HMP Hewell "missed opportunities" to save life of prisoner with leukaemia (From Redditch Advertiser)

HMP Hewell "missed opportunities" to save life of prisoner with leukaemia

8:40am Tuesday 19th March 2013 in Local

A JURY sitting with HM Coroner for Worcerstershire, Geraint Williams, has returned its verdict after a five day inquest into the death of a prisoner at HMP Hewell, on November 9, 2011.

Kyal Gaffney, from Coventry, died from a spontaneous intracerebral haemorrhage as a result of clotting malfunction due to Acute Myeloid Leukaemia (AML) (promyclocytic variant).

A statement released stated: “It is the conclusion of the jury that Mr Kyal John Gaffney, died at 13.20 hrs on November 9 2011 at Alexandra Hospital, Redditch, of an intracerebral haemorrhage. It is also the conclusion of the jury that there were a number of missed opportunities for further intervention prior to November 7 2011. The jury concludes that had further intervention occurred, then it is more likely than not, that an intracerebral haemorrhage could have been avoided.”

In July 2010, Nr Gaffney was involved in a car accident in Leamington. He was the driver and one of his best friends died and he sustained significant injuries leaving him disabled.

On 18 October 2011, he was sentenced to 21 months imprisonment having pleaded guilty to causing death by careless driving under the influence. He was taken to HMP Hewell.

On October 26 2011, Mr Gaffney tried to see a prison doctor but he was turned away as he did not have an appointment. On October 31 he saw a doctor who recorded that he had been bringing up blood for five days but who thought it was a chest infection. She later told the inquest she did not consider a blood test would have revealed the leukaemia. On November 5, he saw another doctor who admitted that he did not read the earlier records and consequently did not ask about him bringing up blood, which the jury was told probably continued to occur.

This doctor also failed to see extensive bruising on Mr Gaffney, and diagnosed oral thrush for what may have been the blood blisters that are common in leukaemia patients. The doctor did order blood tests, because he seemed anaemic, but the tests were not ordered on an urgent basis.

When those tests were carried out on 7 November 2011 they showed that Kyal's blood was severely abnormal. Kyal was rushed to hospital that night for treatment but very shortly thereafter he suffered the catastrophic bleed that killed him.

The jury heard that had Kyal been blood tested on October 31 2011, or urgently on 5 November 2011, then he would probably have survived.

His mother Mary Currie said: “I wish to thank the coroner and his staff for their compassion and fearless investigation into Kyal’s death. My unfailing legal team for their guidance, support and expertise and INQUEST, who have been a pillar of strength.

“There was a catalogue of errors at the prison not only in relation to Kyal’s medical care but his disability. The jury’s verdict confirmed what we had always known; that despite our best efforts to alert the prison to Kyal’s deterioriating health, there were missed opportunities. If there had been earlier medical intervention, it is more likely than not that Kyal would be alive today. Our family feels vindicated by the jury’s verdict but devastated that Kyal’s death could have been prevented. We felt powerless watching him decline whilst at HMP Hewell. We can only hope that lessons are learnt and no other family has to endure this heartbreak.

“Following a death in custody, there must always be an inquest. The Prison and Trust, which provides healthcare at the prison, are both legally represented at the taxpayer’s expense. Yet I struggled to obtain funding for legal representation from the Legal Services Commission. Not only did it take months for a funding decision to be made but I was asked to make a financial contribution. Legal representation should be free for all families regardless of their finanical circumstances.”

Solicitor Anna Thwaites from Hodge Jones & Allen LLP, said: “There were missed opportunities at HMP Hewell that led to Kyal’s tragic death. This case raises serious concerns about the care Kyal and other prisoners receive within the prison system. It is hoped that lessons are learnt from Kyal’s inquest and in the future prisons respond more effectively to prisoners’ health concerns.”

Mr Gaffney's family is represented by INQUEST Lawyers Group member Anna Thwaites from Hodge Jones & Allen LLP and Counsel Nick Armstrong from Matrix Chambers.