 tablets

Ended early on 13 Apr 2018: Other (CSU) by FRANKE, Theodorus

13 Apr 2018 Mirtazapine 30mg tablets 1 tablet 14 tablets A

Ended early on 24 Apr 2018: Other (transferred to another establishment) by HUMPHRIES, Emma L

Administrative notes: Pt in CSU

13 Apr 2018 Sodium valproate 500mg gastro-resistant

tablets

1 tablet 28 tablets A

Ended early on 19 Apr 2018: End of course by APPLEFORD, James (Dr)

Administrative notes: Pt in CSU

25 Apr 2018 Mirtazapine 30mg tablets one at night 28 tablets

23 May 2018 Mirtazapine 30mg tablets one at night 28 tablets

27 May 2018 Paracetamol 500mg tablets 2 2 O

Thu 23 Apr 2020 15:02



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20 Jun 2018 Mirtazapine 30mg tablets one at night 28 tablets

Ended early on 11 Jul 2018: Patient Preference by SAMOUELLE, Richard (Dr)

22 Jun 2018 Paracetamol 500mg tablets 1-2 tablet 2 tablets A

Ended early on 22 Jun 2018: Medication has been administered by GREGORIOUS, Mathew

Administrative notes: Every 4-6 hours Maximum 8 tablets per day

13 Aug 2018 Ibuprofen 200mg tablets 1-2 tablet 2 tablets A

Ended early on 13 Aug 2018: Medication has been administered by SMITH, Lynda (Mrs)

Administrative notes: Every 6-8 hours, up to three times a day (max 6 tablets in 24 hours)

13 Aug 2018 Ibuprofen 200mg tablets 1-2 tablet 1 pack of 24

tablet(s)

A


Administrative notes: 24 tablets supplied IP Every 6-8 hours, up to three times a day (max 6 tablets in 24 hours)

13 Aug 2018 Paracetamol 500mg tablets 1-2 tablet 2 tablets A



13 Aug 2018 Paracetamol 500mg tablets 1-2 tablet 1 pack of 16

tablet(s)

A


Administrative notes: 16 tablets supplied IP

16 Aug 2018 Paracetamol 500mg tablets 1-2 tablet 1 pack of 16 A

tablet(s)

Ended early on 16 Aug 2018: Medication has been administered by HAMPSHIRE, Ann (Miss)

Administrative notes: 16 tablets supplied IP

20 Aug 2018 Ibuprofen 200mg tablets 1-2 tablet 2 tablets A

Ended early on 20 Aug 2018: Medication has been administered by ROBSON, Bryan

Administrative notes: Every 6-8 hours, up to three times a day (max 6 tablets in 24 hours)

20 Aug 2018 Paracetamol 500mg tablets 1-2 tablet

Ended early on 20 Aug 2018: Medication has been administered by ROBSON, Bryan

2 tablets A


25 Aug 2018 Paracetamol 500mg tablets 1-2 tablet 2 tablets A

Ended early on 25 Aug 2018: Medication has been administered by HAMPSHIRE, Ann (Miss)


10 Sep 2018 Aqueous cream 1-5 application 1 pack of 100 A

gram(s)

Ended early on 10 Sep 2018: Medication has been administered by SMITH, Lynda (Mrs)

Administrative notes: Apply to the affected area upto five times daily - to be used as a soap substitute only.

09 Jan 2020 Zopiclone 7.5mg tablets 1 tablet 3 tablets A

15 Jan 2020 Mirtazapine 30mg tablets 1 tablet 28 tablets

Repeat Templates

C143

06 Sep 2010 Doxycycline 100mg capsules Noon: 1.0 capsules 30 capsules 04 Oct 2010, Ended

Issues: 3

End Reason: Patient Preference (patient has stopped

colecting for long time) by SHAH, Rajiv (Dr)

04 Oct 2010 Venlafaxine 150mg

modified-release tablets

AM: 1.0 tablets 28 tablets 04 Oct 2010, Ended

Issues: 1

End Reason: Patient Preference (patient has DNA for

medicine) by SHAH, Rajiv (Dr)

24 Sep 2012 Minocycline 100mg

modified-release capsules

take one daily 56 capsules 07 Jan 2013, Ended

Issues: 3

End Reason: Patient Deducted (Hmp Camp Hill) by

PACKER, Julie

Indication: Acne vulgaris (XE1BO)

24 Sep 2012 QUINODERM ANTIBACTERIAL

wash [QUINODERM]

bd 100 millilitres 20 Oct 2012, Ended

Issues: 2

End Reason: Patient Deducted (Hmp Camp Hill) by

PACKER, Julie

Thu 23 Apr 2020 15:02



C143

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15 Feb 2017 Amitriptyline 50mg tablets 1 tablet 28 tablets 18 Mar 2017, Ended

Issues: 2

End Reason: Re-Authorised by HARDING, Tim

15 Feb 2017 Paracetamol 500mg tablets 2 tablet 80 tablets 16 Feb 2017, Ended

Issues: 1

End Reason: Patient Deducted (Sentence Ended)

10 Mar 2017 E45 cream (Forum Health Products ao 500 grams 10 Mar 2017, Ended

Ltd)

Issues: 1


12 Apr 2017 Amitriptyline 50mg tablets 1 tablet 28 tablets 13 May 2017, Ended

Issues: 2


14 Nov 2017 Mirtazapine 15mg tablets [16:00-1 tablet] 28 tablets 14 Nov 2017, Ended

Issues: 1

End Reason: Patient Deducted

17 Nov 2017 Mirtazapine 15mg tablets [16:00-1 tablet] 28 tablets 21 Nov 2017, Ended

Issues: 1


12 Dec 2017 Mirtazapine 15mg tablets 1 tablet 28 tablets 10 Jan 2018, Ended

Issues: 2


16 Jan 2018 Valproic acid 250mg

1 tablet 28 tablets 16 Jan 2018, Ended

gastro-resistant tablets

Issues: 1





16 Jan 2018 Valproic acid 500mg

1 tablet 28 tablets 16 Jan 2018, Ended


Issues: 1





15 Feb 2018 E45 cream (Forum Health Products

Ltd)

ao 500 grams 19 Feb 2018, Ended

Issues: 1


16 Mar 2018 Mirtazapine 30mg tablets One to be taken daily 1 pack of 28 10 Apr 2018, Ended

tablet(s)

Issues: 2


16 Mar 2018 Sodium valproate 500mg


To be taken Twice

Daily

56 tablets 10 Apr 2018, Ended

Issues: 2

End Reason: End of course by APPLEFORD, James (Dr)

25 Apr 2018 Mirtazapine 30mg tablets one at night 28 tablets 20 Jun 2018, Ended

Issues: 3

End Reason: Patient Preference by SAMOUELLE, Richard

(Dr)

15 Jan 2020

Issues: 1

Mirtazapine 30mg tablets 1 tablet 28 tablets 15 Jan 2020, Ended


Drug Sensitivities

No information recorded

Allergies

C144

CS = Chronic Summary MS = Major Summary OS = Minor Summary S = Unspecified Summary NE = New

Episode OE = Ongoing Episode

22 Feb 2013 No known allergies (1151.)

14 Jan 2015 No known allergies (1151.)

26 Mar 2015 No known allergies (1151.)




Thu 23 Apr 2020 15:02



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30 Sep 2017 No known allergies (1151.)

25 Apr 2018 No known allergies (1151.)

08 Jan 2020 No known allergies (1151.)

Problem Substances


Recalls


C145

Reminders

03 Jan 2018 Does not want to take valproic acid until reviewed as struggling with side

effects

03 Jan 2018 DOES NOT WANT TO TAKE SODIUM VALPROATE CURRENTLY UNTIL

REVIEWED

22 Dec 2017 If depressed and suicidal do not prescribe amitryptiline as Saul is aware of the

Cardio toxicity of this antidepressant.

Normal Priority

Cancelled on 03

Jan 2018

High Priority

He is aware of this alert.

15 Dec 2017 Constant watch in segregation unit following suicide attempt. Cancelled on 19

Jan 2018

02 Oct 2017 No SCR record, therefore no NHS number or gp Cancelled on 14

Mar 2018

12 Apr 2013 MEDICATION SCORE - 11 Cancelled on 14

Mar 2018

12 Apr 2013 CSRA - HIGH - SINGLE Cancelled on 14

Mar 2018

Vaccinations


Summary

CS = Chronic Summary MS = Major Summary OS = Minor Summary S = Unspecified Summary NE = New

Episode OE = Ongoing Episode

22 Jul 2010 Tinea pedis (Xa97k) S

02 Nov 2011 Paper record held here (Y1800) S

22 Feb 2013 First Reception Screening (Positive Response) (Y0801) S

11 Apr 2013 Hep B Vacc - immunised already (Y075d) S

11 Apr 2013 Smoker (137R.) S

25grams of tobacco a week

11 Apr 2013 Asthma: no (Y0944) S

11 Apr 2013 Does not have a psychiatric nurse or care worker (Y08e4) S

11 Apr 2013 Normal vision (668A.) S

11 Apr 2013 No hearing problems (Y1103) S

11 Apr 2013 Patient registered - GPR (XE2y4) S

11 Apr 2013 Reads English (XaIMM) S

11 Apr 2013 English language (Xa6ev) S

11 Apr 2013 White British (XaFwD) S

11 Apr 2013 Consent given to share patient data with specified 3rd party

(XaNwR)

S

11 Apr 2013 Prisoner has received treatment from a psychiatrist outside prison

(YX016)

S

2007 & 2011 re: Depression. No longer on medications

11 Apr 2013 Has not stayed in a psychiatric hospital (Y08e2) S

11 Apr 2013 Teetotaller (1361.) S

Thu 23 Apr 2020 15:02



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11 Apr 2013 Did not attend substance misuse clinic (XaJsy) S

11 Apr 2013 Moderate suicide risk (XaIeW) S

17 Jan 2015 No relevant family history (122..) S

30 Mar 2015 FH: Ischaemic heart disease at less than 60 years (XE0oG) S

Sister has diabetes


30 Mar 2015 FH: Diabetes mellitus (1252.) S

Sister has diabetes


16 Feb 2016 First Reception Screening (Unknown) (Y0803) S

16 Feb 2016 No (Y0428) S

16 Feb 2016 Unknown (X90UG) S

16 Feb 2016 Hep B Vacc - immunised already (Y075d) S

02 Mar 2016 No relevant family history (122..) S

17 Aug 2016 Declined consent to share pt data with specified 3rd party (XaNwT) S

17 Aug 2016 Patient registered - GPR (XE2y4) prison S

17 Aug 2016 Teetotaller (1361.) S

17 Aug 2016 No (Y0428) S

17 Aug 2016 Not disabled (Y3416) S

17 Aug 2016 No (Y0428) S

17 Aug 2016 Able to read (XaBme) S

17 Aug 2016 English language (Xa6ev) S

17 Aug 2016 Able to write (XaAzO) S

17 Aug 2016 Smoker (137R.) S

17 Aug 2016 Asthma: no (Y0944) S

30 Sep 2017 Rolls own cigarettes (137M.) S

30 Sep 2017 Wants to stop smoking (XaLQh) S

30 Sep 2017 Cigarette smoker (XE0oq) S

16 Nov 2017 No (Y0428) S

16 Nov 2017 No (Y0428) S

16 Nov 2017 English language (Xa6ev) S

16 Nov 2017 Interpreter not needed (XaI8Y) S

16 Nov 2017 Able to write (XaAzO) S

16 Nov 2017 Patient not registered (9121.) S

16 Nov 2017 Smoker (137R.) S

16 Nov 2017 Asthma: no (Y0944) S

16 Nov 2017 Able to read (XaBme) S

16 Nov 2017 Consent given to share patient data with specified 3rd party

(XaNwR)

S

16 Nov 2017 Not disabled (Y3416) S

16 Nov 2017 Teetotaller (1361.) S

02 Jan 2018 Seen by member of prison inreach mental health team (XaP7x) S




02 Feb 2018 Seen by member of prison inreach mental health team (XaP7x) S






Thu 23 Apr 2020 15:02



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Printed




07 Mar 2018 Seen by member of prison inreach mental health team (XaP7x) S


15 Mar 2018 Admission to segregation unit (XaPma) ALGORITHM S

OE

22 Mar 2018 Consent obtained (Y001d) S

OE

consent to share info and medication compact


05 Apr 2018 Prescription (X904q) PRESCRIPTION S

NE

10 Apr 2018 Seen in segregation unit (Y0ce3) SRU ALGORITHM S

OE

25 Apr 2018 Patient consented to sharing of information (Y3358) S

27 Apr 2018

27 Apr 2018

Patient health questionnaire (PHQ-9) score (XaLDN)


0 S

S

27 Apr 2018 No thoughts of deliberate self harm (XaIuw) S

27 Oct 2018 No suicidal thoughts (XaIJ7) S

27 Oct 2018 No thoughts of deliberate self harm (XaIuw) S

24 Dec 2019 Seen by primary care mental health team (XaZrh) S

08 Jan 2020 Patient consented to sharing of information (Y3358) S

08 Jan 2020

09 Jan 2020

Health assessment questionnaire (XM0e6)

Admission to ward (XaAMw)

1 S

S

09 Jan 2020 General observation of patient (Xa1bt) S

15 Jan 2020 Inpatient stay (XaBV3) S



29 Jan 2020 Depressive disorder (X00SO) S

05 Feb 2020 Discharged from inpatient care (8HE2.) S

Pathology Results


Active Problem: Dental care (Ua1RH) (26 Apr 2016 - Ongoing)

A = Acute P = Private I = Instalment Dispensed D = Dental H = Hospital O = Other

27 Apr 2016 Amoxicillin 500mg capsules [08:00-1][12:00-1][16:00-1] 15 capsules A

27 Apr 2016 Ibuprofen 200mg tablets [08:00-1][12:00-1][16:00-1] 15 tablets A

26 Apr 2016 Problem: Dental care (Ua1RH)

H: Emerg appt. co - pain LRQ ? swelling. Pain since Saturday.

Mhx: NRMH.

Another year of sentence to serve.

Non smoker. Occasional alcohol when out.

E: Directed exam only

LR8 P.E. and operculum swollen and gum cut where tooth is erupting.

Pus draining from underneath.

Pericoronitits LR8. First episode.

Advised OHI ( small single tufted brush given).

Hot salt water mouthwash.

Px done amoxicillin 500mg tds 5/8 and ibuprofen.

Advised if recurrs then would recommend xla LR8.

C147

Active Problem: Prisoner has a psychiatric nurse or care worker in the community : no (Y09d1)

(17 Aug 2016 - Ongoing)


Thu 23 Apr 2020 15:02



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Active Problem: Depressive disorder (X00SO) (29 Jan 2020 - Ongoing)


Inactive Problems


Care Plans

05 Jul 2010 Self Harm (HMP Elmley) Reviewed:

Care Goal: To reduce self injury behaviour.

To avoid self injury.

To enable communication of thoughts and feelings about self harm.

To promote feelings of safety and security.

Review Due: 12 Jul 2010 09:57

1) Ensure that all staff are aware of the potential for self harm. 27 Aug 2010

2) Initiate a therapeutic relationship with key worker. 26 Aug 2010

3) Demonstrate acceptance and non judgmental responses. 26 Aug 2010

4) Ensure all potentially harmful substances and implements are removed whilst

22 Aug 2010

encouraging to retain and use personal belongings. - no concernss were raised inthis

regard.

5) Provide clear and understandable instructions about care and treatment. - complied with 22 Aug 2010

his treatment plan.

6) Identify factors which appear to trigger self harm thoughts. - No triggers reported. 26 Aug 2010

7) Identify potential factors which appear to reduce suicidal preoccupation. - Mr Altel 26 Aug 2010

occupied himself with reading and watching TV. No self harm behaviour displayed.

8) Encourage diversional or recreational activities. - Mr Altel came out during exercise time 22 Aug 2010

and interacted well with his peers.

9) Record all notes and observations in this template - Mr Altel was off ACCT on 24/8/10, for 26 Aug 2010

closure review next week. Denied deliberate self harm thoughts or intent.

05 Jul 2010 Low in Mood (HMP Elmley) Reviewed:

Care Goal: To facilitate opportunities for emotionally positive experiences

To reduce the influence of depressive thoughts on behaviour, emotions and communication

To promote control over thoughts and behaviour

Review Due: 12 Jul 2010 09:58

4) Saul is to be managed as per careplan. 31 Aug 2010

12) Allocated/treatment nurse to ensure that he is compliant with his treatment plan. - 01 Sep 2010

Presented as euthymic in mood and remains concordant with medication regime.

13) Allocated nurse to ensure that Saul has a 1.1 session facilitated per every shift, 01 Sep 2010

outcome to be documented on system 1. - 1.1 session facilitated amenable and pleasant on

approach.

18 Aug 2010 Dsh and depression. (HMP Elmley, IPD) Reviewed:

Care Goal: Mental and physical wellbeing.

Review Due: 23 Aug 2010 18:14

1) Monitor and document, Mr Altel's mood and behaviour. - diet and fluids taken at 01 Sep 2010

mealtimes.

2) To explore areas/activities of interest and encourage participation - Interactive with peers 01 Sep 2010

played pool.

