Manager of a UK for-profit detention centre tells inquest jury: “There was no room for discretion. Challenging it would have slowed him going to hospital.”
A frail and confused 84 year old Canadian man was taken to hospital in handcuffs twice because staff at a UK detention centre thought he was an “escape risk”, the inquest into the death of Alois Dvorzak heard yesterday.
Dvorzak landed at Gatwick Airport on 23 January 2013, en route from Canada to visit his daughter in Slovenia. UK immigration officers were concerned about his mental health and vague travel arrangements.
Officials sent Dvorzak to East Surrey Hospital, then detained him at Harmondsworth immigration removal centre, pending repatriation. He died on 10 February 2013.
The inquest at West London Coroner’s Court heard yesterday from Firat Loveridge, who was a duty operations manager responsible for the day to day running of Harmondsworth. Loveridge worked for Geo, the private security company that ran Harmondsworth and provided security escorts for hospital visits.
Loveridge explained: “On the night shift I’m the only one in the building in a managerial position.”
He said he first heard of Alois Dvorzak at six o’clock in the morning of 10 February, when healthcare staff alerted him that an ambulance was coming to take Dvorzak to hospital.
He explained to the jury that for many trips to hospital a Detention Services Order required detainees to be handcuffed.
Loveridge checked Dvorzak’s paperwork and found he had been handcuffed once already for a hospital visit and that he had “previously escaped from a secure mental hospital in Canada”. He understood that detainees deemed an escape risk should be handcuffed.
There were no notes from the healthcare staff about Dvorzak’s extremely frail condition. Loveridge had not yet seen Dvorzak for himself.
No room for discretion
Senior Coroner Chinyere Inyama repeatedly asked Loveridge, who sat in the witness stand, if Dvorzak posed a threat to anyone. Loveridge said security staff had put information in the paperwork about the “escape”.
He conceded: “I didn’t see a threat to anyone once escaped.”
Loveridge told the jury that he saw Dvorzak only after he was already in the ambulance, seated upright.
The coroner asked: “Did he need handcuffs?”
Loveridge responded: “To be honest, no. When I’m reading the paperwork and then I see him it is a bit different. Our decision-making was based on information. There was no room for discretion. Challenging it would have slowed him going to hospital.”
Dvorzak was taken to Hillingdon Hospital by ambulance staff and two Geo escorts. Loveridge said that any one of them could have challenged the use of handcuffs.
The jury also heard from Manpreet Sidhu, who was acting centre manager for the Home Office at Harmondsworth in January 2013. She said that seeing detainees in handcuffs was “such a routine occurrence I wouldn’t even think about it and I would not question Geo’s policy on that”.
Sidhu told the inquest that she was in charge only temporarily. “I might not have been as experienced as I should have been,” she said. “The expectation was that Harmondsworth was a detention centre that could manage most types of detainees... We were expected to just get on with it.”
Sidhu said she had “no understanding” of what a Mental Health Act assessment involved and did not know how often a psychiatric doctor came to the centre.
The coroner asked Sidhu who was responsible for Dvorzak’s health.
“It was quite a collaborative exercise and there were many parties involved in his welfare,” Sidhu replied.
Not fit for detention
Sidhu was told by Dr Farrah Jarral on 30 January 2013 that Dvorzak was not fit for detention. She said it was “rare” for a doctor to contact her directly like that and it showed the seriousness of the situation.
Sidhu revealed that chickenpox was a “huge issue” at Harmondsworth at the time. There were two chickenpox cases in isolation on the healthcare wing where Dvorzak was staying. She said: “the implications of Mr Dvorzak being in the same area could be serious.”
Harmondsworth had a “very basic type of hospital system”, run by private healthcare company Primecare, she said.
When Dr Davies first saw Dvorzak on 30 January 2013, “he was in the corner of the ward with his hat on, curled up and very quiet”. She said: “We were all concerned about him because of his age and his obvious frailty.”
“He was a frail elderly gentleman, he was clearly vulnerable, it was just not the right place for him. We were not set up to provide that level of support. He needed a care home,” Dr Davies told the inquest.
“Clearly things weren’t going well for him,” Dr Davies said. “We had serious concerns about his physical health. He was not taking any of his heart medication.” Dr Davies said she told Manpreet Sidhu, the Home Office manager: “I think he is fit for very short term detention. I would be concerned if it took more than a week at most.”
Dr Davies said: “Harmondsworth was a difficult place to staff, and was not fully staffed.” She revealed that a psychiatric doctor came there only once a fortnight for a routine visit. A direct assessment could be arranged more quickly, but it would “never happen on the same day”. A psychiatric doctor appointment from Hillingdon hospital usually took several weeks to arrange.
The coroner pointed out that immigration officers had asked for Dvorzak to have a Mental Health Act assessment, and this required a doctor with particular experience in the assessment or treatment of mental illness.
However, initially Dvorzak was given only a mental health assessment by a nurse. Dr Davies said the nurse was the “quickest and most appropriate person to deal with him on a Thursday. The [psychiatric] doctor was due on Monday”.
Dr Davies told the jury: “I did not have great knowledge about old age psychiatry. Most of the guys we dealt with were under 65.”
“There was no alternative”
Michael Langran, a Chief Immigration Officer at Gatwick airport, told the inquest that he was Dvorzak’s case worker after he was discharged from East Surrey Hospital. (Case workers are responsible for the progress of a detainee’s immigration case.)
Langran told the jury: “Everyone who had ever dealt with him deemed him unfit for detention. We were all of opinion that he was unfit for detention but there was no alternative.”
He aimed to deport Dvorzak with a medical escort on 6 February 2013 and for police in Canada to meet him on arrival. The Canadian authorities were searching for a care home because Dvorzak’s previous care home had closed. However, Dvrozak could not go on the flight because he refused to cooperate with the medical escort who was assessing his fitness to travel on an aircraft.
Langran told the jury that he had not dealt before with a case involving “semi-dementia coupled with heart problems coupled with non-cooperation coupled with no friends or family”. The Home Office was trying to contact Dvorzak’s daughter. The Canadian authorities succeeded in contacting her several months after Dvorzak’s death.
Dr Jarral’s Rule 35 Report, which said Dvorzak was unfit for detention on 30 January, did not reach Langran until days later, on 4 February. Langran insisted that “nothing would have changed” had he seen that medical report sooner.
“There was no alternative,” he said repeatedly. “This was the only place we had where he could be looked after ...Mr Dvorzak was either in Harmondsworth or on the street. He had had two heart attacks in the last week.”
The coroner read from a written statement by Jatinder Kaur, a Harmondsworth centre manager. Kaur stated that “staff shortages” caused the delay in Dr Jarral’s Rule 35 Report reaching Michael Langran, the caseworker. According to Kaur: “We have always had difficulties getting administrative staff.”
The inquest continues.