Report by the nsw state Coroner into deaths in custody/police operation
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- Events of 2 August 2003
- Events prior to 2 August 2003
Recommendation Section 22To the Minister for Justice that immediate action be taken to remove all Notice Boards from Prisoners cells that may be used for the purpose of securing a ligature. 1314/03 Inquest into the death of RM on 2August 2003 Finding given 3 August 2005 at Gosford by Magistrate Dorelle Pinch, Deputy State Coroner. Events of 2 August 2003Throughout Saturday 2 August 2003 RM, aged 54, had one predominant message for everyone he encountered, namely, the air in his unit was toxic, the ventilation was poor, there was mould on the walls, he could not breathe properly and he needed to move away from the unit immediately. At 8.45 am he called the real estate manager of the property, Ms C, and pleaded with her to help him move into a motel because he couldn’t live in the unit any longer. She was so concerned about his state of agitation - he kept moving away from the phone and uncharacteristically swearing - that she kept talking to him, trying to calm him down while her co-worker organised for ambulance officers to attend. Concerned he may be violent, the ambulance dispatcher had also contacted police. Two officers arrived at RM’s unit at The Entrance at 9.40 am. Senior Constable R described RM as distressed and shaking violently. He reiterated that he was unable to breathe inside because the ventilation was poor. However, he refused the offer of the ambulance officers to take him to hospital. Around midday, RM called the real estate agency and left a message for Ms C saying that the police had been and he was “OK”. However, he left another message left around 2 pm again requesting that he be moved to a motel. Ms C telephoned RM about 3pm and explained that because of his special needs as a sufferer of Parkinson’s Disease, the Agents could not take responsibility for moving him to a motel. He politely thanked her, then terminated the conversation. Around 5.30 pm RM entered The Entrance Police Station, wheeling a shopping trolley with an overnight bag that contained some “essentials” and his Parkinson’s medication. When he arrived he was breathless and mumbling incoherently. Although he initially managed to sit on a chair in the foyer his limbs were thrashing about uncontrollably. Constable O, who had seen RM at the police station on 29 July comparatively calm and his speech intelligible. On 2 August, police could not make out what he wanted but they were convinced he needed medical treatment so they called for an ambulance. By that time RM had been identified by the name “BM” and also by the fact that he had Parkinson’s Disease. This information was passed on to the ambulance dispatcher. The fact of the Parkinson’s Disease was not, however, passed on to the ambulance officers who attended the police station. Ambulance Officers W and S formed the view that RM was psychotic and displayed suicide ideation. Mr W requested that police use their powers to “schedule” him and take him in a police wagon to Mandala Psychiatric Unit at Gosford Hospital. Police, however, considered that RM’s condition was a general health, not a mental health, problem. There does not appear to have been any concerted attempt by police to apprise the ambulance officers of their previous dealings with RM, the similarities and the differences in his presentation on those occasions and, in particular, traits of which they were aware could be associated with his Parkinson’s Disease. This may have been because all the police officers who gave evidence considered it was obvious that RM’s condition was a physical health problem. Indeed, the evidence of the two ambulance officers was that it would have made no difference to their assessment if they had known about his Parkinson’s Disease. They did not associate RM’s involuntary large body movements or postural instability with the disease. They thought it was solely characterised by small tremors. From the observations of the ambulance officers, they assessed RM as liable to harm himself. They managed to calm him down and carry out a health assessment. It was noted, however, that they did not try to ascertain why RM had come to the police station nor ask about his previous medical history. This was despite the fact that RM continued to assert that he would go anywhere, even be locked up, as long as he did not have to return to his unit. There was a delay in moving RM while the issues of who would transport him and by what means were resolved. Time appeared to be taken as well while ambulance officers tried to check out their patient’s medication. At 6.20 pm RM stopped breathing. Paramedics were called and arrived at 6.33 pm. However, despite the efforts of all the ambulance officers, RM could not be revived and he was pronounced dead on arrival at Gosford Hospital just after 7 pm. Events prior to 2 August 2003In the early hours of 29 July 2003 RM fell in his bathroom and was unable to rise. After a considerable time a neighbour heard his cries for help and called the police. However, by the time police broke into the unit and assisted him, he had been stuck for some three and a half hours. According to his carers and even the estate agent, RM’s confidence was shattered by this experience. The situation was made worse by the fact he subsequently fell off his lounge and also his computer chair. RM attended Gosford Hospital to be treated for minor injuries he sustained in these falls on both 29 July and 1 August. According to the hospital records for 1 August 2003, RM complained of experiencing respiratory difficulties. However, no such problem was detected on examination. Classification under the Coroners Act 1980 RM’s death was initially classified and investigated as a death in the course of police operations under section 13A(1)(b) Coroners Act 1980. It was noted that it also falls with section 13AB(1)(f) of the Act in that RM received service provider assistance to enable him to live independently in the community. Under each of those provisions an inquest can only be held by a coroner of the State Coronial Bench. This requirement has been met. The Deputy State Coroner was still of the opinion that this case is appropriately classified as a death in the course of police operations. Cases have previously been so classified where police have attended premises to carry out official duties and, in the process of escorting a person from the premises, that person has collapsed and died. In this instance RM attended the police station seeking police assistance. Decisions were made and actions were taken by police officers in the course of their official duties that affected his welfare and could, potentially, have impacted on his death. Therefore, no reason was seen to distinguish between situations when police are carrying out their official duties at the police station or outside. Directory: Documents Documents -> Concept stage Documents -> Concept stage Documents -> The great global switch-off Documents -> Nonprofit grant application Documents -> The Truth about the Rwandan Genocide Documents -> Annual InStructional unit plan Documents -> Chaos equipment included Download 0.8 Mb. Share with your friends:
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