3) Observe how Mr Altel interacts with peers - Good rapport observed with peers. 31 Aug 2010

5) Provide Mr Altel with opportunity to express his thoughts, feelings and anxities. - Mr Altel 31 Aug 2010

stated he is fine on spoken to, no deliberate self harm thoughts or suicidal intent expressed.

Social Services Contacts


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Admissions


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Communications

2010 Incoming Prescription or Medication details Arrived 01 Jan 2010 09:16

From ,

To ,

Entered By FORSHAW, Karen

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26 Jun 2010 Incoming F213 Arrived 26 Jun 2010 21:58

From ,

To ,

Entered By STANLEY, Dermot (Mr)

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15 Jul 2010 Incoming Blood Results Arrived 15 Jul 2010 11:26

From ,

To ,

Entered By CRIPPS, Janet

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Scanned Documents

08 Dec 1982 Prescription or Medication details to unknown

Letter Type

Prescription or Medication details

Letter To

Letter From

Page 1 of 1

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02 Feb 2010 Prescription or Medication details to unknown

Letter Type


Letter To

Letter From

HMP Swaleside

C166

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Page 2 of 2

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25 Feb 2010 Prescription or Medication details to unknown

Letter Type


Letter To

Letter From

HMP Swaleside

C168

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Page 2 of 2

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23 Mar 2010 Prescription or Medication details to unknown

Letter Type


Letter To

Letter From

HMP Swaleside

C170

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Page 2 of 2

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27 Mar 2012 Clinic Letter to Hmp Camp Hill

Letter Type

Clinic Letter

Letter To

Hmp Camp Hill

Letter From

Hmp Camp Hill

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12 Dec 2012 Clinic Letter to Dr Victoria Manning

Letter Type

Clinic Letter

Letter To

Dr Victoria Manning

Letter From

Maxillofacial, St Mary's Hospital

C174

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11 Apr 2013 Document to Hmp Rochester

Letter Type

Document

Letter To

Hmp Rochester

Letter From

Hmp Rochester

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15 Jan 2015 Consent Form to The Station Practice, Hastings

Letter Type

Consent Form

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Non

418605bdd01d47659e207caa74ba7d90418605bdd01d47659e207caa74ba7d90-1

Appendix C — foreseeable death Clinical Reviewer template

D1

Clinical Review for the purpose of the Prisons and Probation

Ombudsman’s investigation into the death of

Saul Altal

06.02.2020

HMP Highdown

Carried out by Dr Peter Saunders

Date of final clinical review report: 6.7.20

D1

181

418605bdd01d47659e207caa74ba7d90-2

D2

1. Terms of Reference

The aim of the review is to consider clinical care pertinent to the death the

deceased received in relation to his/her cause of death while in custody at

HMP Highdown.

The approach of how and why has been adopted, not apportioning blame.

This clinical review report is for the purposes of informing the PPO report and

providing clinical oversight and the report is not intended to offer expert

witness testimony for the purposes of the Coroner’s inquest.

The following key questions must be covered in relation to the death:

- How

- Is

- Was

- Are

- Were

- Is

- Are

and when did Saul Altal die?

there any root cause(s) of the death?

the clinical care equivalent to that which could have been

expected in the community?

there any learning opportunities?

local and national policies and procedures (both

establishment and NHS) followed?

there an opportunity to prevent future deaths in similar

circumstances?

there any examples of good practice?

The purpose of the clinical review is to support the aims of the PPO

investigation, which are to:

• Establish the circumstances and events surrounding the death, in

particular the health care the deceased received, while in custody.

• The management of the individual by the relevant authority or authorities

within remit, but also including any relevant external factors.

• Examine whether any change in operational methods, policy, and practice

or management arrangements would help prevent a recurrence.

• In conjunction with NHS England or the relevant authority where

appropriate, examine relevant healthcare received whilst in custody or

detention and assess clinical care pertinent to the death.

• Provide explanations and insight for the bereaved families, carers and

relatives

• Help fulfil the investigative obligation arising under Article 2 of the

European Convention on Human Rights (‘the right to life’) by working

together with coronets to ensure as far as possible that the full facts are

brought to light and any relevant failing is exposed, any commendable

action or practice is identified, and any lessons from the death are made

clear.

Clinical review template —Non foreseeable death

Version 1.0 June 2018

2 D2

Non

418605bdd01d47659e207caa74ba7d90-3

D3

The aims of the clinical review are to:

• Establish the circumstances and events surrounding the death,

especially as regards management of the individual by the relevant

service or services, but including relevant outside factors.

• Examine relevant health issues and assess the clinical care.

• Examine whether any change in operational methods, policy, and

practice or management arrangements would help prevent a

recurrence.

• Identify any root causes that inform the identification of learning

opportunities.

• Make SMART (Specific, Measurable, Achievable, Realistic and

Timely) recommendations for the health community and service.

• Provide explanations and insight for the bereaved relatives to aid

understanding of care whilst in custody or detention.

• Identify any good practice to support improvement work across the

criminal justice system.

2. Methodology

Level 2 — a single clinical reviewer carrying out a review of records, interviews

with healthcare staff at the establishment and report. Some self-inflicted

deaths can involve individuals with complex health needs and may require an

expert review of a particular element of their healthcare, such as a forensic

psychiatrist and drug misuse and dependence.

Due to the circumstances and information available regarding the deceased

this Clinical Review report is a level 2: a single clinical reviewer carrying out a

review of records, telephone interviews with healthcare staff at the

establishment and report.

The assigned Prisons and Probation Ombudsman’s investigator for this

review is Steve Lusted I Senior Investigator.

Table 1

below details documentary evidence reviewed.

Documents relating to

healthcare

Date published/version

number

Documents for evidence of healthcare provision

SystmOne electronic patient record received 216 pages from 2.2.10 to

23.4.20 and include tasks & electronic care 12.2.20

plans

Clinical review template — foreseeable death

Version 1.0_June 2018

3 D3

Non

418605bdd01d47659e207caa74ba7d90-4

D4

Healthcare Provider Initial review! 72 hour 31 .03.2020

review report

Substance Misuse!Use Services records and or None

additional mental health records [add which

other records reviewed]

The clinical reviewer will report on the quality of records management in line

with NMC Code of Conduct and GMC Good Medical Practice Guidelines and

Health Care Professional Council (HCPC) Standards of conduct, performance

and ethics.

In addition to the documents reviewed, interviews were also conducted by

telephone with Kerry Martin, Head of the healthcare team at HMP Highdown

Francois Victoire, Nurse Access Role at HMP Highdown.

Interviews were conducted by the clinical reviewer and contemporaneous

notes of the responses were recorded.

The report is written based on documentary evidence and information

ascertained from interviews with clinical staff and discussions with the

assigned Prisons and Probation Ombudsman’s investigator.

The family of Mr. Saul Altal wished the following issues to be considered in

relation to clinical care

Bruising to head and spine.

The post mortem report does not indicate such bruising:

The neck structures soft tissues showed no evidence of bruising or other

injury.

Reflection of the scalp revealed no evidence of bruising or other injury.

Appendix A — chronology

of clinical events leading up to death.

3. Clinical Reviewer

I am Dr Peter Saunders, the Clinical Reviewer who has reviewed the case and

written this report.

My qualifications are BSc., MB ChB, MRCGP, DRCOG

My professional experience -

I have been a GP for over 30 years based in Bristol.

Clinical review template —


foreseeable death

4 D4

Non

E1

418605bdd01d47659e207caa74ba7d90-5

D5

I am also a Performance Assessor for the General Medical Council; a Case

Investigator for NHS England; an Appraiser and Senior Appraiser for GP

Appraisal for NHS England South.

I have undergone NCAS Case investigation training and have had follow up

training from NHS England and NCAS as a clinical reviewer in Deaths in

Custody. I have also undertaken training in Performance assessment by the

GMC with biannual follow up training.

I

have current professional registration with GMC.

4. Conflict of interest statement

I confirm there are no actual or potential conflicts in my carrying out this

clinical review. I have not previously worked at HMP Highdown either in

my capacity as a qualified healthcare professional or in any other

employed or voluntary capacity.

5. Clinical Care

It should be noted that the medical records are named Saul Turner rather than

Saul Altal (SA).

a. Outline medical history

Mr. Altal entered HMP Highdown from the community on 8.1.2020. He had a

long history of incarceration at other establishments and had been released

from HMP Guys Marsh in May 2019.

Mr. Altal’s significant medical history was:

• Depression and Dysthemia (persistent depressive disorder) for many

years both in prison and in the community

• Substance Misuse (mainly Cannabis and Spice) for many years both in

prison and in the community

Mr. Altal’s regular medications included:

• Mirtazepine and Vaiproate (antidepressants)

Mr. Altal was also under the care of:

• Dr Adrian Feeney — consultant

psychiatrist

Mr. Altal had been an inmate for other offences in various prisons. The last

sentence was served at HMP Guys Marsh and he was released May 2019.


Version 1.0 June 201$

foreseeable death

5

D5

Non

he

418605bdd01d47659e207caa74ba7d90-6

D6

During that admission at HMP Guys Marsh he had significant mental health

issues and was at times managed under an ACCT. He had attempted suicide.

He had also built up significant debt due to his use of Spice.

On 8.1.20 entries in the SystmOne record by Niamh FUGILL (Health

Professional Access Role) confirm that the first reception screening was

undertaken on admission to HMP Highdown.

b. Reception Screen

The reception screen carried out by Niamh Fug ill (health professional access

role) was comprehensive and revealed:

• Low mood and previous mental health issues, but no current thoughts

of suicide or self-harm. An ACCT was declined by SA and not opened.

He admitted to previous “chronic depression” and a “nervous

breakdown” in 2011.

• Mr. Altal admitted previous drug use, but no injecting drug use

• That he was an ex-drinker — denied any alcohol consumption and

therefore Audit C was not carried out.

• He was a non-smoker.

• He was not offered referral to substance misuse services, but he

admitted to Cannabis and Spice usage

He was referred to Mental Health Services (MHS)

c. Full health assessment

He was prescribed Zopiclone (sleeping tablet), by the GP, for 3 days to aid his

sleep. He was not referred to the GP for an appointment.

He was seen by the psychiatrist DrA Feeney on 15.1.2020.

He did not attend his appointment for a secondary health assessment. He

was not sent another appointment for this secondary screening.

At interview the Head of Healthcare stated that this was due to him being

reviewed daily on the Healthcare Unit and that the same questions would be

asked during these reviews. However, there is no record of completion of the

secondary care template or the questions on it being asked, nor any answers

recorded.

This did not therefore comply with NICE Guidelines (NG 57).

d. Physical care



foreseeable death

6 D6

Non

and

when

418605bdd01d47659e207caa74ba7d90-7

D7

During his time at HMP Highdown Mr. Altal did not complain of any physical

health issues.

He therefore was not seen by the GP while in HMP Highdown —

reviewed by the psychiatrist regularly.

e. Mental Health and Wellbeing

but

was

Mr. Altal had a long history of mental health problems both during his time in

prison and in the community.

He was referred promptly to Mental Health services after the reception screen

at HMP Highdown, and he was reviewed regularly by the psychiatrist who

confirmed his diagnoses of acute depression with Dysthemia.

He was treated with anti-depressants.

At all times Mr. Altal denied any thoughts of self-harm or suicide and it was

not deemed appropriate to open an ACCT — he himself declined this.

The psychiatrist reviewed him appropriately and comprehensively on 3

occasions, and another member of the mental health team also assessed his

needs.

He was initially prescribed the anti-depressant Mirtazepine

He was discharged from the HCU, after a final assessment by Dr Feeney on

29.1.20

f. Mental Capacity Act

During his psychiatric and mental health team assessments no capacity

issues were highlighted.

g. Assessment and access to secure Mental Health Transfer

N/A

h. Substance Misuse

Mr. Altal admitted to extensive previous drug misuse (both in prison and in the

community) on several occasions:

• At his reception screen

• To the nurse reviewing him on HCU — it was also noted he

appeared to be under the influence of

• During his psychiatric assessments



foreseeable death

7 D7

Non

418605bdd01d47659e207caa74ba7d90-8

D8

but he was not at any time referred to Substance Misuse Services

During his assessments on HCU, NEWS scores were frequently calculated.

i. Other vulnerabilities

N/A

j. Other clinical issues and care such as missed appointments and

follow-up

N/A

6. Key Findings of fact and Issues of Concern Relating to Healthcare

Cause of Death

1 a Coronary Artery Thrombosis

1 b Coronary Atheroma

2 5F-MDMB-PICA (Spice) Toxicity

a. Physical Healthcare

Mr. Altal had no physical health issues during his time in HMP Highdown.

Although the post mortem examination revealed coronary artery disease, at

no time during his time in prison did Mr. Altal complain of chest pain or any

other symptoms related to coronary artery disease. There would be no reason

therefore to suspect coronary heart disease in this case.

However, a concern is noted that NICE Guidance was not followed when

he did not receive a formal secondary Health Screen.

b. Mental healthcare

Mr. Altal was referred promptly to mental health services at his reception

screen and he was reviewed comprehensively (including his previous

psychiatric notes) by the psychiatrist.

He was also reviewed by another member of the mental health team with a

view to continuing these reviews when he was discharged from Healthcare.

He was prescribed anti-depressants and this medication was reviewed

appropriately.



foreseeable death

$ D8

418605bdd01d47659e207caa74ba7d90-9

D9

c. Substance misuse care

Despite a history of drug misuse mainly with Psychoactive substances (Spice)

and cannabis, Mr. Altal was not referred to Substance Misuse services during

his time in HMP Highdown.

At one review in HCU (on 9.1.20) a nurse noted that he may have been under

the influence of a substance. At interview the nurse confirmed that he wasn’t

acting “normally” and was irritable. The nurse noted that he may have used

cannabis or Spice before coming into prison and that although he was a

known drug user he would not refer Mr Altal to SMS under these

circumstances.

He stated that he would review him the following day when a “clearer picture”

could be appreciated, but that there was “nothing to indicate” a referral should

have been made. There is no record in the notes of a subsequent assessment

on the following days to obtain this “clearer picture”.

Even though he denied drug use on several occasions, a concern is

noted that despite a clearly documented drug misuse issue, and an

observed occasion when he appeared to be under the influence of a

substance and was not acting normally, he was not offered a referral to

Substance Misuse Services.

The post mortem report revealed the presence of 5F-MDMB-PICA (Spice)

toxicity and it is noted by the pathologist that:

the presence of the Spice had played a part in death by increasing heart

rate and myocardial ischaemia in a man with underlying coronary heart

disease, and increasing the risk of the development of a fatal arrhythmia in

the presence of a coronary artery thrombus.

Thus a referral to Substance Misuse services, or a discussion with Mr. Altal

about such a referral, would have been pertinent here.

d. Other vulnerabilities

N/A

e. Other clinical issues

N/A

7. Custodial management and Partnership working

N/A

Clinical review template — Non foreseeable death


9 D9

Non

418605bdd01d47659e207caa74ba7d90-10

D10

a. Information sharing

N/A

b. Prison regime and escorts to internal clinics and any impact for

individual accessing healthcare

N/A

c. ACCT/ACDT process and healthcare role and input

Mr. Altal had been managed under an ACCT during previous prison

admissions but during this admission he consistently denied any thoughts of

self-harm or suicide and an ACCT was not deemed necessary. Mr Altal also

declined the opening of an ACCT.

d. Health care input into restraints risk assessment

N/A

e. Escort and bed watch and impact on timely attendance to external

healthcare appointments

N/A

f. Emergency Response

When Mr. Altal was discovered unresponsive a Code Blue was called

appropriately. Staff responded quickly and he was positioned on the floor and

defibrillator pads were attached.

Although he may have been deceased some while, it was appropriate to start

CPR at this stage.

No shockable rhythm was identified and CPR commenced.

It was however, quickly realised that he had significant signs of rigor mortis,

with post mortem skin discolouration, and life support measures were

appropriately discontinued.

g. Social Care needs (including any physical health needs)

Nil

h. Location

He was admitted to the Healthcare Unit (HCU) at admission to HMP Highdown.

At interview Head of Healthcare stated this was because he was distressed and

Clinical review template — foreseeable death


10 D10

Non

418605bdd01d47659e207caa74ba7d90-11

D11

dishevelled and it was thought that he could be better supported on the unit than

on the wing. He was reviewed by the psychiatrist who concurred — until he was

stable when he was discharged from healthcare.

This discharge took a few days to find a suitable placement on the wings and he

was discharged to a shared cell on 5.2.20. He died that night in the cell.

It is noted that during his whole time on the HCU he was observed hourly during

day and night. Head of Healthcare stated these were visual observations (and

required a light to be switched on at night), and that this was standard practice at

HMP Highdown when a prisoner was on the HCU.

It is noted that hourly checks are not standard practice at other institutions

and could be considerably disruptive to sleep and maintaining normal daily

activities. This could also affect mental health. Mr. AItal complained that

these observations were indeed disrupting his sleep.

I. Clinical hold and recommendations

N/A

8. Key findings of fact and issues of concern

Mr Altal was in HMP Highdown for one month before his death. He was

located on the Healthcare unit for all of this time except the final night, during

which he died.

