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Cancelled brain scan could have saved UK immigration detainee

Inquest, Day Four: Neurologist testifies that he might have saved 25 year old Bruno Dos Santos. 

Phil Miller
26 May 2016

Dorchester County Court (Phil Miller)

A missed brain scan could have led to potentially life saving treatment for a young man who died in immigration detention, an inquest jury heard yesterday.

Bruno Dos Santos, a 25 year old Angolan, died suddenly at the Verne prison in Dorset on 4 June 2014, alone in his cell.

Dr Mark Walker, a neuropathologist who examined brain tissue from the dead man, found swelling consistent with a rare disease called neurosarcoidosis. 

“The likely cause of death was that an inflammatory process in the brain cells resulted in sudden death,” he said. “Inflammation in this region may have resulted in sudden stoppage of heart or breathing.”

Dos Santos, who also suffered from epileptic seizures, had been scheduled to attend an MRI scan months before he died.

At the time of the appointment, 24 February 2014, Dos Santos was being held as an immigration detainee at HMP Thameside, a private prison run by Serco, with healthcare contracted to Care UK. Staff refused to let him attend the appointment due to “security reasons”, the senior coroner Mr Sheriff Payne said.

Dr Cocco, a neurologist, said that a brain scan appointment could have led to life saving treatment.

“It was probable that I would have seen abnormalities and definite that I would have made further investigations,” he told the inquest jury at Dorchester county hall.

Doctors have to rule out multiple causes of brain swelling before arriving at a diagnosis of neurosarcoidosis.

Although this takes time, Dr Cocco said tests could have been completed before Dos Santos died.

“I could have obtained all the results within two to three months… Most probably a diagnosis would have been made between 24 April and 24 May,” he said.

The neurologist would then have given Dos Santos potentially life saving steroids at least ten days before he died. 

Nick Brown, a barrister from Doughty Street Chambers who is representing the Dos Santos family, asked the neurologist: “Would he have responded enough to prevent the neurosarcoidosis causing him to go into respiratory or cardiac arrest?”

Dr Cocco replied: “Probably in 60 to 70% of cases he would have responded to steroids within days.” 

A lawyer for the Ministry of Justice, Georgina Woolf, argued that it was unlikely the medical tests would have happened fast enough, telling Dr Cocco:

“I wish it was an ideal world but in the real world, on the balance of probabilities, by 4 June it is unlikely that you would have been able to get a clear diagnosis, start treatment and that he would respond.”

Dos Santos had swelling in a part of his brain which neuropathologist Dr Walker described as the “most complicated structure in the known universe”.

The medulla, or brain stem, sits above the spine and subconsciously controls a persons breathing and heart beat. Dr Walker compared it to a plane’s autopilot. 

It is not certain whether Dos Santos had already developed this condition at the time of the missed brain scan. Academic literature on the evolution of neurosarcoidosis is scarce.

The inquest continues. A verdict is expected today.

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