Alois Dvorzak and his wife

The use of handcuffs and a chain on a dying 84 year old man was condemned today in a report by the Prisons & Probation Ombudsman, Nigel Newcomen. He said that the UK government’s contracting out of immigration detention may have led to the increased use shackling, because escapes triggered financial penalties.

The Ombudsman’s report was published after an inquest jury concluded unanimously that Alois Dvorzak, aged 84, had died of natural causes.

Dvorzak, a retired electrical engineer from Canada, was held at Harmondsworth, an immigration removal centre near Heathrow Airport after immigration officers denied him entry to the UK. Harmondsworth, at the time, was run by GEO Group, the American prisons company spawned by the Wackenhut Corporation.

The Ombudsman said: “It is a tragic indictment of the system, that such a frail and vulnerable man should have spent his final days in prison-like conditions of an immigration removal centre.”

He went on: “It is particularly shameful that he should have spent his last hours chained to a custody officer without justification and the Home Office needs to ensure such a situation cannot reoccur.

“Unless risk is properly assessed and the use of restraints fully justified, particularly for elderly and infirm detainees, such use is likely to amount to inhuman and degrading treatment under Article 3 of the European Convention of Human Rights”, Newcomen said.

“In this man’s case, we believe that this is likely to have reached the threshold of inhuman and degrading treatment.”

Dvorzak arrived from Vancouver, Canada, on 23 January 2013 and was refused entry to Britain. He was placed in temporary holding at Gatwick airport, then taken to East Surrey Hospital from 24-28 January. From there he was locked up and Harmondsworth, and shuttled between the airport and Hillingdon hospital on several occasions while the Home Office tried variously to return him to Canada and manage his failing health.

He was shackled on two separate visits to hospital, based on security assessments which the Ombudsman said “did not take into account the man’s actual risk”.

He had been taken outside the centre on other occasions, without restraints, and not tried to escape.

“He had spent four days in hospital unescorted when he first arrived in the UK and had not tried to leave. He had never been convicted of any criminal offence and there was no evidence of any risk to the public,” Newcomen said.

Security guards at Harmondsworth told the inquest they thought that Dvorzak had to be handcuffed because he had “escaped” from a mental hospital in Canada. They understood he had been taken to a mental hospital, for fear that he was having a breakdown, after he hit a member of staff at his care home.

The Ombudsman said that this “inaccurate” information “could easily have been checked”.

In fact, said Newcomen, Dvorzak had been “the last resident in the care home which had now closed  . . . The Canadian police had found the man in the streets and had taken him to hospital for assessment. Doctors diagnosed him with dementia and referred him to social services, and the hospital then discharged him.”

This information was obtained by medical staff at East Surrey hospital, where Dvorzak was taken after landing at Gatwick, and crucially before he was detained in Harmondsworth. The Ombudsman is emphatic that Dvorzak had not been detained in a hospital in Canada but had “chosen to leave of his own free will and bought a ticket to London”.

The Ombudsman discovered that Home Office staff themselves had written in Dvorzak’s file that “given his age and vulnerability, restraints should not be used.” Newcomen wrote: “It is difficult to see why this did not apply when he was being taken to hospital.”

He concluded: “It became clear during our investigation that, at the time the man was at Harmondsworth, detainees going to hospital were restrained almost by default.”

Newcomen directly criticised Home Office policy. He wrote: “we consider that the instruction to immigration removal centres in Detention Service Order 08/2008 about the use of handcuffs for escorts is inadequate to cover the legal position and the need to take into account the specific needs of elderly and frail detainees and those with serious medical conditions.”

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

He said that the privatised character of the immigration detention system might have led to increased use of handcuffs. “We note that immigration removal centres such as Harmondsworth are run by private companies under Home Office contracts which may encourage risk aversion in the use of restraints because of the financial penalties imposed should a detainee escape.”

The Ombudsman said Dvorzak’s was the “second death from natural causes at Harmondsworth since the beginning of 2012. … We did not investigate the case of another elderly man who died after being taken to hospital from Harmondsworth in restraints in November 2012.”

The Ombudsman’s report was published today after an inquest jury concluded unanimously that Alois Dvorzak had died of natural causes. Dvorzak died on 10 February 2013 at Hillingdon hospital from coronary heart disease, the jury said.

In his summing up, Senior Coroner Chinyere Inyama referred to five incidents in which where doctors involved in treating Dvorzak at Harmondsworth had warned that he was not fit to be in detention.Dvorzak spent his last night “crying” and complaining of chest pains on three occasions before an ambulance was eventually called. He was taken to the ambulance in a wheelchair and shackled to a security guard by a six foot long chain for over five hours until he took his last breath. The family did not attend the nine day inquest and they were not represented.

The jury gave a short form conclusion that the 84 year old Canadian had been “declared unfit for detention” over ten days before he died. They found a “lack of unified procedures and training and access to relevant data records in dealing with a person of his age and capacity”.

The inquest heard evidence from the former head of detention operations at the Home Office who said that 90% of detainees were being restrained for hospital visits and that it appeared to be the “default position”. She said the guidance had been updated and now contained a presumption against handcuffing detainees for hospital visits, which had seen the use of restraints almost halve.