His mental health issues were identified promptly at intake and he was

referred to, and managed by, the Mental Health Team and the Psychiatrist.

His care was comprehensive and of a good standard.

He did not have any physical health issues during his admission.

A concern is noted that he did not receive a formal secondary health

screen along NICE Guidelines.

Mr. Altal admitted to significant drug misuse issues while at other prisons and

in the community but denied any illicit drug use in HMP Highdown during his

frequent assessments. However, he was noted to be possibly under the

influence of a substance on one occasion.

5F-MDMB-PICA (Spice) was discovered in the toxicological analysis of his

blood and may have contributed to his demise.

A concern is noted that despite a significant recent history of drug

misuse (in a previous prison and in the community), and an observation

of possible drug use, he was not referred to the Substance Misuse

Services.



foreseeable death

11 D11

Non

418605bdd01d47659e207caa74ba7d90-12

D12

9. Conclusion

Having reviewed the clinical care extended to Mr. Saul Altal, I consider that

the care received was of a reasonable standard and was equivalent to that

which would have been received in the wider community.

JO.

Recommendations

Head of Healthcare should:

• Review the protocol around carrying out a secondary health screen for

those admitted to the Healthcare unit.

• Review the policy around referral to Substance Misuse Services when

a prisoner admits to previous drug misuse issues and/or is observed to

be possibly under the influence of an illicit substance.

• Review the policy of hourly observations when a prisoner is on the

Healthcare Unit, taking into account policies in other establishments.

Other findings to bring to the attention of the NHS England

Commissioning Team (healthcare commissioners)

Nil

Other recommendations

N/A



foreseeable death

12 D12

. in

418605bdd01d47659e207caa74ba7d90-13

D13

of relevant events

Chronology

Annex A —

Date Time Event Location Name Source (eg IMR)

Summary of previous prisons’ events

2017 Long offending history and was transferred into HMP Medical records

HMP Rochester. Depression and on Mirtazapine. Rochester

Known user of drugs in prison. Suicide attempt

Dec 2017 in segregation. On ACCT and

constant watch. Seen by psychiatrist and

diagnosed with depression and dysthymia with

co-morbid cannabis/spice use. To be managed

by in-reach team. Medication review and Na

Valproate added. Has built up debt due to Spice

usage

Jan 2018 Further threat of self-harm but later rescinded HMP Medical Records

this and ACCT closed Rochester

16.2.18 HMP TIDY, Michael (Mr) Medical Records

Rochester (Nurse Access

Role)

March & Transfer to HMPYOI Stoke Heath. Review by HMPYOI Medical Records

April 2018 Mental Health team and taken onto caseload. In Stoke

segregation. Low mood — food and medication Heath

refusal - ACCT opened in April (hourly obs).

ACCT closed later when started eating. Transfer

to HMPYOI Portland on health wing — stated

feeling well and not requiring input from MH

team. No thoughts of self-harm.

foreseeable death

Non


Version.061 $0917

I—’

I-)

D13

418605bdd01d47659e207caa74ba7d90-14

D14

19.4.18 Reviewed by Psychiatrist and reported feeling South DrJKAppleyard Medical Records

better. Not suicidal. Subjectively not depressed Staffs NHS (Consultant

and Valproate discontinued. Trust Psychiatrist)

HMPYOI Medical Records

he

September In segregation unit after “injury to inmate” —

2018 flooded his cell. No thoughts of suicide or self- Portland

harm

October Transfer to HMP Guys Marsh. Suicide attempt HMP Guys Prison Officer Medical Records

2018 on 27.10.18 and put on ACCT. Reviewed by Marsh Woodbridge

mental health team. Self-isolating in cell but

Reception Screening — previous mental health using Spice again. Declined to engage with Medical Officer A.

Substance misuse team Hampshire

May 2019 Discharge from Prison. HMP Guys Medical Records

Marsh

Medical Records

8.1.20 HMP FUGILL, Niamh Medical Records

issues discussed. Feeling low in mood and Highdown (Miss) (Health

feeling hopeless but no thoughts of self-harm or Professional

suicide. Declines and ACCT and ACCT not Access Role)

opened. No medication repeat required. Ex

drinker — no Audit C — and non-smoker. Drug

use (Cannabis and Spice) in community but no

injecting — no record of referral to Substance

misuse service (SMS). BP normal. Referred for

Mental Health services (MHS) assessment and

to GP. Admitted to Health Care Unit (HCU). On

hourly observations.

foreseeable death

Non


Version.061 $0917

14

D14

i1

418605bdd01d47659e207caa74ba7d90-15

D15

engaging with HMP VICTOIRE, Medical Records

not

9.1.20 Reviewed on HCU —

15

assessment but has history of persistent Highdown Francois (Nurse

depressive disorder (dysthemia). Had been Access Role)

treated with valproate and mirtazapine in prison.

Referred to psychiatrist for assessment and 1 :1

support provided with information about help e.g.

Samaritans, chaplain etc. Appeared agitated and

confused? drug use. Zopiclone prescribed by GP

for 3 nights only.

release from HMP Guys Marsh HMP TAFIRENYIKA, Medical Records

after

9.1.20 Review —

last year did not receive support and was • Highdown Stellah (Health

homeless, no financial support and relationship Professional

broke down. Very low mood and feeling Access Role)

hopeless. Reports hearing voices in head,

arguing. Denies self-harm. Advice on alcohol —

but denies any alcohol intake recently. Referred

to smoking cessation service as using electronic

cigarette. Denies any drug misuse but doctor

noted previous issues in prison. Not referred to

SMS. He was looking somewhat confused,

appeared to be under substance influence.

Daily routine assessments during January while HMP Medical Records

on HCU continue but no issues highlighted Highdown

routinely. BP and NEWS recorded. Reported to

come out of cell for association and behaviour

was normal. Not regularly cleaning his cell and

sometimes not showering.

foreseeable death

Non


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and asking for further HMP TAFIRENYIKA, Medical Records

denied. Denies any intention of self- Highdown Stellah (Health

14.1.20 Review - Agitated

Zopiclone —

harm. Professional

Access Role)

15.1.20 Comprehensive review by psychiatrist and of HMP FEENEY, Adrian Medical Records

previous notes. History of psychoactive Highdown (Health

substance use in prison but claimed no recent Professional

alcohol or drug use. Assessed in 2018 for Access Role)

initially

recurrent depression and dysthymia —

referred for counselling then started Mirtazepine

in 2018. Previously prescribed valproate.

Irritable and again mentioned voices — but not

threatening. Not clearly depressed and no

thoughts of self-harm or suicide but

recommended to restart Mirtazepine (30mg od) —

not IF — referred to mental health for psychiatrist

consultation and to be discussed in Mental

Health team meeting.

15.1.20 He did not attend his secondary health screen

?was a further appointment sent

21.2.20 Review and medication review. Rapport better HMP FEENEY, Adrian Medical Records

and less brittle in interaction. Mood scored at Highdown (Health

3/10 and no thoughts of self-harm since in Professional

prison. No effect of Mirtazepine at this stage. Access Role)

Claimed to have been purposely arrested to get

help with mental health. Mental health review

expedited.

16


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26.1.20 HMP BOSU, Kwaku (Mr) Medical Records

‘ mood

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Highdown (Nurse Access

Role)

Review of mental health and risk assessment

completed — occasional unpredictable mood and

behaviour. No thoughts of self-harm or suicide.

No safeguarding issues. No evidence of selfneglect

or substance misuse. Comprehensive

review of personal (patient held) Care Plan for

personal care in place. Compliant with

Mirtazepine medication. Is self-caring but

requires prompting to maintain good standard of

personal hygiene. Stated in good physical

health. Encouraged to maintain social skills.

Hourly observations continue in healthcare unit.

in mood and showered. HMP BROWN, Beverly Medical Records

Highdown (Nurse Access

Role)

brighter

28.1.20 Review —

29.1.20 Comprehensive review by psychiatrist. No HMP FEENEY, Adrian Medical Records

evidence of psychosis; no thoughts of self-harm; Highdown (Health

has lifted and is euthymic. To be Professional

discharged from HCU Access Role)

Daily routine assessments while on HCU. No HMP Medical Records

concerns highlighted. Hourly observations Highdown

continue until discharge from HCU.

5.2.20 Discharged from HCU to wing in double HMP BROWN, Beverly Medical Records

occupancy cell. Highdown (Nurse Access

Role)

6.2.20 9.09 Code Blue called. Attended cell and noted that HMP MILES, Verity (Mrs) Medical Records

he was in rigor mortis when moved off top bunk. Highdown (Health

CPR commenced though and defibrillator pads

foreseeable death

Non


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attached. No shockable rhythm. During the CPR Professional

discussion about rigor mortis and decided with Access Role)

in-house paramedic to discontinue life support

and life extinct. Dr Gareth Ruse confirmed life

extinct at 09.18

6.2.20 Arrived while CPR in motion and visible rigor HMP BAKHT, Ana (Miss) Medical Records

mortis with arms in flexion, post-mortem staining Highdown (Health

and no spontaneous breathing or heart sounds Professional

with fixed dilated pupils. Decided life extinct at Access Role)

09.15 and CPR discontinued, ambulance arrived (Paramedic)

and confirmed asystole with ecg rhythm strip and

confirmed life extinct.

Telephone Interviews

5.5.20 Reception Screen HMP Kerry Martin —

He was known to use drugs both in prison and Highdown Head of Healthcare

outside but no referral to Substance misuse

services (SMS) at reception screen. Please

comment.

It would normally be standard practice to refer

such a person to SMS but this did not happen.

He was adamant he was clean from drugs

though.

Location on HCU

He was admitted to Healthcare Unit (HCU) from

reception — why was this? Why was he kept on


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HCU for the month? Why did he require hourly

observations for the whole month?

H (

H:: v/H IC’ HECOfl1E3

Secondary Health Screen

DNA on 15.1.20 — what was the outcome and

would another appointment have been offered?

: r1jR;


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foreseeable death

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visits and it was possibly felt to be less important

to complete the template formally.

19.5.20 You noted he may have been under influence of HMP Francois VICTOIRE

substance/drugs on 9.1.20 and that he had a Highdown (Nurse Access

previous drug problem, but not offered referral to Role)

Substance Misuse services (SMS). Please

comment.


Version.06 180917

Non

foreseeable death

i1

20

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21

foreseeable death

Non


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Prisons &

Probation

Ombudsman

Independent Investigations

Independent investigation into

the death of Mr Saul Altal (aka

Turner), a prisoner at HMP High

Down, on 6

A report by the Prisons and Probation Ombudsman

Third Floor, 10 South Colonnade Email mafl@ppo.gov Uk T 102076334100

Canary WharI London E14 4PU Web www ppo.gov.uk P10207633 4141

LII

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%, I

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Our Vision

To carry out independent investigations

to make custody and community

supervision safer and fairer.

Our Values

We are:

Impartial: we do not take sides

Respectful: we ai’çQnsiderate and courteous

Inclusive: we value diversity

Dedicated: we areetrmined and focused

Fair: we are hpnesand act with integrity

CCL

© Crown copyright 2020

This publication is licensed under the terms of the Open Government Licence v3.O except where otherwise

stated. To Aew this licence, Asit nationalarchies. gov. uk/doc/o pen -g overnme nt-licence/ye rsion/3 or write

to the Information Policy Team, The National Archies, Kew, London 1W9 4DU, or email:

psi©nationalarchiesgsigov. uk.

Where we ha identified any third-party copyright information you will need to obtain permission from the

copyright holders concerned.

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The Prisons and Probation Ombudsman aims to make a significant contribution to safer,

fairer custody and community supervision. One of the most important ways in which we

work towards that aim is by carrying out independent investigations into deaths, due to

any cause, of prisoners, young people in detention, residents of approved premises and

detainees in immigration centres.

My office carries out investigations to understand what happened and identity how the

organisations whose actions we oversee can improve their work in the future.

Mr Saul Altal, who also used the surname Turner, died from heart failure linked to drug

use on 6 February 2020 at HMP High Down. Mr Altal was 36 years old. I offer my

condolences to Mr Altal’s family and friends.

The post-mortem found that he had a significant level of heart disease. He spent

almost all his four weeks in prison in High Down’s healthcare centre while his mental

health was assessed. No symptoms of heart disease were observed and he did not

complain of any.

We are satisfied that the healthcare Mr Altal received at High Down was equivalent to

that he could have expected in the community.

We do, however, have some concerns, although we do not consider that they

contributed to his death. We are concerned that Mr Altal did not have a secondary

health screen, although it is unlikely that this would have picked up his heart disease.

We are also concerned that, despite staffs suspicion that Mr Altal had taken drugs and

his history of substance misuse, no one submitted an intelligence report and he was not

referred to substance misuse services for sLipport.

We are also concerned that the officer who unlocked Mr Altal’s cell on 6 February did

not check on his welfare as he should have done. This did not affect the outcome for

Mr Altal as he had been dead for some hours when he was found. ft could, however,

make a significant difference in other cases.

Sue McAllister, CB

Prisons and Probation Ombudsman September 2020

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Contents

Summary .1

The Investigation Process 3

Background Information 4

KeyEvents 6

Findings 10

Annexes

1. Clinical review

Transcripts of interviews with:

2. Mr Gary Stevens, prison officer

3. Mr Jason Willis, prison officer

Notes of interviews with:

4. Mr Victoire Francois, nurse

5. Mr Tommy Gurney, prisoner

6. Ms Kerry Martin, Head of Healthcare

7. Mr Jack Ripley, prisoner

8. Mr Matthew WaltersKitson, prisoner

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Summary

Events

1. Mr Saul Altal was remanded to HMP High Down on 8 January 2020, charged

with burglary. He had been in prison before.

2. At a reception health screen, Mr Altal said he had not used drugs recently, so he

was not given a drug test. He was concerned about his mental health, so was

admitted to the healthcare centre for assessment. The next morning, a nurse

tried to assess him, but MrAltal was possibly under the influence of something

and was abusive. The nurse referred him to a psychiatrist, but did not refer him

to substance misuse services or submit a security intelligence report.

3. On 15 January, Mr Altal saw the psychiatrist., who prescribed antidepressants

and said that he should remain in the healthcare centre for further assessment.

That afternoon, Mr Altal did not go to his secondary health screen. There is no

evidence that staff followed this up.

4. When the psychiatrist assessed him again the following week, Mr Altal did not

report any improvement in his mood. The doctor assigned someone from the

mental health team to work with him when he left the healthcare centre.

5. When he saw the psychiatrist on 29 January, Mr Altal said that his mood had

lifted. The doctor recorded that he no longer needed to remain in the healthcare

centre. When a suitable cell became available on 5 February, Mr Altal was

moved to a shared cell on a standard prison wing.

6. Mr Altal was unwell during the night. His ceilmate asked him if he was alright,

and Mt Altal said that he was being sick.

7. In the morning, a prison officer unlocked the cell, but Mr Altal did not wake up.

His cellmate told a prison officer that Mr Altal had been unwell and might need to

see a nurse at some point. After about an hour, Mr Altal’s cellmate called

another prisoner to check on him, and this prisoner raised the alarm. Staff

responded and attempted to resuscitate Mr Altal, but coLild not do so.

Findings

Healthcare

8. The clinical reviewer considered that the healthcare Mr Altal received was

equivalent to that which he could have expected in the community.

9. The post-mortem found that MrAltal had heart disease which contributed to his

death. He was being observed in the healthcare centre for four weeks before he

died. Healthcare staff did not observe any symptoms of heart failure and Mr Altal

did not complain of any.

10. Mr Altal did not attend his appointment for a secondary health screen. We share

the clinical reviewer’s concern that this was not followed up, a matter we have

drawn to the Head of Healthcare’s attention in previous investigations. However,

we do not consider that it would have altered the outcome in this case.

Prisons and Probation Ombudsman

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Substance misuse

11. Post-mortem reports found that Mr Altal had traces of synthetic cannabinoids in

his system when he died, which indicated relatively recent use.

12. Despite a nurse’s suspicion that he might be under the inflUence of something

and his history of substance misuse, no one referred him for support with his

substance misuse. We are also concerned that the nurse did not report her

suspicions to the security department.

Unlock procedures

13. When officers unlock cells, they should check on a prisoner’s wellbeing. The

officer who unlocked Mr Altal on 6 February, did not do so. Although this did not

affect the outcome for Mr Altal, it could make a significant difference in other

cases.

Recommendations

• The Head of Healthcare should ensure that all new prisoners are offered a

secondary health screen. If they do not attend, there should be a follow up

process and this should be reflected in the monthly audits.

• The Governor and the Head of Healthcare should ensure that all staff are aware

of their responsibilities to tackle the use of illicit drugs, including submitting

intelligence reports and referring prisoners to substance misuse services where

appropriate.

• The Governor should ensure that staff are aware of their responsibility to ensure

prisoners’ welfare at unlock.

• The Governor should share a copy of this report with Officer Willis and arrange

for a senior manager to discuss the Ombudsman’s findings with him.


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The Investigation Process

14. The investigator, Mr Steve Lusted, issued notices to staff and prisoners at HMP

High Down informing them of the investigation and asking anyone with relevant

information to contact him. No one responded.

