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90% of immigration detainees visiting hospital were handcuffed, inquest hears

  • Dvorzak inquest. Day 8: Juror: Should arrangements for vulnerable detainees have been in place a long time ago?
  • Home Office official: “Yes. I don't know why they weren’t.” 
Phil Miller
29 October 2015

Harmondsworth Immigration Removal Centre, 2015. Demotix/Mark Kerrison All rights reserved.

Nine out ten people in immigration detention centres were taken to hospital in handcuffs, an inquest into the death of Alois Dvorzak heard yesterday.

Dvorzak, a frail 84 year old, was taken to Hillingdon Hospital in handcuffs twice. He died there on the second visit, on 10 February 2013. Dvorzak was shackled to a security guard by a six foot long chain for more than five hours before he took his last breath.

Karen Abdel-Hady, who was the Home Office’s director of detention operations at the time of Dvorzak’s death, said a new policy had since been introduced. There is now a presumption that sick detainees should not be restrained on hospital visits.

“The death of Mr Dvorzak fed into that,” she told the jury at West London Coroner’s Court. “Following the death of Mr Dvorzak we held workshops [at detention centres] around the country about what their use of restraint was. Some centres were using restraints 90% of the time, which looked like a default position.”

In June 2014, 91% of detainees taken from Harmondsworth detention centre to hospital were cuffed. A year later, 56% did not have restraints.

John McClure, manger of Dungavel detention centre, for commercial contractor GEO, said that under the old regime at Dungavel: “ninety percent were going out handcuffed. Under the new risk assessment people going out averages 18%.” McClure said the new risk assessment was “totally different...much more comprehensive”.


Abdel-Hady said she should have been aware of Dvorzak’s case at the time. However, the system for notifying her was “not as robust as it should have been”.

She went on: “I introduced a new system after death of Mr Dvorzak so the head of detention operations was aware on a daily basis of any cases that we should be aware about – specifically detainees aged over 65.”

She said: “We should have been more heavily involved in escalating it more ... that’s just my view, that's why we have the escalation process now.”

A juror asked Abdel-Hady if: “these updated systems should have been in place a long time ago?”

She replied: “Yes. I don’t know why they weren’t.”

Abdel-Hady agreed that it was the Home Office’s responsibility to trace Dvorzak’s family and that her department had been “previously criticised about next of kin details.”


Alois DvorzakValerie Anderson, clinical contract manager for Primecare, a medical company that ran healthcare at Harmondsworth, said her staff had concerns about Dvorzak and it was inappropriate for him to be in the detention centre. She insisted her staff had done an “awful lot” for Dvorzak while he was in their care.

Dr Burran, a psychiatrist, saw Dvorzak at Harmondsworth days before he died and referred him for sectioning. Dvorzak was refusing medication for his heart condition. Dr Burran noted that Dvorzak had “a life threatening acute medical condition … he would be most appropriately treated in a hospital setting, not a detention centre”.

However, efforts to section Dvorzak failed. Dr Pramod Prabhakaran, clinical director at Central and North West London NHS Foundation Trust, said that the process of referring elderly detainees to secure pyschogeriatric wards was “clearly something that needs to be looked at”.

He said that “the operations policy is being reviewed as we speak”. Dr Prabhakaran said that had Dvorzak “not been subject to detention, then all healthcare services could have been open to the gentleman”.

Dvorzak died from heart disease, according to the post-mortem report that Senior Coroner Chinyere Inyama read to the jury.

The forensic pathologist, Dr Ashley Fegan-Earl, who examined Dvorzac’s body, said it could not be stated that Dvorzac had died because of the chain.

“It is entirely reasonable to suggest that this man could have died at any time regardless of whether he was involved in any strenuous activity or not. In other words, he could have died whilst in bed, whilst walking or indeed whilst struggling,” he went on.

“Physical and emotional stresses heighten the chance of an adverse cardiac event. This is due to the effects of adrenalin placing additional demands upon an already diseased heart and making an abnormal and, ultimately, a fatal heart rhythm,” he said. 

Late morning on Thursday 29 October, the jury retired.

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