An 84 year old Canadian man told staff at a British detention centre “I will die here” days before he passed away, the Alois Dvorzak inquest heard yesterday.
Jane Fada, a healthcare assistant at Harmondsworth immigration detention centre, said she saw Mr Dvorzak in distress on the night of 30 January 2013.
Fada said she tried to reassure Dvorzak and told him he would be released soon. Dvorzak repeated: “No, I will die here.”
In her written statement, read out by Senior Coroner Chinyere Inyama to the jury at West London Coroner’s court, Fada noted that she had “never really forgotten that”.Dvorzak was a retired electrical engineer, originally from Slovenia, who had lived in Canada for the past 15 years.
He had left a care home in Canada to try to find his daughter in Slovenia. He was detained by UK immigration officials when he changed flights in London. They were concerned about his fitness to travel — Dvorzak had dementia and acute coronary syndrome.
Jane Fada saw Dvorzak on three night shifts in the weeks before he died. She recalled his sleepless nights at Harmondsworth, where he lay down on the floor, or paced the corridor and said: “Evil spirits won’t let me sleep, evil spirits are boring into me.”
One evening Dvorzak lay down on the floor and shouted out: “You’re all lying pigs.”
In the early hours of the morning he told Fada he was “giving up hope”. He did not fall asleep until after 7am.
Fada said she told him: “I have got respect for you because of your age and you could be my dad.”
She noted: “He could have been totally fed up with being in detention. This was not what he had planned. He was going to see his daughter.”
“Unfit for detention”
The jury heard yesterday from three doctors who saw Dvorzak during his time in Harmondsworth. All three had considered him unfit for detention.
One of the doctors, Mazen Mohammed, who was a locum GP, was asked by the coroner had he heard of Rule 35?
Rule 35 of the Detention Centre Rules (a statutory instrument) requires doctors working in detention centres to inform the Home Office about detainees who have experienced torture before coming to the UK or who are otherwise unfit to detain.
Dr Mohammed said he had not heard of Rule 35.
Dr Mohammed’s superior, Dr Anni Tripathi, also gave evidence. She managed The Jersey Practice, a clinic that provided locum GPs to Harmondsworth at the time of these events, but stopped working at Harmondsworth in November 2013.
The coroner asked Dr Tripathi who was responsible for training Dr Mohammed about Rule 35?
Dr Tripathi said she thought the responsibility lay with healthcare management at the detention centre, which was run by the commercial contractor Primecare.
The coroner asked her: “Was there an agreed training programme you could feed into?”
Dr Tripathi said: “There was not a structured programme.”
Dvorzak refused any treatment from Dr Tripathi, and she recorded that he was not fit to be detained.
Harmondsworth Immigration Removal Centre, 2014. Demotix/Guy Corbishley All rights reserved.
A third doctor also told the jury he had raised the issue that Dvorzak was not fit to be in a detention centre.
Dr Burrun, who had special training in assessing people under the Mental Health Act, was the only psychiatric doctor who regularly visited Harmondsworth. Psychiatric visits were scheduled for once a fortnight.
On 6 February 2013, more than a week after the Dvorzak arrived at Harmondsworth, Dr Burrun examined him.
The coroner pressed Dr Burrun on whether this Mental Health Act assessment should have been done sooner. Dr Burrun replied that an assessment by a psychiatric doctor should have happened on the first day Dvorzak arrived at Harmondsworth, as this was clearly such a serious case.
Dr Burrun performed a “mini-mental state exam” to test Dvorzak for dementia. He scored 16 out of 30, which indicated “mild to moderate cognitive impairment … Any score below 26 would raise concerns regarding the cognitive ability of the patient”, Dr Burrun told the jury.
“A pointless exercise”
Dr Burrun said Dvorzak was refusing to take vital medication for his dementia and for his heart condition.
The doctor declared Dvorzak unfit for detention and recommended sectioning him under the Mental Health Act (so that he could be admitted to mental health care with or without his consent).
He made a referral to Colne Ward, a psychiatric ward at nearby Hillingdon Hospital. But the jury heard that this referral failed because Colne Ward could not take patients aged over 65.
The coroner asked: “Why were they even considered when he needed an old age psycho-geriatric ward?”
Dr Burrun said: “That was the initial point of contact.”
The coroner replied: “It sounds pointless. Why could there not be an approach to a psycho-geriatric ward from the start?”
Burrun said: “That was the care pathway.”
The coroner persisted: “My puzzlement is that Colne Ward were making an assessment for his placement on their ward, not to a psycho-geriatric ward. It just seems a pointless exercise.”
The jury heard that another doctor later had to refer Dvorzak to Accident & Emergency for an urgent mental health assessment just days before he died.
Dr Burrun explained that referrals to A&E were an “alternative care pathway in an emergency” for sectioning detainees.
Fears of catastrophic consquences
Amid all the stark medical warnings, the Home Office was trying to put Dvorzak on a plane back to Canada.
Noel Dickson, an emergency medical technician for private health and security contractor Taylormade, collected Dvorzak from Harmondsworth on 6 February to take him to the airport.
Dvorzak was “quite calm and compliant and wanted to return to Canada” when Dickson first met him, but he refused a screening health-check.
Dickson knew that Dvorzak had had chest pains the week before and that he had been hospitalised previously. He told the jury about his fears that Dvorzak’s stress levels might increase and overload his heart.
“The major point was my concern that a gentleman of his age, having had the week before complained of chest pains and had no obvious intervention … That could have been catastrophic,” Dickson said.
He went on: “A short time into the journey Dvorzak became angry and stressed. There was constant shouting ‘NO NO NO’ and banging on windows of the vehicle. He was distressed.”
Worried that “stress on his heart could cause a cardio vascular episode”, Dickson said he “called our doctor for superior clinical advice”.
Dickson told the jury what happened next: “The doctor was not very helpful at all. He asked if I was not confident to carry on with the removal? I said it was not about confidence, it was about superior clinical advice.”
Dickson felt he was left to make his own decision. Half an hour later, Dickson and his senior escort officer were both “not happy”. They called the head office of Tascor, the company that provided overseas escorts for deportation flights.
Tascor told them that the removal “could not be aborted unless there was resistance”.
Dickson said: “This was quite a shock to say the least. This 80 something year old gentleman was not going to fight. So I immediately made the phone call to say the removal was being aborted.”
On the way back to Harmondsworth, Dickson recommended to immigration authorities over the phone that “it was probably not the right place for this gentleman to be in detention because of his age and he was very vulnerable”.
Dvorzak died four days later.
The inquest continues.
* Colne Ward was part of the Central and North West London NHS Foundation Trust.