15. Mr Lusted visited High Down in February 2020. He obtained copies of relevant

extracts from Mr Altal’s prison and medical records.

16. Mr Lusted interviewed two members of staff and three prisoners at High Down.

NHS England commissioned Dr Peter Satinders to review Mr Altal’s clinical care

at the prison. Dr Saunders interviewed two members of High Down staff.

17. We informed HM Coroner for Surrey of the investigation. He gave us the results

of the post-mortem examination. We have sent the coronet a copy of this report.

18. One of the Ombudsman’s family liaison officers, Ms Lizzie Laing, contacted Mr

Altal’s mother to explain the investigation and to ask if she had any matters she

wanted the investigation to consider. Solicitors representing Mr Altal’s mother

asked about bruising to his head and spine. They also asked for the dates that

Mt Altal was in the healthcare unit and the rationale for this. We have addressed

these questions in this report.


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Background Information

HMP High Down

19. HMP High Down is a local prison in Surrey, which holds up to 1 ,1 50

men. Central and North-West London NHS Foundation Trust provides primary

health services and in-reach mental health care. The healthcare unit has

inpatient facilities with 24-hour nLlrsing cover.

HM Inspectorate of Prisons

20. The most recent full inspection of HMP High Down was in May 2018. Inspectors

reported that drugs were easily available. They were particularly concerned

about the prevalence of psychoactive substances (PS). Governance and

partnership arrangements for healthcare were good. Demands for mental

healthcare were high but services were good. Nurses and prison officers in the

healthcare unit worked collaboratively to deliver respectful care.

Independent Monitoring Board

21. Each prison has an Independent Monitoring Board (1MB) of unpaid volunteers

from the local community who help to ensure that prisoners are treated fairly and

decently. In its latest annual report, for the year to December 201 9, the 1MB

reported that prisoners said that drugs were easily available in the prison. There

had been a 68% increase in reported drug finds.

Previous deaths at HMP High Down

22. Mr Altal was the ninth prisoner to die at High Down in the last two years. Five of

the previous deaths were due to natural causes and three were self-inflicted. We

have previously identified an issue over staff failing to check prisoners’ wellbeing

when unlocking cells. We have also made a recommendation about prisoners

receiving secondary health screenings. We found both these issues relevant

again in this investigation.

Assessment, Care in Custody and Teamwork

23. ACCT is the Prison Service care-planning system used to support prisoners at

risk of suicide or self-harm. The purpose of ACCT is to try to determine the level

of risk, how to reduce the risk and how best to monitor and sLipervise the

prisoner.

24. After an initial assessment of the prisoner’s main concerns, levels of supervision

and interactions are set according to the perceived risk of harm. Checks should

be irregular to prevent the prisoner anticipating when they will occur. There

should be regular multi-disciplinary review meetings involving the prisoner. As

part of the process, a caremap (plan of care, support and intervention) is put in

place. The ACCT plan should not be closed until all the actions of the caremap

have been completed.

25. All decisions made as part of the ACCT process and any relevant observations

about the prisoner should be written in the ACCT booklet, which accompanies


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the prisoner as they move around the prison. Guidance on ACCI procedures is

set out in Prison Service Instruction (PSI) 64/2011.

Psychoactive Substances (PS)

26. Psychoactive substances, previously known as ‘legal highs’, are a problem

across the prison estate. They are difficult to detect and can affect people in a

number of ways including increasing heart rate, raising blood pressure, reducing

blood supply to the heart and vomiting. Prisoners under the influence of PS can

present with marked levels of disinhibition, heightened energy levels, a high

tolerance of pain and a potential for violence. Besides emerging evidence of

such dangers to physical health, there is potential for precipitating or

exacerbating the deterioration of mental health with links to suicide or self-harm.

27. In July 2015, we published a Learning Lessons Bulletin about the use of PS and

its dangers, including its close association with debt, bullying and violence. The

bulletin identified the need for better awareness among staff and prisoners of the

dangers of PS; the need for more effective drug supply reduction strategies;

better monitoring by drug treatment services; and effective violence reduction

strategies.

28. HMPPS now has in place provisions that enable prisoners to be tested for

specified non-controlled psychoactive substances as part of established

mandatory drugs testing arrangements. HMPPS continue to analyse data about

drLlg use in prison to ensure new versions of PS are included in the testing

process.


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Key Events

29. Mr Saul Altal was remanded to HMP High Down on 8 January 2020, charged

with burglary. He was Lising the surname Turner at the time. He had been in

prison before and was on licence when arrested. His licence was subsequently

revoked.

30. At an initial health screen with Nurse Niamh Fugill, Mr Altal said that he had had

contact with a mental health team that morning in police custody, and they had

recommended that he be held in the healthcare centre. He said he had used

drugs in the past, but not for some time, apart from cannabis. He expressed

concerns about his mental health, and Nurse Fugill arranged for him to be

admitted to the healthcare centre for review.

31. The next morning, Nurse Francois Victoire recorded that Mr Altal was under the

influence of an illicit substance. Nurse Victoire noted Mr Altal’s history of

depression and drug use, but had to stop the assessment when Mr Altal became

verbally abusive. He referred him to the psychiatrist for further assessment.

32. That evening, Nurse Ste(lah Tafirenyika assessed Mr Altal. He told her that he

felt low and had trouble sleeping. He said he did not use drugs or alcohol,

though Nurse Tafirenyika noted that his record suggested this was not true. He

said that he had been hearing voices for the previous six months. Nurse

Tafirenyika confirmed that he had been referred to the psychiatrist.

33. Prisoners in the healthcare unit are checked hourly. Records indicate that over

the following days Mr Altal slept well at night. During the day, he came out of his

cell and mixed with other prisoners in the day room. Although he had minimal

interaction with staff, they had no concerns about him.

34. On 15 January, Mr Altal saw the psychiatrist, Dr Adrian Feeney. Dr Feeney

noted that Mr Altal was not very co-operative. He said that he heard voices, but

the doctor did not think it likely that these were hallucinations. Nor did he think

that Mr Altal was clearly depressed, though he described him as very irritable. Dr

Feeney prescribed mirtazapine (an antidepressant) and said that Mr Altal should

remain in the healthcare centre for a further week and be reassessed. That

afternoon, Mr Altal did not attend an appointment for a secondary health screen.

35. On 21 January, Dr Feeney assessed Mr Altal again. Mr Altal did not report any

improvement in his mood despite a week of taking mirtazapine. Dr Feeney noted

that he would assign someone from the mental health team to provide ongoing

support when Mr Altal was discharged from the healthcare centre. In the

meantime, Dr Feeney said he should remain in the healthcare centre for at least

a further week.

36. Over the next few days, Mr Altal slept well, but did not interact much with either

staff or prisoners. He took his medication as directed, and staff had no concerns

about his physical health. When Mr Altal saw Dr Feeney again on 29 January,

he said he felt better. He was due to appear in court after 10 February, and said

he intended to plead guilty. Dr Feeney noted that Mr Altal did not appear to be at

risk of self-harm and his mood had lifted. He recorded that Mr Altal no longer

needed to be located in the healthcare centre. That afternoon, Mr Reddy


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Naghee introduced himself to Mr Altal as his care co-ordinator for after his

discharge from the healthcare centre.

5 to 6 February

37. On the evening of 5 February, Mr Altal was discharged from the healthcare

centre. He arrived at Houseblock 3 at 513pm, and was put into a shared cell

with Mr Tommy Gurney. Mr Gurney told the investigator that Mr Altal did not look

well and was pale. He arrived in the cell after everyone had been locked up for

the evening. Mr Altal said that he had a problem with drugs, and Mr Gurney said

that his appearance confirmed this.

38. Mr GLirney took his own medication and went to bed on the bottom bunk at about

1000pm. When he went to bed, Mr Altal was still awake, sitting in a chair.

39. Mr Gurney said that Mr Altal disturbed him a few times in the night by moving

about. More than once, Mr Gurney heard him being sick in the toilet. At one

point he asked Mr AltaT if he was airight, and Mr Altal replied, ri just feel ill and

am throwing up.”

40. High Down told the investigator that they cocild not provide cell bell records for

that night because of a technical fault. Mr Gurney told the investigator that he did

not press the cell bell during the night, and assumed that Mr Aital would press

the bell if he needed to.

41. At approximately 800am, Officer Jason Willis unlocked the cell. CCIV footage

showed that he put his head inside the doorway but did not go into the cell.

Officer Willis said that Mr Altal appeared to be asleep. Mr Gurney came out of

the cell and spoke to Officer Willis. Officer Willis said that Mr Gurney told him

that Mr Altal had kept him awake going back and forth between his bed and the

toilet all night. Officer Willis said that he glanced into the cell and saw Mr Altal

lying in bed, and presumed he was still asleep.

42. Over the next 50 minutes, Mr Gurney kept walking in and oLit of the cell,

preparing himself for a visit. He told another prisoner, Mr Jack Ripley, that he

was concerned that Mr Altal had not moved, and did not seem to be reacting to

loud noises. Mr Ripley went into the cell and looked at Mr Aital. He thought that

Mr Aital was asleep, but his eyes were slightly open. Mr Gurney told the

investigator that he thought Mr Altal was still asleep because he had been awake

all night. Mr Gurney then went for a shower.

43. At the showers, Mr Gurney told Officer Willis that he was worried about Mr Aital,

and thought he might need to see a nurse. Officer Willis was supervising another

prisoner at the time so could not leave. Officer Willis said he did not get the

impression Mr Gurney thought the situation was urgent, so he decided to check

Mr Altal when he was back on the landing. He told Officer Gary Stevens and

Officer Mark Grover that Mr Gurney had mentioned that his celimate had been

unwell and might ask to see a nurse. Officer Willis told the investigator that the

three officers agreed that someone would check Mr Altal once ‘free flow’ (when

prisoners move from their wings around the prison) was over.

44. Mr Gurney spoke to another prisoner when he got back to the wing, Mr Matthew

Walters-Kitson, and said he was concerned about Mr Altai. Mr Walters-Kitson

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went into the cell. He told the investigator that Mr Altal’s eyes were slightly open,

his mouth was open and his lips were dry. Mr Walters-Kitson spoke to him and

touched his shoulder, with no response. He then held the back of his hand to Mr

Altal’s mouth and nostrils, but could not feel any breathing. He shouted, “This

guy’s dead.” Mr Ripley was on the landing outside the cell and COW footage

showed him calling to staff and pointing to the cell. Officer Stevens and Officer

Jess Gardner were nearby and immediately went into the cell.

45. Officer Stevens tried to get a verbal response from Mr Altal but without success.

He touched Mr Altal’s arm, which was cold, and he saw that his eyes were open.

Officer Stevens radioed a code blue emergency (meaning a prisoner is not

breathing or is having difficulty breathing). This prompted the control room to call

an ambulance. Prison records showed that the code blue was called at 909am

and ambulance service records showed that the call was received at 910am.

46. CCTV footage showed that three other prison officers and Nurse Margaret

Sawmy arrived within a minute and went into the cell, shortly followed by further

staff. The prison officers moved Mr Altal and his mattress from the bed onto the

floor. Nurse Sawmy left to get the emergency medical bag.

47. Nurse Verity Miles arrived and began cardiopulmonary resuscitation (CPR)

briefly. Officer Dorian Rodger arrived at the cell and switched on his body-worn

video camera, and Healthcate Assistant (HCA) Simon Triptree applied a

defibrillator (a machine that assesses and, in some circumstances, restarts the

heart). Ms Ana Bakht, a paramedic working in the prison, arrived at the cell. She

noted that Mr Altal had visible rigor mortis and was displaying no signs of life.

Having assessed Mr Altal, she and Nurse Miles agreed that Mr Altal had died

and that CPR should not continue.

48. Dr Gareth Ruse arrived at the cell and pronounced Mr Altal dead at 920am. In

his notes, Dr Ruse said that rigor mortis was apparent and Mr Altal was likely to

have been dead for at least six hours.

Contact with Mr Altars family

49. MrAltal had not giventhe details of his next ofkinwhen he arrived atthe prison.

Officer Maria Killigrew, the prison’s family liaison officer, traced MrAltal’s sister

and broke the news of her brother’s death to her on the telephone. Later that

day, Officer Killigrew travelled with Ms Katie Jefferson, the prison Governor, and

Ms Jane Gosden, one of the prison’s senior managers, to Mr Altal’s mother’s

home and met her and other family members. In line with Prison Service

guidance, High Down offered a contribution to the costs of Mr Altal’s funeral.

Support for prisoners and staff

50. After Mr Altal’s death, Mr Ben Mnyama, the duty governor, debriefed the staff

involved in the emergency response to ensure they had the opportunity to

discuss any issues arising, and to offer support. The staff care team also offered

support.

51. The prison posted.notices informing other prisoners of MrAltal’s death, and

offering support. Staff reviewed all prisoners assessed as being at risk of suicide

or self-harm in case they had been adversely affected by Mr Altal’s death.


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Post-mortem report

52. Post-mortem toxicology tests showed that Mr Altal had traces of ‘Spice’ (a type of

PS) in his system, indicating relatively recent use, and the toxicologist noted that

Mr Altal may have been experiencing the effects of this drug at the time of his

death.

53. The post-mortem report concluded that Mr Altal died as a result of coronary

artery thrombosis (a blood clot in the heart), caused by coronary atheroma (a

build-tip of fatty deposits in the arteries around the heart), with ‘Spice’ (PS)

toxicity as a contributory factor.

54. The pathologist noted that Mr Altal had significant heart disease. He commented

that the use of PS is associated with abnormal heart rhythms and heart attacks,

and that it appeared likely that PS contributed to Mr Altal’s death.

55. The post-mortem report stated that there was no evidence of bruising or other

injury to Mr Altal’s neck or head.

After Mr Altal’s death

56. An intelligence report after Mr Altal had died noted that prisoners on the wing

were overheard discussing Mr Altal’s death. They speculated that Mr Altal must

have taken drugs given to him by someone on the wing the night before he died.

Prisons and Probation OmbLldsman

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Findings

Mr Aftal’s clinical care

57. The clinical reviewer concluded that the clinical care Mr Altal received in prison

was of a reasonable standard and equivalent to that he could have expected to

receive in the community.

58. Mr Altal was promptly referred to mental health services on arrival at High Down,

regularly reviewed by the psychiatrist, and treated with antidepressants. There

were plans in place for ongoing support from the mental health team after he was

discharged from the healthcare unit. He was discharged following advice from

the psychiatrist, once a suitable cell was identified.

59. Mr Atal was observed by healthcare staff for the four weeks that he was

accommodated in the healthcare centre and they recorded no symptoms of heart

disease.

60. National Institute for Health and Clinical Excellence (NICE) guidelines and Prison

Service Order (PSO) 3050, Continuity of Healthcare for Prisoners, set out the

expectation that prisons ensure continuity of care for prisoners. This includes

that all new prisoners should be offered a secondary health screen, equivalent to

a primary care assessment when registering with a new GP in the community.

Mr Altal did not attend his secondary health screen and no one followed it up.

Although this does not comply with NICE guidance, the clinical reviewer said that

the health screen would not have identified Mr Altal’s heart disease.

61. In a previous report we recommended that High Down conduct audits of

successful completion of secondary health assessments. This was accepted, but

the prison said that as Mr Altal was offered a screen (even though he did not

attend), this was not picked up by the audit. This raises the question of what

constitutes a successful completion. Prisoners may not attend appointments for

a variety of legitimate reasons. We make the following recommendation:

The Head of Healthcare should ensure that all new prisoners are offered a

secondary health screen. If they do not attend, there should be a follow up

process and this should be reflected in the monthly audits.

62. Solicitors representing Mr Altal’s mother asked about bruising to his head and

spine. The post-mortem report does not refer to any such injuries, and we are

therefore unable to comment further.

Substance misuse

63. Post-mortem toxicology tests found that Mr Altal had traces of PS in his system

when he died, which was likely to have contribLited to his death.

64. In their last report on High Down in 2018, HM Inspectorate of Prisons said that

drugs were easily available in the prison. The Independent Monitoring Board

annual report for 2019 also raised this issue. High Down updated their Drug

Strategy in 2018.


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65. There were no intelligence reports during Mr Altal’s time in High Down that

indicated he was using substances. The ambulance service reports said that no

drug paraphernalia were found in his cell. The police searched the cell, as well

as rubbish that Mr Altal’s cellmate removed from their cell on the morning of 6

February, and did not find any drug-related detritus. We have not been able to

establish where or when MrAltal obtained drugs in prison.

66. Healthcare staff in reception at High Down carry out drug screening if the

prisoner discloses drug use in the previous month. Mr Altal had a history of drug

misuse, which he admitted to and which was known from his record. On

reception to High Down, however, he did not disclose recent drug use so was not

tested.

67. On 9 January, a nurse noted in his medical file that he might have been under

the influence of a substance, but did not submit an intelligence report.

68. We are concerned that despite his history, and suspicion of being under the

influence, Mr Altal was not offered a referral to substance misuse services. The

clinical reviewer recommended a review of the referral process to substance

misuse services. We make the following recommendation:

The Governor and the Head of Healthcare should ensure that all staff are

aware of their responsibilities to tackle the use of illicit drugs, including

submitting intelligence reports and referring prisoners to substance

misuse services where appropriate.

