Keith John MURPHY · Prevention of Future Deaths report

The inquest into Keith John Murphy’s death was opened on the 23rd July 2013 was resumed with a jury on 9th March 2015. The Jury returned their conclusion on the 13th March 2015.

The jury found the cause of death was:
1a – Ischaemic Heart Disease
1b – Coronary Artery Atheroma/ SPICE (Synthetic Cannabinoid)
Toxicity

The Jury returned box 3 as:

On Thursday 18th July 2013, Keith John Murphy was pronounced dead by paramedic staff at 20.37hrs at Shaftsbury Road, Bisely. Mr. Murphy’s death was caused by Ischemic Heart Disease and Coronary Artery Atheroma. He had a history of both smoking and also drug use in later life. Mr. Murphy displayed uncharacteristic behaviors such as aggression, abnormal movements, dehydration and profuse sweating. He also admitted to using ‘Spice’. The ingestion of a synthetic cannabinoid had a more than minimal contribution to Mr. Murphy’s death.

And their conclusion was;
Natural Causes hastened by the use of synthetic cannabinoid.

On the 18th July 2013, Keith John Murphy was noted by other prisoners and staff to be physically ill and to be acting in such a manner that appeared to indicate he might have taken some form of drug. He later admitted to another prisoner and a member of staff he had taken SPICE. As a consequence of him refusing to take medical advice to attend hospital, he was locked in his cell. Later Mr Murphy was found on the cell floor and an ambulance was called. Prison Officers attempted to assist Mr Murphy until the paramedics arrived. There was some confusion over whether the defibrillator was working or not. Such was the extent of the Ischaemic Heart Disease that any assistance in the circumstances would have been unlikely to have saved Mr Murphy.

The inquest further heard that between the hours of 7am and 6.30pm prisoners had access to on site Healthcare staff and Prison Staff had the benefit of their guidance when dealing with prisoners. After this period reliance is placed upon either Thamesdoc or an Ambulance being called with the associated time delay in their arriving at the prison. The Court further heard that in a prison of over 500 inmates, from 6.30pm to 7am one person would be available who was first aid trained.

1. Action is required to ensure that Prison Officers and Staff with direct access to prisoners have basic first aid training, CPR training and familiarisation with the use of a defibrillator.

2. Action is required to ensure someone from Healthcare is available beyond the current arrangement of 7am – 6.30pm to provide an