Unlock procedures

69. When officers unlock cells, they should take active steps to check on a prisoner’s

wellbeing. The Prison Officer Entry Level Training (POELT) Manual states:

‘Prior to unlock, staff should physically check the presence of the

occupants in every cell. You must ensure that you receive a positive

response from them by knocking on the door and await a gesture of

acknowledgement. If you fail to get a response you may need to open the

cell to check. The purpose of this check is to confirm that the prisoner has

not escaped, is ill or dead.”

70. Prison Service Instruction 75/2011, Residential Services, states:

“Reports from the Prisons and Probation Ombudsman on deaths in

custody have identified cases in which a prisoner has died overnight

but staff unlocking them have not noticed that the prisoner had died. This

is not acceptable...

“[Differingj arrangements will depend on the local regime, but there need

to be clearly understood systems in place for staff to assure themselves of

the well-being of prisoners during or shortly after unlock ... Where

prisoners are not necessarily expected to leave their cell, staff will need to

check on their well-being, for example by obtaining a response during the

unlock process.”


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71. Officer Willis said that he thought Mr Altal was still asleep when he unlocked his

cell on 6 February. When Mr Gurney told him that Mr Altal had been awake

through the night, he thought it likely that he would be tired. While this is of

course possible, he should still have checked on Mr Altal’s welfare in line with the

instruction.

72. We are satisfied that the failure to check did not affect the outcome for Mr Altal,

as he had been dead for some hours when he was found. However, it coLild

make a significant difference in other cases.

73. In a previous investigation we found deficiencies in unlock procedures at High

Down. In response, the Governor issued a Notice to Staff (143/2018), reminding

staff that they must check prisoners’ wellbeing when they unlock cells.

Unfortunately, the issue has arisen again, so we make the following

recommendations:

The Governor should ensure that staff are aware of their responsibility to

ensure prisoners’ welfare at unlock.

The Governorshould share a copy of this report with Officer Willis and

arrange for a senior manager to discuss the Ombudsman’s findings with

him.


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Prisons &

Probation

Ombudsman

Independent Investigations

Third Floor 10 South Colonnade Email mali@ppo.gov uk T 102076336100

Canary Whar1 London E14 4PU Web www ppo govuk F 102076334141

I7

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Investigation into the death of Saul Turner

At HMP Highdown on 6 February 2020

Case Number: F4141-20

Date of Interview: 6 May 2020

Name of Interviewee:

Name of Interviewer:

Gary Stevens

Steve Lusted, Prisons and Probation Ombudsman’s

Office.

Steve Lusted:

Gary Stevens:

Steve Lusted:

Okay, good afternoon. Today is Wednesday 6 May

2020. I have the time as 235pm. I’m Steve Lusted. I’m

an investigator for the Prisons and Probation

Ombudsman and we’re looking at the circumstances

around the death of Mr Saul Atwal at HMP High Down.

Mr Atwal was convicted under the name Turner so staff

at High Down would know him as Mr Turner. So I’m

going to refer him through this interview as Turner.

Joining me this afternoon is.

My name is Prison Officer Gary Stevens.

Thank you Mr Stevens. Mr Turner died on 6 February

this year in High Down and you were working in the

prison on that day. You understand the point of the

Ombudsman’s investigation, you know why I’ve asked

to see you today?

Gary Stevens: Yes, that’s correct, 1 understand.

Steve Lusted:

Thank you, if you need a break at any point while we’re

recording then please say so, that’s fine. And just to

reiterate what I said before I switched on the recorder,

that when we publish our report, transcripts of all

interviews will be annexed to it and what we’re saying

today will go to the governor, to Mr Atwal’s farnly and

to the Coroner so it could be used in court. So. what

we’re saying today is not confidential. I just want to

make that clear. Right, before we talk specificafly about

Mr Turner himself could you just give me a very brief

rundown of your service history and your role in High

Down please?

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Gary

Stevens:

Fm a Prison Officer, on Block 3 at HMP High

Down. I’ve held this role for over six I’m a

residential officer, I work on the block. My

particular block approximately 195

I’m to, one of levels

approximately 65

in total which we obviously

unlock and for.

that

house

assigned

care

House

has

spur

prisoners

house

three

years.

prisoners

Steve

Lusted:

Thank you very much. Mr Turner, Saul Turner, did you

know, had you come him prior to 6

across

February?

Gary

Stevens:

was

No, I

he’d

that

on the day previous and I

located from

him or met him.

been

came across

healthcare

was aware

but I

never

late on

Steve

Lusted:

please

happened

No, okay. So, talk me through what

then. How did he first you radar? What was the

first time you

of Mr Turner?

that

cross

became aware

Gary

Stevens:

Well, basically on the day in question, on

6 February 2020 1 my at 7.30 hours on

my block, on House Block 3. I was detailed

along with Officers

work on A

briefing and then we unlocked. Mr Willis went and

unlocked level 3 and Officer Grover level 2 and myself

level 1. During this time

unlocked for their

hour in which they showers, go oLit on

and clean their cells, etc, etc. During this time,

particular things

or wants. On this day in

well

a lot of on regime

remained behind their doors. So,

animosity and they’ve very rude and to

staff, ringing their cell bells so it was quite taxing in

of our

hour, Officer Willis and Grover went out to dc-exit off

block, to the going off for

flow to activities, work and education. Sorry.

house

domestic

exercise

started

duties

Jason Willis and Mark Grover to

spur where Mr Turner resided. We had our

everyone’s

have

also we deal with tots of queries about

that everyone needs

as

that

terms

the house

free

there was

been

prisoners

question

basic

there was a lot of

abusive

resources. When it come to the end of the

search

prisoners

Steve

Gary

Lusted:

Stevens:

Unaudible)

just Officer Willis was going off, he was

Okay,

then

(‘ThaudThIe1 and he just said to me that a

prisoner, Gurney, A4756DP said to him that his cell

who arrived the day before and that’s Mr Saul

Turner, A2425AM basically up during night

and said he might ask to the at point.

So, I just left level 2 ‘on my own to with a

board to

off. It was then

Prison Ripley A6548AM down from level 3 to

me. I couldn’t

saying it was so noisy

became

mate

spur

the

see

gate

check prisoners

been

shouted

hear what he wa

nurse

the

some

then

that

Saul Turner- F4141-20 Page 2

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on the housebiock. Then eventually I heard him say

“he’s dead”. I ran up the stairs, luckily Officer Gardner,

that’s Jessica Gardner was following behind me, she

was there at the time. I was initially a bit apprehensive

because Mr Ripley, who was obviously going to

adjudication that morning, was saying that he was

going to assault staff because he didn’t want to go to

his adjudication down the Segregation so I kind of

thought he was maybe going to try and lure me into a

cell or something, assault me. So, I was kind of a bit

apprehensive going through the gate but then I saw, I

think it was MrAmey. A2159EF. He also came out the

cell 33A10. He also said he’s dead. So, I was kind of

obviously a bit panicky at that point. I went straight in

and I saw Mr Turner ... who I now know to be Mr

Turner, laying on the top bunk. He had a sheet pulled

up to his face clutching in front of his chest. I tried to

get a response from him, by you know verbal, saying,

Are you okay, are you okay?’ I got no reply. I then tried

to pull the sheets slightly away and nudge his arm

gently to wake him because I thought he was asleep.

Then I kind of saw his eyes, were you know slightly

open and his face was dark and blotchy and he felt a

bit cold and rigid. At this point I kind of thought he, you

know might be deceased but I wasn’t entirely sure. So,

immediately I called a code blue from my radio, which

was call sign Charlie 9, giving the location. Then

comms kind of came through to me again and asked

for the name and number and what the situation was.

Luckily, I looked on the table and there was his ID card

with his name and number and location so I gave that

and seeing as I thought it might be a possible death in

custody I immediately just said possible death in

custody. Because I haven’t really kind of experienced

that situation before and I thought well if I say that then

everyone who needs to be there is going to come

straightaway. So, then basically, Officer Rigby, that’s

Ross Rigby, Doreen Roger and Alex James were there

in the cell with myself and Officer Jess Gardner. I

started puffing gloves on because I normally do just in

preparation if I touch anything or give any medical aid.

Nurse Margaret saw me. She looked at prisoner Turner

and then Hotel 2, who was the duty nurse for the day,

Verity Miles, came in. We were already moving

Mr Turner down as Officer Roger said we needed to

• get him down and assist with medical aid. We used a

mattress to basically hold on to. because it was quite

difficult getting him down from the top bunk, securely

and safely so we used it as a kind of you know a prop

to kind of get him down onto the floor safely. I then

Saul Turner-F4141-20

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removed the sheet and blanket which he was clutching

onto and Officer Rigby cut his tee-shirt when Nurse

Miles asked him to. She then started CPR hut then she

asked someone to take over while she set up the

defibrillator. I was the closest in proximity so I started

chest compressions. I kind of looked at Mr Turner and

saw no ligature marks or obvious cuts. After a couple of

minutes, I was instructed to stop compressions and she

was about to put defibrillator pads on so I just sat back

away on top of the table as we were told to clear the

area. Some staff outside the cell kind of informed us to

exit the cell, the people that initially responded. So, we

then left the areas and we were told to go and wait in

the holding room where we awaited further instruction.

And thafs all my part in dealing with Mr Turner.

Steve Lusted:

Gary Stevens:

Steve Lusted:

Gary Stevens:

Steve Lusted:

Gary Stevens:

Steve Lusted:

Thank you very much, that’s very comprehensive. If I

can just take you back to a couple of questions I’ve got

during that.

Of course.

When Officer Willis mentioned to yourself and Officer

Grover that Mr Gurney had said that Mr Turner might

need a nurse, what sense did you get from that

conversation. Was there any urgency in it?

No, it was very low key in terms of, we normally kind of

get, that someone will say oh you know he’s been up

during the night and you know he might ask to see the

nurse at some point. It wasn’t like oh you need to give

medical assistance now, otherwise Mr Willis would

have definitely, you know, called a code or you know

got the houseblock nurse to go and see him. It was

more in general that when we were locking up, possibly

he might ask to see the nurse or press his cell bell at

some point.

So, he was kind of tipping you off that this might

happen, yes?

Yes, pretty much. No, just because obviously he

assumed that Mr Turner was asleep at that point

because Mr Gurney had told him that you know he’d

been up during the night so he assumed that you know

he didn’t want to be disturbed.

Okay, and how did you leave that between the three of

you? When he said that, was there a kind of yes, okay,

I’ll go and see him, sort of conclusion to that or were

you going to wait until you know, Mr Turner, had sort of

asked for a nurse himself?

Saul Turner-F4141-20 —

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Gary Stevens: Well, I would have asked him, obviously because when

we let the prisoners off for their period of going off to

activities we then go around to every single cell and

lock the door and would normally kind of you know

speak to the remaining prisoners in there. So, would

probably if I was looking at a level would have you

know asked him if he was alright.

Steve Lusted:

Gary Stevens:

Steve Lusted:

Yes.

But obviously it didn’t get to that point because we

were alerted before that situation arose.

What was the time lapse approximately between

Officer Willis telling you this and you being alerted to

the fact that there was a problem?

Gary Stevens: I can’t recall exact time but you’re probably looking at

about between five and 10 minutes, you know probably

enough time because it was only really let off a few

people onto free flow before obviously, Mr Ripley

phoned down, sorry, called down to me. So, it’s

probably, matter of, between five and 10 minutes.

Steve Lusted:

Gary Stevens:

Steve Lusted:

Yes, thanks. I’m not trying to pin you down to the

second, what I meant was, he mentioned this, he went

oft the wing. You were then supervising others going

off the wing and then this would have, you know the

lock-up would have been shortly after that. We’re not

talking an hour?

Oh yes, definitely, when the last few come off and we

go straight on and we lock up every door and speak to

the prisoners inside.

Okay, okay, thank you. Your emergency response was

quite detailed, thank you. When you actually looked at..

Sorry do you have any first aid training?

Gary Stevens: No, I mean I was previously in the British Army so I

have some but obviously I’m not in date with any first

aid at work, which I have done subsequently after the

incident. But I wasn’t in date or anything at the time.

Steve Lusted:

Gary Stevens:

Steve Lusted:

You weren’t in date but you have had training?

Yes.

Yes, okay. And when you saw, Mr Turner, you say you

sort of nudged him to try and see, you know to try and

make him stir. You thought he was asleep, trying to

make him stir. Was there any movement at all or was it

beyond that?

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Gary Stevens: No, none at all. Obviously, I used verbally first to try

and get a response, got none then obviously I

of like slightly you know with my thumb and forefinger

just tugged the sheets slightly next to his arm and I

patted his arm very gently. There was no movement.

just kind

Steve Lusted:

No, okay. Debrief. VVere you invited to the hot debrief?

Gary Stevens: I was but unfortunately, I wasn’t in at that point so I

didn’t actually go to it.

Steve Lusted:

Gary Stevens:

Steve Lusted:

Was this not held directly after the emergency

response?

Oh sorry, you mean the one on the day?

Yes.

Gary Stevens: Oh sorry, I thought you meant the one that was just a

while ago. Yes, we were held in the chapel area and

then we were debrief and I think the DC, police kind of

spoke to myself and Mr Willis just as an initial

statement.

Steve Lusted: Yes, okay, I don’t need to know if you took but was

support made available to you if you needed it?

Gary Stevens:

Steve Lusted:

Gary Stevens:

Steve Lusted:

Gary Stevens:

Steve Lusted:

Is that help, sorry?

Yes, help, the Care Team, you know some kind of

support that you might need if you wanted it. Was it

there for you?

Yes, we had a member of the Care Team with us and

then I think the day after they said to me, said if we

need anything obviously, we didn’t, resource is

available.

Yes, okay, thank yoti. Thank you, Mr Stevens, there

wasn’t really anything else on my list to ask. Is there

anything about that day that you recall, anything else

about Mr Turner you may have heard subsequently or

you recall from that day that we haven’t discussed or

are you content that we’ve gone through it all?

Yes, l’r’n very content we’ve gone through it all. As I

said I mean obviously he came the day previous and I

had no knowledge of him as such and then, yes, so

there’s nothing really, I can add on that, unfortunately.

That’s great, thank you very much. I’ve now got the

time as 2.42.

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Endorsement

I understand that if I do not sign and return this transcript, it will be deemed to have

been agreed by me as an accurate record of my interview which may be used as

evidence at inquest.

I agree that this is a true and accurate record of my interview with Steve Lusted on

6 February 2020 I confirm I have been given the opportunity to make any necessary

amendments.

Signed

NAME IN CAPITALS

G.....

Dae .0S..

Signed

NAME IN CAPITALS

Data

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Co

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Investigation into the death of Saul Turner

At HMP Highdown on 6 February 2020


Date of Interview: 6 May 2020



Jason WiHis

Steve Lusted, Prisons and Probation Ombudsman’s

Office

Steve Lusted: Good morning. Today is VVednesday, 6 May 2020. 1

have the time as 11 .3lam. I’m Steve Lusted. I am an

investigator for the Prisons and Probation

Ombudsman. And we are looking at the circumstances

around the death of Mr Saul Turner, who was also

known as Mr Saul Atwal. He died on 6 February this

year at HMP High Down. Joining me this morning is.

Would you introduce yourself, please?

Officer WHlis:

Steve Lusted:

Officer Willis:

Steve Lusted:

My name is Officer Willis, at HMP High Down.

Thank you Mr Willis. For the benefit of the transcriber

would you give your first name as well.

Oh yes, Jason.

Thank you very much. You’ve seen the notes for

interviewees, you understand the point of the

Ombudsman’s investigation, you know why I wanted to

see you today, yes?

Officer Willis: Yes, I understand, yes.

Steve Lusted:

Officer Willis:

Steve Lusted:

Thank you. You’re on your own. If you decide that you

want a break or you want someone with you then that’s

fine and as I say if you need a break in the recording

that’s fine as well. Just say so and we can pause.

Okay.

Final point, just to reiterate when we publish our report

the transcripts of all interviews will be annexed. So,

what we’re saying today will go to Mr Atwal’s family, it

will go to the Coroner and it will possibly be used at

inquest in open court. So, what we’re saying today is

not confidential, just so you’re clear.

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Officer Wiflis:

Steve Lusted:

Officer Willis:

Steve Lusted:

Okay, that’s fine.

Thank you. Again, I’M just point out for the benefit of

anyone reading the transcript. That afthough Mr Atwal,

note as Mr AtweM. He was convicted as Turner and

he was in High Down as Turner so I’m going to refer to

him as Mr Turner. That’s how you knew him, isn’t it?

That’s right, yes.

Yes, before we go straight into that, Officer Willis,

would you just give me a very brief rundown of your

service history and your role at High Down?

Officer Willis: Basically, I’ve been in the role as of today 1 1 months

on live act service. So, I’ve been with the actual Prison

Service since February 2019 and I went live on

3 June 2019.

Steve Lusted:

Officer Willis:

Steve Lusted:

Officer Willis:

Steve Lusted:

Sorry, how fong have you been working in High Down?

In High Down, since 3 June last year.

Okay, so at the time that you’ve had dealings with

Mr Turner you’ve been live in High Down for seven,

eight months, yes?

Seven or eight months, yes that’s right.

Okay, you came across Mr Turner on the afternoon of

5 February but had you had any dealings with him prior

to that, did you know him?

Officer Willis: No, but my first interaction with him was when I was

asked by Supervising Officer Terry, to locate him into a

cell on A spur which is the spur I normally work.

Steve Lusted:

Okay, so just talk me through the logistics of that. Was

this after lock-up or something or was it just because

you had to escort him across from healthcare?

Officer Willis: No, basically he came onto the house block and I was

actually working on the spur. I was called over by

Supervising Officer Terry and he said this is Mr Turner,

put him into cell 10 on the 3’s. Which I did, walked up

the stairs with him and yes put him into the cell with,

Mr Gurney, who was already there.

Steve Lusted:

Officer Willis:

Okay, so you were actually on the wing, you just

walked him, you know from the office to the cell, yes,

showed him where it was?

That is correct, yes.


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Steve Lusted:

Officer Willis:

Steve Lusted:

Officer Willis:

And were prisoners locked away at the time?

No, we had a few out at the time so there was basically

a couple out on the landing but yes it was late

afternoon so they were being locked up, in the process

of being locked up.

Okay, did you talk to Mr Turner, on the way? You

know how was he? Bearing in mind we know what

happened the next day, did he appear okay, did he

appear ill? Was there anything about him that stood

out?

He seemed fine, you know, walked to the cell, just said

hello, you know how are you doing and that’s about it

and he said yeah, fine. So, there was nothing

remarkable about it at all.

Steve Lusted: I appreciate that you didn’t know him, so you didn’t

have anything to compare it with but he didn’t seem

particularly agitated, sweaty, pale, shaking? There

were no signs?

Officer Willis:

Steve Lusted:

No, no, seemed very normal.

Okay, you knew, Mr Gurney, because he was on the

spur and you’ve been working on there so you were

aware of Mr Gurney.

Officer Willis: Yes, I was aware of him. I’ve known him for a little

while before Mr Turner came. Yes, he was on the spur

so I knew him.

Steve Lusted:

Officer Willis:

Steve Lusted:

Officer Willis:

Steve Lusted:

Officer Willis:

Okay, so when you introduced, Mr Turner into the cell,

you know did the three of you have any kind of

conversation?

Just, basically, said to Gurney, you know you’ve got a

new cell mate. He said, alright. fine. They said hello to

each other. So, (‘inaudible) locked up and walked away.

There’s not interaction between the three of us, no.

No, okay, and did you see either of them again that

day?

No, not that day, no.

No, okay. Right, so moving onto the following morning

then, 6 February. YOU were, well, not you alone but you

and your colleagues were unlocking the wing and you

were on the 3s landing on that spur. So, you unlocked

their cell door, yes?

That’s correct, yes.


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Steve Lusted:

Yes, can you talk me through what happened? What

do you do when you unlock? Do you go in, do you

shout, do you bang on the door? Can you talk me

through it?

Officer Willis: Basically, I opened the obs flap which looks into the

cell, which is a smafl window looks into the cell and

obviously I had a look in there, see what’s going on. As

I looked through it. I saw, Mr Gurney, standing on the

side with a bag in his hands. So, I unlocked the cell

door and he said oh you know just got to put my

rubbish out. As he was walking out the door he said

you know, you gave me a right one there. I said what

do you mean? He said, he’s been up aW night you know

to the toilet and what have you. And yes, just walked

off to the bin to chuck his rubbish away. And that’s the

interaction I had with Gurney.

Steve Lusted:

Did you go into the cell?

Officer Willis: I looked into the cell and actually saw Turner. He was

facing towards the wall. I assumed he was asleep

because he’d been up, you know during the night,

what, Gurney, had told me. I assumed he was asleep

and I just left him to sleep.

Steve Lusted:

Officer Willis:

What’s your understanding of what you’re supposed to

do at unlock? Is there a wellbeing element to the...

Yes, you should get a response from the prisoner. But I

mean, basically, rightly or wrongly on my part I

assumed because, Mr Gurney, had, you know

experience with him during the night, He gave me no

impression that was anything wrong, apart from the fact

that he was asleep.

Steve Lusted: Yes, okay. And again, I don’t want to harp too much on

the fact that we know what happened later but at the

time did you actually see Mr Turner’s face? Did you

look at him or did you just kind of look and see that he

was in bed?

Officer Willis: I looked, I saw he was in bed, you know I could see

him, facing the wall. I could basically see part of his

face but not all of his face. Yes, so that’s what I could

see of him really. You know but his blanket was

covering him, the only other parts I could see was

basically his feet just (inaudible) blanket.

Steve Lusted:

Officer Willis:

When you say he was facing the wall, was he laying on

his back, on his side?

Yes, on his back


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Steve Lusted: He was on his back but he’d turned slightly towards ...?

Officer Willis:

Steve Lusted:

Officer Willis:

Yes, that’s right.

Okay, alright so that happened, you went about your

business. Then I understand that you bumped into Mr

Gurney again at the showers.

No, before that basically, Gurney, asked me to get an

iron and an ironing board for him because he had a

visit that morning. So, basically returned to the office,

got the iron because obviously we need to sign the

irons out and got him an ironing board. And then

basically got him the iron and the ironing board and he

took it up to the landing and started ironing some

clothes outside his cell.

Steve Lusted: That’s right, yes, I saw that on the CCTV. Yes, so he

was actually, on the corridor, wasn’t he?

Officer Willis:

Steve Lusted:

Yes, and again unconcerned, didn’t seem to be you

know, didn’t give me any reason to be alarmed

basically.

Okay, so please carry on with the story.

Officer Willis: Yes, then just before 9 o’clock I was escorting a

different prisoner to the shower. I spoke to Gurney, you

know, he basically said that Turner might need to see

the nurse, you know he was indicating up to the cell,

just basically pointing out that he might need a nurse.

No urgency in his voice. There was nothing you know

which actually made me overly concerned so I went off

the wing, said to my colleagues, Officer Stevens,

Officer Grover, that Gurney had told me that he maybe

see nurse and then I went out to D spur to do free flow

when all people going off to work and carried on

searching and stuff.

Steve Lusted:

Officer Willis:

Steve Lusted:

Officer Willis:

Steve Lusted:

So, from what Mr Gurney said to you didn’t ... it said in

your statement I think at some point, you said it didn’t

give you any particular, sense of urgency. It wasn’t “oh

my God he needs to see a nurse now”. It was..

No, it was like, yes, he might need to see a nurse and

that is you know pretty much exactly what he said.

He wasn’t asking you to get a nurse?

No, no.

And he wasn’t suggesting that one was needed

immediately?

Saul Turfler-F4111-20 —

Page

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Officer Willis:

Steve Lusted:

No, he hasicaHy said he might need to see a nurse.

Okay.

Officer Wiflis: Like I say no urgency in his voice at aH, you know just

like sort of casual, he might need see a nurse.

Steve Lusted:

Officer Willis:

Steve Lusted:

In what circumstances then would you have you know,

would you have then taken further action? When

would you contact healthcare yourself, off your own

back? Would you have done that at some point here,

did that cross your mind or did the fact that you’ve told

your colleagues that he may need to see a nurse

were you in essence waiting for Mr Turner to ask for

one?

Basically, what we were going to do was get free flow

out of the way. Which takes about five, 10 minutes and

then go up and see what the (inaLlUthIe) was with him.

Yes, and did you actually say that to either of your

colleagues or was that just what was in your mind?

Officer Willis: No, I said to my colleagues, you know he might need to

see a nurse. Gurney said he might need to see the

nurse and so apparently, we’ll sort that out after free

flow so.

Steve Lusted:

Officer Willis:

Steve Lusted:

Officer Willis:

Steve Lusted:

Officer Willis:

Steve Lusted:

Who said that, sorry?

Between the three of us basically, Officer Stevens and

myself and Officer Grover.

Between the three of you, you said someone will go

and see him after flow?

Yes.

Yes, okay. When did you became aware that there’d

been an emergency?

Basically, there was a radio message by my colleague,

Officer Stevens, I believe and he basicaHy called on the

radio saying that you know there’s problem in the cell.

Yes.

Officer Willis: I believe it came over as a death in custody over the

actual radio?

Steve Lusted:

Officer VVillis:

Steve Lusted:

And so that’s when you became aware of it?

Yes.

Did you attend the debrief?

Saul Turner-F41%1-20 Page 6

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Officer Wiflis: Yes, I did, yes.

Steve Lusted: You did, yes. I dont need to know if you took but was

support available for you if you wanted it?

Officer Willis:

Steve Lusted:

Officer Willis:

Steve Lusted:

Yes, support was available?

It was yes, then and subsequently, yes?

Yes.

Okay, bearing in mind that we know what happened, is

there anything that we haven’t discussed that you

remember or anything that you want to tell me about

that morning? Anything about the circumstances that

you think would give me a better flavour of it or are you

happy that you’ve captured it?

Officer Willis: I don’t think so, I mean basically what happened on

that morning is how I’ve said just now and in my

statement earlier so I think that’s it.

Steve Lusted:

Okay, thank you very much. I’ll end the interview. It’s

now 11A3.


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Endo reern en t




I agree that this is a true and accurate record of my interview with Stove Lusted on

6 February 2020 I confirm I have been given the opportunity to make any necessary

amendments

Signed:

NAME IN CAPITALS

Date [../..

Signed

NAME IN CAPITALS

Date

Saul Turnr-F4141-20 Page 8

OFFICIAL

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Date of Telephone 19 May 2020

Interview:

Name of Interviewer: Dr Peter Saunders

Clinical Reviewer

NHS England

Name of Interviewee: Francois Victoire (Nurse Access Role)

Introductions and process explained on 18.5.20 and telephone interview on 19.5.20.

Question

You noted he may have been under influence of substance/drugs on 9.1.20 and that he had

a previous drug problem, but not offered referral to Substance Misuse services (SMS).

Please comment.

IS

iI

I: F [j --

bei

cc

vouki not no;mI]y oFfer rferrai to SMS uncir these cIrcumsaicCs. He would hsce been

reerreci at reception if necessary.

would wait until the folloviino day to get a clearer picture befom referring him to SMS

There was nothing to indicate anywhere that he should have been referred to SMS

He was fine ever since on the folIo ving days and nights.

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Endorsement




I agree that this is an accurate record of my conversation with Peter Saunders on 19 May

2020.

Print name

Signed

Date

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Date of Telephone 5 May 2020

Interview:



Introductions and process explained.

Dr Peter Saunders

Clinical Reviewer

NHS England

Kerry Martin — Interim Head of Healthcare

Questions

Reception Screen

Mt Altal was known to use drugs both in prison and outside but no referral to Substance

misuse services (SMS) at reception screen. Please comment.

Location on HCU

He was admitted to Healthcare Unit (HCU) from reception —why was this? Why was he kept

on HCU for the month? Why did he require hourly observations for the whole month?

Secondary Health Screen

DNA (did not attend) on 15.1.20 —

have been offered?

was the outcome and would another appointment

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Endorsement

I understand that if I do not sign and return this transcript, it wiN be deemed to have



I agree that this is an accurate record of my conversation with Peter Saunders on 5 May

2020.

Print name

Signed

Date

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D59

Investigation into the death of Mr Saul Turner on 6 February

2020 while a prisoner at HMP High Down


Date of Interview: 12 February 2020

Name of Interviewer: Steve Lusted,

Senior Investigator,

Prisons and Probation Ombudsman’s Office

Name of Interviewee: Jack Ripley

Mr Steve Lusted explained that he wanted to speak to Mr Ripley as he had

been one of those who raised the alarm when Mr Turner was found to be

unresponsive on the morning of 6 February. He explained the purpose of the

Ombudsman’s investigation and that he would provide a note of this interview

for Mt Ripley to agree. Once agreed, the note would likely be published as an

annex to the Ombudsman’s report along with notes of interviews with other

prisoners and staff. The interview was therefore not confidential. Mr Ripley

said that he understood.

Mr Ripley said that he had not known Mr Turner. He was friends with Mr

Turner’s celimate, Mr Gurney.

On the morning of 6 February, downstairs by the showers, Mr Gurney had

said that he thought something might be wrong with his celimate. He was still

asleep despite amounts of noise in and around the cell. Mr Gurney told

Officer Willis this, though Officer Willis was busy supervising another prisoner

at the time.

When they returned to their cells, Mr Gurney told Mr Ripley that he was still

concerned about Mr Turner. He had been making noise, and had banged the

door shut, and Mr Turner still made no response. Mr Ripley went into their

cell, and looked at Mr Turner. He was lying on the top bunk bed, with the

covers up to his chest. His eyes were slightly open, and Mr Ripley was

unsure if he was asleep. He said as much to Mr Gurney and another prisoner

called Dave, then called to staff. At this point prison officers responded and

went into the cell.

Mr Ripley said that support had been available to him.

Ripley for his time and for the information provided.

Mr Lusted thanked Mr

I agree that this is an accurate record of my conversation with Steve Lusted

on 12 February 2020.

Print

Signed.,.?

Date...(..(94/.)

D59

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Investigation into the death of Mr Saul Turner on 6 February

2020 while a prisoner at HMP High Down

D60


Date of Interview: 12 February 2020

Name of Interviewer: Steve Lusted,

Senior Investigator,

Prisons and Probation Ombudsman’s Office

Name of Interviewee: Tommy Gurney

Mr Steve Lusted explained that he wanted to speak to Mr Gurney as he had

been Mr Turner’s ceilmate. He explained the purpose of the Ombudsman’s

investigation and that he would provide a note of this interview for Mr Gurney

to agree. Once agreed, the note would likely be published as an annex to the

Ombudsman’s report along with notes of interviews with other prisoners and

staff. The interview was therefore not confidential. Mr Gurney said that he

understood.

Mr Gurney said that he had not known Mr Turner. During the evening of 5

February, after prisoners had been locked away for the evening, staff brought

Mr Turner to Mr Gurney’s cell and said that he had a new cellmate. Mr

Gurney and Mr Turner introduced themselves to each other. Mr Turner said

that he had a problem with drug use, and Mr Gurney told Mr Lusted that he

had not been surprised at this. Mr Turner did not look well and was pale, with

the overall appearance of someone who was a drug user, although he did not

appear to be under the influence of anything at the time.

Mr Gurney went to bed, leaving Mr Turner sitting in a chair. During the course

of the night, Mr Gurney was awoken several times by Mr Turner moving about

the cell, going to the toilet to be sick on more than one occasion. Mr Gurney

said “Are you alright?”, and Mr Turner replied that he just felt ill. Mr Lusted

asked if they had pressed the cell bell. Mr Gurney said that he had not done

so. Mr Turner was able to move about the cell, so if he needed assistance he

could press the bell himself. He did not ask Mr Gurney for any help.

On the morning of 6 February, when the cell was unlocked Mr Gurney got out

of bed. Mr Turner was still in bed. His eyes were slightly open, but Mr

Gurney thought that he was still asleep, having been ill during the night.

Mr Gurney went to the showers, and said to Officer Willis that he thought he

ought to have a look at Mr Turner. Officer Willis was supervising- a prisoner

on restricted security at the time and was unable to leave him.

Mr Gurner returned to his cell and began to prepare for a visit. He ironed

some clothes on the landing, and spoke to some fellow prisoners, including

Mr Jack Ripley. He went back into the cell, and Mr Turner was still apparently

asleep. Mr Gurney noted that he had not moved, and asked another prisoner,

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Mr Walters-Kitson to have a look at him. Mr Shipley called to staff, and at this

point it became apparent that something was wrong. Mr Gurney moved away

from the cell, as a number of staff arrived.

Mr Gurney was taken to a different cell, and remained there for approximately

six hours. His clothes were taken from him, and the police spoke to him. He

told Mr Lusted that he had not been offered support during that time. A

member of the chaplaincy team had visited him on the morning of 12

February and offered support then.

Mr Lusted asked Mr Gurney if there had been any indications as to what

might have been wrong with Mr Turner. Mr Gurney said that he had been in

the cell with Mr Turner for such a short period of time before he went to bed

that he had not really had much chance to form an opinion. Mr Lusted said

that he had noticed the end of a rolled cigarette on the window sill. Mr Gurney

said that it was not his, and he had not noticed Mr Turner smoking anything

but he may have done while Mr Gurney had been asleep. ft may have

belonged to a previous cell occupant. Mr Gurney said that it appeared that

drugs were available on the wing but as Mr Turner had been there such a

short time and had spent it all in the cell, he did not feel able to comment

further than that.

Mt Lusted thanked Mr Gurney for his time and for the information provided.

I agree that this is an accurate record of my conversation with Steve Lusted

on 12 February 2020.

Print name

Signed

Date

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Occurrence Number: 45200014974

Statement of: ANNA BAKHT

WITNESS STATEMENT

Criminal Procedure Rules, r 16.2; Criminal Justice Act 1967, s.9

Age if under 18: Over 18 (if over 18 insert ‘over 18’)

URN

Occupation: Ambulance service

This statement (consisting of page(s) each signed by me) is true to the best of my knowledge and

belief and I make it knowing that, if it is tendered in evidence, I shall be liable to prosecution if I have wilfully

stated in it anything which I know to be false, or do not believe to be true.

Signature: _____________________________ Date: 24/03/2020

Signature Witnessed By: ______________________________

Statement Locked By:

Tick if witness evidence is visually recorded

The statement is in relation to a death of a prisoner called Saul Turner at HMP High Down. I am a registered

Paramedic. I qualified with a Paramedic Science BSc (Hons) in September 2018. I have been employed by

Central and North West London NHS Foundation Trust to work at HMP High Down (Prison) within the

Healthcare Team in the role of a Paramedic. I have worked within this role for 1.5 weeks from when this

incident occurred. My role as a Paramedic involves responding to emergency healthcare incidents at HMP High

Down.

On Thursday 6th February 2020, my role was to shadow Nurse Sophie in the Reception. Prior to this, I have

had no interactions with Mr Saul Turner.

On Thursday 6th February 2020 at approximately 09:09 I responded to a Code Blue called over the radio. From

my location in Reception, I attended the Code in House Block 3, A Spur, Level 3 and was directed to the cell by

Officers. Upon arrival to the incident with Nurse Sophie Marshall at approximately 09:14, multiple Officers,

Nurse Verity Miles and HCA Simon Triptree were present. The Patient Mr Saul Turner appeared unresponsive,

lying on his back on a mattress on the floor with both arms raised and fixed in a flexed position with visible rigor

mortis. The defibrillator pads had been applied. HCA Simon Triptree was performing compressions with Nurse

Verity Miles overseeing CPR. I received a handover from Nurse Verity Miles during which it was relayed that

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Mr Saul Turner had been assessed and was unresponsive and showing no signs of life following an ABC

assessment. I was then requested by Nurse Verity Miles to assess and if required recognise life extinct.

Upon my examination, Mr Saul Turner displayed visible rigor mortis and upon unsuccessful attempts to move

his arm I was able to confirm rigor mortis. I also observed evidence of post mortem staining around Mr Saul

Turner’s upper chest and the flank of his back. Mr Saul Turner was unresponsive. Following auscultation of the

chest, I was able to confirm the absence of breath sounds and heart sounds. In addition to this, on my arrival

the defibrillator assessed and verbally relayed the rhythm to be as shock not advised. With the use of a pen

torch I was able to confirm Mr Saul Turner’s pupils were fixed and dilated. I was unable to obtain a 30-second

Asystole rhythm strip due to the absence of an ECG machine. I observed no obvious deliberate self-harm or

injuries on Mr Saul Turner.

Following my assessment and with support from Nurse Verity Miles I recognised life extinct at approximately

09:15 and CPR was halted at this time. Following this, GP Dr Gareth Ruse arrived at approximately 09:18 and

following his own assessment confirmed recognition of life extinct.

At approximately 09:22, the ambulance Paramedics arrived and conducted their own assessment for

recognition of life extinct including obtaining a 30-second Asystole rhythm strip. They confirmed recognition of

life extinct at approximately 09:35.

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Statement of: CLAIRE FRANKLIN

WITNESS STATEMENT


Age if under 18: Over 18 (if over 18 insert ‘over 18’)

URN

Occupation: Prison officer

This statement (consisting of 2 page(s) each signed by me) is true to the best of my knowledge and belief

and I make it knowing that, if it is tendered in evidence, I shall be liable to prosecution if I have wilfully stated

in it anything which I know to be false, or do not believe to be true.

Signature: _____________________________ Date: 21/03/2020




This statement is in relation to the death of Saul Turner at HMP HighDown on 6th February 2020. I work at

HMP HighDown as custodial manager and I have worked at the prison since 2012. On the morning of 6th

February 2020 I was on the walk way and heard a call over the radio for available staff. The next call over the

radio asked for medical staff to assist. I went to the cell and prison officers Ross, Gary and Jess were already in

the cell. The cell door was half open and I was in the cell. They had lifted Turner from the top bunk and onto

the floor, including his mattress. Verity a prison nurse arrived and completed some quick assessments and

almost immediately started carrying out CPR on Turner. I told Ross to take the pillow from under Turners head

as I thought he might need to open his airway. Ross moved the pillow and exited the cell. From where I was

standing I couldn’t see that Turner was deceased. It was myself and Gary in the cell with Verity. Simon Triptree

arrived with a defibrillator and plugged it in. The defibrillator was assessing and advised to continue CPR. I

offered my assistance to take over from verity performing CPR but Gary was in a better position in the cell and

he took over CPR. Anna a paramedics arrived and had a discussion with medical staff and confirmed Turner

was dead. Dr Ruse attended a short time later and again confirmed Turner was dead. Turner’s body was

covered with a sheet for dignity. I waited for the external paramedics to arrive and I had a look around Turners

cell without disturbing anything. I couldn’t see anything that could have caused or contributed to his death. I

exited the cell when the paramedics arrived. When I saw Turners body on the floor it was obvious he was dead,

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I could see his top half was exposed. I noticed his hands were in front of his face, elbows bent and his eyes

were open. Turner had a purple staining on his upper chest to his shoulder line. I didn’t see Turners neck.

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WITNESS STATEMENT


Statement of: Dorian Fredrick Arthur RODGER

Age if under 18: O18 (if over 18 insert ‘over 18’)

URN

Occupation: Prison officer




Signature: _____________________________ Date: 17 th April 2020




I have been employed by the prison service for 9 years and I am currently based at Highdown Prison in Surrey.

I have been asked to make a statement to police in relation to an incident that I attended whilst on duty at the

prison on 6 th February 2020. I had been in the role of Custodial manager for 12 months immediately prior to this

which included acting as point of contact for all deaths in custody for all agencies and overseeing family liason

officers. I would also 'enhance case manage' all self harm cases and some of the more challenging prisoners in

Highdown. The 6 th February was my first shift back as a regular prison officer.

I was posted to block 3, starting at 0730 hours. I heard over the radionet that there was a code Blue at 0909

hours on my house block. Gary STEVENS, a colleaugue established that it was on A spur I went up to that

landing where I saw Officer STEVENS and Officer GARDENER outside Cell 33A 10, whilst I was with Officer

Abbie JAMES. As we reached the door, Officer GARDENER said to me "He is dead". I have entered the cell

with Officer JAMES where I saw a prisoner that I now know to be Mr TURNER on the top bunk of the bed. The

bed was positioned on the left hand side and his feet were pointing towards the door. TURNER was lying on his

back with the bed sheet completely covering him, I.E. it was covering his head aswell as his body.There was

nobody else in the room as I entered. Officer STEVENS came into the cell and I asked him if he could see a

ligature around his neck, if there was it needs to be cut. He checked and then stated that there was no ligature.

We were joined byOfficers RIGBY and GARDENER and I informed the staff even though we believe that he is

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dead we are not medically trained so can not state that he is. I then said we need to get him off the bed and

commence CPR. One of his ankles was exposed and I touched his leg and it was cold to the touch and he felt

quite rigid. Together officers GARDENER, STEVENS, RIGBY and I lifted TURNER off the bed and onto the

floor still on the mattress and CPR was started. As the sheet was lowered in order to do this I noticed some

pooling around the side of his chest which made me believe that he had been dead for some time. As far as I

can remember nurse Margaret SAWMY and Officer STEVENS started CPR to begin with and then nurse Verity

MILES took over. Custodial manager Claire FRANKLIN also attended and I remember that she was there whilst

chest compressions were carried out.I also remember that Nurse Kirsty SHEEHAN was present at that time. By

now it was 0915 and the nurses collectively, decided that there were no signs of life and CPR should be

stopped. Dr RUSE then attended the cell and declared life extinct and confirmed that he estimated that

TURNER had been dead for between 4-6 hours. I was then instructed to leave the cell by Governor Karen

LEAK and she led me to a side office where i was offered support from the care team and made a cup of tea.

Prior to this incident I had never met Mr Turner, I believe that he was new to the block also.

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Statement of: Simon TRIPTREE

WITNESS STATEMENT


URN

Age if under 18: (if over 18 insert ‘over 18’) Occupation: Health Care Assistant




Signature: _____________________________ Date: 17 th April 2020




I have been employed as a heath care assistant at Highdown Prison since 2012. I primarily work in the inpatient

department which is the health care unit. On 6 th February 2020 I responded to a code blue call and

attended A3, house block 3 where I had followed the discipline staff to. This was around 9 O'Clock in the

morning but I do not have the exact time. When I arrived I saw that the patient was lying on the floor receiving

chest compressions. Verity MILES asked me to put the defib on, which is a standard practice. I set up the defib

and attached the pads to the patient but we did not shock him. It is an automatic Defibrillator and it decides

whether to shock the patient or not, in this case it did not. The attendees continued to give chest compressions

until the paramedic called life extinct, this was around 0915 at this time. I think I was there for about 4 minutes

in total. When I stood back I recognised the patient as someone that I had seen in the in-patient department. I

remember that I had given him medication at some point whilst he was there and I believe he suffered from

depression. I know now that he was called Mr Turner.

10/2017


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10/2017


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PHOTOGRAPH EXHIBIT BOOK

THIS BOOKLET CONTAINS: 7 PHOTOGRAPHS

THIS BOOKLET IS EXHIBIT: SPR/PHOTO/01 – photos of cell and deceased

THE DEFENDANT IN THIS CASE IS: N/A

THESE PHOTOGRAPHS WERE TAKEN BY: PC RICHMOND 40487 OF SURREY POLICE.

THE PHOTOS WERE TAKEN ON: 06/02/20 AT 1453 HOURS

THIS BOOKLET WAS PRODUCED BY: PC 40487 Richmond of Surrey Police

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/wEdAAjgGrx2TZx

THIS DOCUMENT IS SUBJECT TO DATA PROTECTION - Printed

from CAD Browser V3

Incident

Number

P20029697 Call

Source

OFFICER Phone - Date

Time

06/02/2020

09:43:16

Name 1795 Address -

Location

1000 HIGHDOWN LN HMP_HIGHDOWN SUTT HMP

Type P2 SUDDEN DEATH Centre IHC

P20029697 15:44 04/06/20 15:44 05/06/20 ALL

Event

Grade

2

Comments

Date Time Oper Comment

06/02/202

0

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cad039 15689 IN FROM 1795

dbserve

r

15689 [SYSTEM] LOI search completed at 06/02/20 09:43:20

cad039 15689 .

cad039 15689

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DETAILS TO FOLLOW...

1795 IS PRISONER LIAISON AT LOCATION

GOVERNOR HAS JUST MADE US AWARE OF A

SUDDEN DEATH OF A PRISONER

FOUND DECEASED IN HIS CELL

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COLLEGUE EN ROUTE TO CELL NOW TO SEAL

CELL

REQUESTING NPT TO ATTEND

NO PRISONER DETAILS KNOWN AT THIS TIME OR

CAUSE OF DEATH

WILL FIND THIS OUT AND EMAIL !FCR WITH

DETAILS

ADVISED WILL PASS FOR ATTENDANCE AND FOR

DUTY INSP REVIEW

INFT REQUESTING CID MADE AWARE

CC

cad039 15689 ##

cad007 7950

cad012 16962 .

cad012 16962

OPS2 NOTED AND REVIEWING - THIS WILL

REQUIRE REVIEW - DUTY DI AND CORONER WILL

NEED TO BE MADE AWARE - DEATH IN

CUSTODY/PERSON UNDER DOL ORDER

RB20 AWARE WILL VIEW

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cad007 7950

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cad014 11794 .

OUT TO CID

OPS2 - OUT TO CORONER'S OFFICE

DS GRIFFIN AWARE AND MONITORING CAD

CC

cad014 11794 # NDM #

cad014 11794

cad014 11794

SARAH CAWSEY AT THE CORONER'S OFFICE

AWARE

OPS2 - THE INFT IS PRISON LIAISON - THEY NOW

HAVE AN OFFICE WITHIN HIGHDOWN

PC DOBISZ MOBILE GOES STRAIGHT TO

ANSWERPHONE

OPS2 - DUE TO THE DEATH BEING IN CUSTODY -

CAN THE OFFICER ATTENDING PLEASE

CONTACT THE CORONER'S OFFICE ASAP ON

01483 404530 AS SOON AS INITIAL DETAILS OF

THE DECEASED HAVE BEEN ESTABLISHED -

THANK YOU ##

THREAT: SUDDEN DEATH OF PRISON INMATE

HARM: NO CIRCS KNOWN

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cad039 15689 ##

RISK: UNKNOWN - NO DETAILS KNOWN

WHATSOEVER - UNKNOWN

CIRCS OR IDENTITY OF THE DECEASED

INVESTIGATION: UNIT TO ATTEND CONFIRM

DETAILS AND ASSESS

WHETHER ANY SUS CIRCS

VULNERABILITY: N/A

cad039 15689 IN FROM 1795

cad039 15689

cad039 15689

cad039 15689 .

ENGAGEMENT: NPT ATTENDANCE

[SYSTEM] Event Location changed from "@HMP :

1000 HIGHDOWN LN HMP_HIGHDOWN SUTT" to

"1000 HIGHDOWN LN HMP_HIGHDOWN SUTT: #

UNKNOWN SUDDEN DEATH # : @HMP" at: 06/02/20

10:12:48

PRISONER: TURNER/SAUL/ALEXANDER

08/12/1983

WHITE BRITISH

cad039 15689 IN HOUSE BLOCK 3 SPUR A LEVEL 3 CELL 10

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cad039 15689 ONLY ARRIVED ON 8TH JAN 2020

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SHARING CELL, CELL MATE SPOKEN TO, AND

WHEN UNLOCKED AT

0900HRS CELL MATE LEFT THE CELL DON'T

KNOW IF TRIED TO WAKE

HIM BUT AS FAR AS HE WAS AWARE NOTHING

HAD HAPPENED

COUPLE OF PRISONERS GONE INTO CELL TO

SPEAK TO HIM OF A

CELL MATE

NOTICED THAT HE WAS STILL IN BED

APPARENTLY ASLEEP

TRIED TO ROUSE HIM BUT BEEN UNABLE TO DO

SO

A CODE BLUE HAS BEEN CALLED AT 0909HRS

WHICH IS MEDICAL

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EMERGENCY

HEALTH CARE HAVE ATTENDED AND FOUND HIM

UNRESPONSIVE

AND SUSPECT DECEASED

ON SITE DOCTOR HAS ATTENDED AT 0918HRS

AND COME TO THE

SAME CONCLUSION

AMBULANCE CALLED AND EXTERNAL

PARAMEDICS ATTENDED AT

0922HSR

THEY HAVE DECLARED DECEASED AT 0935HRS

SOME CONCERN FROM COLLEAGUE APPEARS

TO BE

DISCOLORATION AROUND THE NECK AREA -

POSSIBLE BRUISING TO

E45


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THE THROAT AND WHITES OF EYES SHOW

BLOWN BLOOD VESSELS

WHICH WOULD INDICATE STRANGULATION

NOT KNOW IF SELF-INFLICTED OR OTHERWISE

AT THIS TIME

NO ON ANY ACT REPORT WHILST AT LOC

HOWEVER HE HAS GOT A HISTORY OF

PREVIOUSLY SELF-HARM

PRIOR TO COMING TO HIGH DOWN - PREVIOUS

FOR BEING A

'CUTTER'

NO LIGATURE IN SIGHT

COLLEAGUE HAS ASKED FOR FULL DETAILS OF

ALL PARAMEDICS

AND HEALTH CARE THAT HAVE ATTENDED

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HIS CELL MATE AND THE TWO PRISONERS THAT

RAISED THE

ALARM WILL BE SEPARATED AND CONTAINED

INDIVIDUALLY AND

CLOTHING SEIZED

NO NAIL KITS SO CAN'T TAKE NAIL SCRAPINGS

AND NO SWABBING

CAPABILITIES

CELL HAS BEEN SEALED WITH DECEASED STILL

IN SIDE

CPR WAS ATTEMPTED BY IN HOUSE HEALTH

CARE AND

PARAMEDICS WITH NO SUCCESS HENCE THEIR

DETAILS OBTAINED

THAT IS THE UPDATE AT THIS TIME - NO

FURTHER INFO

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cad039 15689

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COLLEAGUE IS 40487 SIMON RICHMOND

CC

cad039 15689 ##

cad007 7950

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cad014 11794

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cad015 10257 .

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cad012 16962 .

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OPS2 NOTED - NPT DEPLOYMENT ASAP PLEASE -

SGT AND DUTY INSP TO BE MADE AWARE -

PLEASE CHECK WITH CID THAT DUTY DI IS

AWARE - THANK YOU

OUT TO RB20 P2P

UPDATED

RB20 - SUGGEST RB35 TO BE DEPLOYED

OUT TO CID

RB35 WILL VIEW AND DEAL

SRCH TURNER/SAUL/ALEXANDER:08121983:::

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cad015 10257

OI:1 AS:30 IP:5 DNA:4 DH:24 AL:5 AB:2 OD:1

RECORD 1

cad015 10257 TURNER, SAUL ALEXANDER PNCID 96/473121X

cad015 10257 08/12/83 KENT CRO 217944/96W

cad015 10257

MALE WHITENORTHEURO

cad015 10257 TATT 2 SCAR 4

cad015 10257

cad015 10257

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cad015 10257

cad015 10257 +

cad015 10257

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SELF-HARM HAS MADE THREATS TO SELF HARM

OFFENDS ON BAIL (12) *HOME DETENTION

CURFEW RELEASED

SUPERVISED

*PROLIFIC OFFENDER *DNA E+W NOT REQUIRED

*FAILS TO APPEAR

LAST KNOWN ADDRESS AS AT 09/01/20 (HOME)

133 EAGLE AVENUE WATERLOOVILLE

HAMPSHIRE PO8 9XB (44JW)

cad015 10257 RECORD LAST UPDATED 04/02/20 09:35

cad015 10257 .

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cad015 10257

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cad015 10257 FOR :

cad015 10257

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OPERATIONAL INFORMATION REPORT

MANAGED OFFENDER

ISSUED AT : HAMPSHIRE IOM

ACTION : INFORMATION

FS/REF : 44FF/44200043488 CASE PAPERS : 44FF

START DATE : 04/02/20 END DATE : UNLIMITED

SUBJECT IS MANAGED BY HAMPSHIRE

INTEGRATED OFFENDER

MANAGEMENT (IOM)

IF YOU HAVE ANY INVOLVEMENT

(STOPS/ARRESTS/INTEL) PLEASE

CONTACT

cad015 10257 478853

IOM.INFORMATION.HUB@HAMPSHIRE.PNN.POLIC

E.UK OR 02380

cad015 10257 ENTERED BY 44FF ON 04/02/20

cad015 10257 LAST UPDATED ON 04/02/20

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cad015 10257

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NO WS PNC

CID DI WILL BE MADE AWARE

WARNINGS/FLAGS [FILTERED] -- PERSON:

TURNER, SAUL

ALEXANDER [G1] / 08/12/1983 (36) M / SUSSEX /

157717 / 96/473121X

TYPE FROM / TIME TO NOTES / REMARKS

------------------------------------------------------------------------

--------

cad015 10257 ++ N/T NFLMS SAUL TURNER ++

cad015 10257 .

cad069 16908

cad069 16908

cad069 16908

cad069 16908

CALL INTO THE CTC FROM HEATHER NIN

01483404507

FROM THE CORONER'S OFFICE WHO WILL BE

ATTENDING

REQUESTING TO SPEAK TO SOMEONE FOR

FURTHER DETAILS

BEFORE THEY ATTEND

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HAVE ADVISED WILL UPDATE THE REPORT AND

WE WILL BE IN

CONTACT IN DUE COURSE

CC

[REVIEW EVENT ALERT] P20029697 RB HAS BEEN

UPDATED. PLEASE

REVIEW ASAP.

3887 WILL BE ATTENDING AS DIVISIONAL DI

3887 CONTACTING CORONER DIRECT

CID DEPLOYING FROM REIGATE

RB35- DI HAS REQUESTED DOUBLE CREWED

WITH A VAN SO RB38 ASSISTING

UNITS ST6

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cad039 15689 ##

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387- HAVE SPOKEN TO CORONERS OFFICER

WHO WILL RV AT HIGHDOWN WITH POLICE AT

MIDDAY

PC RICHMOND IS ON SCENE- HE HAS CELL

LOCKED WITH DECEASED INSIDE

THE CELL MATE HAS BEEN TAKEN BY HMP

STAFF ELSEWHERE ALONG WITH 2 WITNESSES

ABOVE IS FROM 3887 DI CHETTY

3887 NEED SENIOR SOCO DETAILS

PC RICHMOND HAS BEEN TASKED TO FIND OUT

CELL MATE AND WITNESS DETAILS AND WILL

THEN DIRECT 24/7 TO RUN CHECKS IN VIEW TO

FINDING OUT ANY LINKS OR ONGOING ISSUES

SENIOR SOCO DETAILS EMAILED TO DI CHETTY

AS REQUESTED

EMAIL INTO !FCR MAILBOX TIMED - THU

06/02/2020 10:52

DETAILS OF THE DECEASED'S CELL MATE:

E53


E54

06/02/202

0

12:43:06

06/02/202

0

12:43:06

06/02/202

0

12:43:06

06/02/202

0

12:43:06

06/02/202

0

12:43:06

06/02/202

0

12:43:06

06/02/202

0

12:43:07

06/02/202

0

12:43:33

06/02/202

0

12:43:34

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

cad039 15689

TOMMY GURNEY

cad039 15689 28/04/1992

cad039 15689 PNC ID: 03/365056V

cad039 15689

cad039 15689

DEFINITELY A TWO MAN CELL - NO OTHER

OCCUPANTS.

TIM DOBISZ

cad039 15689 POLICE CONSTABLE 1795

cad039 15689 ##

cad039 15689

cad039 15689 .

cad039 15689

cad039 15689

cad039 15689

cad039 15689 .

cad039 15689

EMAIL INTO !FCR MAILBOX TIMED - THU

06/02/2020 12:11

FURTHER UPDATES:

PRISONERS WHO DISCOVERED THE DECEASED

AND RAISED THE

ALARM.

JACK RIPLEY

cad039 15689 23/03/1990

E54


E55

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

cad039 15689 PNC ID: 02/172096Q

cad039 15689

cad039 15689 .

cad039 15689

CELL HB3-3-A-001

DAVID AMEY

cad039 15689 22/01/1981

cad039 15689 PNC ID: 94/187306Y

cad039 15689

cad039 15689 .

cad039 15689

cad039 15689

cad039 15689

cad039 15689

cad039 15689

cad039 15689

cad039 15689 .

CELL HB3-3-A-007

REQUEST FROM DI CHETTY - CAN THIS CAD

PLEASE BE PASSED TO

24/7 INTEL HUB AND RESEARCH CONDUCTED ON

THE VICTIM, CELL

MATE AND THE TWO PRISONERS WHO

DISCOVERED THE

DECEASED, TO SEE IF THERE IS ANY INTEL TO

LINK THEM OR TO

SUGGEST THAT THE VICTIM WAS UNDER ANY

FORM OF THREAT

(FROM ANY PARTY).

E55


E56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:43:56

06/02/202

0

12:44:35

06/02/202

0

12:55:31

06/02/202

0

12:58:09

06/02/202

0

13:20:31

06/02/202

0

13:20:39

06/02/202

0

13:20:40

06/02/202

0

15:27:13

06/02/202

0

16:22:55

06/02/202

0

16:24:17

cad039 15689

TIM DOBISZ

cad039 15689 POLICE CONSTABLE 1795

cad039 15689 ##

cad039 15689

cad019 16006 .

cad019 16006

cad019 16006

cad019 16006

cad019 16006 .

cad012 10161

cad015 17001 .

cad015 17001

24-7 INTEL CURRENTLY COMMITTED

SECAMB OPS1: AMB CREW HAVE BEEN ON

SCENE FOR 3 HOURS. NEED TO ESTABLISH

WHETHER THEY ARE STILL REQUIRED FOR

STATEMENTS, ETC

PC RICHMOND: THE AMB CREW HAVE BEEN

RELEASED AND ARE HEADING BACK TO THEIR

VEHICLE

SECAMB OPS2 UPDATED

RB51 AND RB59 >> LOCATION TO ASSIST WITH

REMOVAL OF DECEASED

CALL FROM 3887, HAS VISITED THE SCENE AND

IS SATISFIED THERE IS NO FURTHER

INVOLVMENT IT IS AN UNEXPLAINED DEATH

HOWEVER, NO SIGNS OF ANY SELF HARM OR

ANY INVOLVMENT OF ANY THIRD PARTY. THE

SOCO (HAZEL) HAS BEEN TASKED TO RECOVER

THE DECEASED TO THE ROYAL SURREY FOR

HOME OFFICE PM, THE SCENE GUARD WILL

REMAIN AND THEN BE REQUIRED TO ASSIST

DECEASED TO MORTUARY

E56


E57

06/02/202

0

16:25:40

06/02/202

0

16:25:52

06/02/202

0

16:25:59

06/02/202

0

16:30:38

06/02/202

0

16:37:21

06/02/202

0

16:37:35

06/02/202

0

17:34:28

06/02/202

0

17:34:34

06/02/202

0

17:34:41

06/02/202

0

17:45:28

06/02/202

0

17:47:29

06/02/202

0

19:28:15

06/02/202

0

19:28:18

06/02/202

0

19:28:39

cad015 17001

cad015 17001 .

cad015 17001

cad015 17001

CORONER OFFICER HEATHER NINN AWARE. PC

RICHMOND 40487 WILL CREATE SVR AND

RELATED NICHE / SCARF . NICHE CREATED AND

LINKED 4500014974, DEATH MESSAGE WILL BE

PASSED BY HMP

3887 REQUESTING CHEIF TEMPLATE LOG

OPS 2 ADVISED OF ABOVE

cad012 10161 IN FROM 40487

cad012 10161

cad014 11730 ...

cad014 11730

cad014 11730

cad015 17001

cad014 11730

cad014 11730 ..

cad014 11730

cad014 11730

UNDERTAKERS CALLED AT 1630 ETA WITHIN THE

HOUR

REQUIRE UPDATE FROM RB51

CURRENTLY ON PHONE WILL CALL DESK WHEN

FREE

RB59 STILL WAITING ATT

SOCO ARE NOT YET ST6, WE ARE AWAITING

THEIR ARRIVAL

OUT TO RB59

SOCO ST6

E57


E58

06/02/202

0

19:28:58

06/02/202

0

19:29:30

06/02/202

0

19:29:34

06/02/202

0

20:46:08

06/02/202

0

20:54:36

06/02/202

0

21:01:06

06/02/202

0

21:11:45

06/02/202

0

21:36:46

06/02/202

0

22:04:52

06/02/202

0

22:59:15

06/02/202

0

23:01:05

06/02/202

0

23:07:51

06/02/202

0

23:19:02

06/02/202

0

23:19:13

cad014 11730

cad014 11730

cad014 11730

cad015 17001

cad015 17001

$RB51 40808

$RB51 40808

cad012 10161

UNITS STILL ON SCENE ATT

BODY STILL IN SITU

CALLING UNDERTAKERS NOW

RB51 ON WAY TO ROYAL SURREY WITH

DECEASED RB59 STAYING IN THE PRISON WITH

SOCO

RB59 DOOR SECURED AT 2036, KEY PASSED TO

OFFICER LINEHAN

[40808]UNDERTAKERS HAVE CALLED ROYAL

SURREY HOSPITAL AND THEY HAVE REFUSED

THE DECEASED DUE TO NO ROOM. RB21 IS

LIAISING WITH CID ABOUT NEXT COURSE OF

ACTION

[40808]RB21 HAS CONFIRMED THAT A SPACE IS

AVAILABLE AT ROYAL SURREY FOR THE

DECEASED AS IT WAS PRE-ORGANISED. RB51 S5

TOWARDS ROYAL SURREY

RB51 ST6 HOSPITAL

$RB51 40808 [40808]DECEASED PLACED IN FRIDGE D RACK 3

$RB51 40808

cad006 2273

500933

9

500933

9

cad012 11008 45200014974

cad012 11008

[40808]DI CHETTY HAS STATED THAT OFFICERS

DO NOT NEED TO STAY WITH DECEASED. THIS

ICAD BE CLOSED

FIM - PLS CONFIRM IF WE STILL HAVE ANY

SCENE GUARDS ON

QH32 ATTENDED SCENE. PHOTOS TAKEN AND

BODY PROCESSED THEN COLLECTED BY

UNDERTAKERS FOR TRANSPORTING TO RSCH

ON 6TH FEBRUARY 2020 TBE DECEASED WHO IS

A PRISONER AT

E58


E59

06/02/202

0

23:19:13

06/02/202

0

23:19:13

06/02/202

0

23:19:13

06/02/202

0

23:19:13

06/02/202

0

23:19:13

06/02/202

0

23:19:13

06/02/202

0

23:19:13

06/02/202

0

23:19:13

06/02/202

0

23:19:13

06/02/202

0

23:19:13

06/02/202

0

23:19:13

06/02/202

0

23:19:13

06/02/202

0

23:19:13

06/02/202

0

23:19:13

06/02/202

0

23:19:13

cad012 11008

cad012 11008

cad012 11008

cad012 11008

cad012 11008

cad012 11008

cad012 11008

cad012 11008

cad012 11008

cad012 11008

cad012 11008

cad012 11008

cad012 11008

cad012 11008

cad012 11008

HMP HIGHDOWN HAS BEEN FOUND IN HIS CELL

AFTER FELLOW

PRISONERS RAISED THE ALARM ABOUT HIM

BEING NON

RESPONSIVE. THE DECEASED HAS BEEN

REMOVED FROM THE TOP

BUNK OF THE CELL HE WAS IN AND HAVE

ATTEMPTED CPR.

MEDICAL STAFF HAVE ATTENDED AND

ATTEMPTED TO

REAUSITATE THE DECEASED BUT HAVE

STOPPED AFTER

DISCUSSION THAT THERE WAS NO RESPONSE.

DR AT THE PRISON

HAS ATTENDED AS WELL TO GIVE SECOND

OPINION. PARAMEDICS

ALSO ATTENDED AND HAVE ATTEMPTED

REAUSITATE BUT HAVE

STOPPED AND ROLE DECLARED AT 0935HRS.

THERE HAS BEEN NO

OBVIOUS SIGNS AS TO CAUSE OF DEATH AND

DUE TO SITUATION

AND INITIAL ASSESSMENT FROM CHECK OF

BODY GAVE CONCERNS

OF A SUSPICIOUS DEATH SO DECEASED HAS

BEEN SEALED IN CELL

AND CRIME SCENE BEGUN WITH SCENE LOG.

DUTY DETECTIVE

INSPECTOR CALLED OUT TO ATTEND.

E59


E60

06/02/202

0

23:44:42

06/02/202

0

23:45:11

cad019 8448

cad019 8448

[SYSTEM] Event Location changed from "#

UNKNOWN SUDDEN DEATH # : @HMP : 1000

HIGHDOWN LN HMP_HIGHDOWN SUTT" to "1000

HIGHDOWN LN HMP_HIGHDOWN SUTT" at:

06/02/20 23:44:42

[SYSTEM] Assigned Result Code: Z3PSW - PUBLIC

SAFETY / WELFARE, Detailed Event Type: PSW25 -

SUDDEN DEATH, Qualifier 1: IHC

06/02/202

0 cad019 8448 [SYSTEM] Event P20029697 closed.

23:45:11

Unit History

Date Time Oper Unit and Status

06/02/2020 16:13:09 5012507 5012507 Unit: QH30 : DISPATCHED

06/02/2020 16:13:10 5012507 5012507 Unit: QH32 : DISPATCHED

06/02/2020 23:18:07 $RB59 8040976 Unit: RB59 : Unknown (AM)


06/02/2020 15:36:10 $RB59 8040976 Unit: RB59 : Unknown (UC)











06/02/2020 22:58:51 $QH30 15519 Unit: QH30 : Unknown (AM)

06/02/2020 17:12:21 $QH30 15519 Unit: QH30 : ARRIVED

06/02/2020 10:34:49 cad013 16577 Unit: RB35 : Unknown (SX)

06/02/2020 10:48:04 cad013 16577 Unit: RB38 : DISPATCHED

06/02/2020 10:53:12 cad013 16577 Unit: RB35 : ENROUTE



06/02/2020 17:45:31 cad015 17001 Unit: RB59 : ARRIVED






E60


E61



















06/02/2020 17:18:11 cad014 11730 Unit: RB59 : Unknown (CL)

06/02/2020 17:18:11 cad014 11730 Unit: RB59 : Unknown (UG)









06/02/2020 16:43:32 cad012 10161 Unit: QH30 : Unknown (SC)











E61


E62





06/02/2020 15:34:17 cad015 17001 Unit: RB51 : Unknown (SC)

06/02/2020 15:34:24 cad015 17001 Unit: RB59 : Unknown (SC)





























06/02/2020 23:08:00 5009339 5009339 Unit: QH32 : Unknown (AM)

06/02/2020 18:21:25 C41HD-CL-INT2 0 Unit: RB51 : ARRIVED




E62


E63






















06/02/2020 11:13:30 C41HD-CL-INT2 0 Unit: RB35 : ARRIVED













Unit Dispatched -> Enroute -> Arrived -> Available Total

QH30

06/02/2020

16:13:09

CHARLOTTE

ANDERTON 15519

00h:59m:12s

00h:59m:12s

E63


E64

QH32 06/02/2020

16:13:10

RB35

RB38

RB51

RB59

Total

06/02/2020

10:19:03

GEORGE

STRATFORD

40991

06/02/2020

10:48:04

ELIZABETH

BLOOMFIELD

41270

06/02/2020

15:26:51

KIERAN TODD

40808

06/02/2020

15:26:55

JACK HOWIE

8040976

00h:34m:09s 00h:20m:18s

00h:05m:09s 00h:21m:56s

02h:20m:45s 02h:43m:23s

00h:08m:12s 04h:57m:51s

+1 day

00h:54m:27s

00h:27m:05s

05h:04m:08s

05h:06m:03s

+1 day

DATA PROTECTION ACT

The information in this document is subject to the Data Protection Act

1998

It must not be disclosed to any unauthorised person

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SaulAlexanderALTALv053FCompleteBundle (1) (5) There is sufficient evidence to justify a prosecution.

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