Independent Investigation Final Report
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The Arrest of Mr Edwards S27
S29 38.
Mr Edwards was spotted at around 9.15pm by PC Fayers on Tollgate Lane, near to the primary school, walking towards Fornham Road and carrying a white plastic bag. PC Fayers explained that he lost sight of Mr Edwards, but then very soon after PS Cappleman, another officer searching for Mr Edwards, explained he was stopped by a member of the public who told him that he had seen a ‘ drunk
’ jump over the wall of Barclays when the police went past. S33
S4a D42
39. PC Bell and PC McNee say that they arrived at Barclays Bank and conducted a search of the area. These were two of the officers deployed to search for Mr Edwards and had been to Belinda Edwards’s home. They have explained that they had been informed over the radio about the assault upon Mrs Edwards and that the suspected offender was Mr Edwards. They explained they had been informed of Mr Edwards’s warning markers on the Police National Computer which were: Violent, Escaper, Ailment, and Drugs, and
informed by another police unit that had g one to Mrs Edwards’s home that Mr Edwards had armed himself with a bread knife and it had not yet been confirmed if he still had the knife.
40. PC McNee explained that he found Mr Edwards hidden in the bushes at the rear right hand corner of the bank. He saw Mr Edwards had his right hand across his chest and hidden beneath his jacket. PC McNee therefore withdrew his taser which he explained was for the protection of the public, his colleague, and himself. Mr Edwards did not then respond to PC McNee’s command s to show his hands. As PC McNee got closer to Mr Edwards he could smell alcohol coming from him, and could see his eyes were half closed. He nudged Mr Edwards with his foot, at that point Mr Edwards stirred and started to talk back. PC IPCC Final Report Mr Robert Edwards
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McNee could see that he was drunk from his demeanour and his slurred speech. PC McNee said he put his taser away, and with the assistance of PC Bell, lifted Mr Edwards out of the bushes and placed him on the ground lying on his front. PC Bell corroborated this account. S30 41.
PS Aylott explained that he then joined PC Bell and McNee as they were controlling Mr Edwards on the ground who was kicking out with his legs. PS Aylott assisted PC Bell and McNee by handcuffing Mr Edwards behind his back, he then helped PC McNee search Mr Edwards. He explained that Mr Edwards struggled throughout, and was swearing at the officers, although no weapons were found on him. PS Aylott has said that Mr Edwards was then kept on the floor until PC Moore, another officer involved in the search for Mr Edwards, drove his van to the rear of the bank. S28
42.
PC Moore has explained that when he joined the other officers, Mr Edwards was uncooperative, refusing to stand, and was swearing at them. He was helped to his feet by PS Aylott, PC Bell and PC McNee, and placed into the rear of the van. Just after being placed in the van, PC Moore saw Mr Edwards kick out and hit PC Bell in the chest, he then refused to put his legs back into the van. PC McNee also explained he saw Mr Edwards kick PC Bell in the chest. However PC Bell has explained that although Mr Edwards did kick out towards him, he did not actually make contact. PC Bell explained that he had to push Mr Edwards ’ s legs back in, and then PC McNee arrested him on suspicion of ABH against Mrs Edwards. PC McNee has also confirmed that he arrested Mr Edwards at this stage, and the arrest was necessary for the prompt and effective investigation of the offence.
43. PS Cappleman was the supervisor on the ground and has explained that in his opinion there was nothing at that time to say Mr Edwards was in need of hospital treatment, he was not aware of any injuries and has said Mr Edwards was conscious and speaking which is why he was taken to the police station.
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D112
D62 44.
CCTV from Barclays Bank showed officers and vehicles arriving and leaving, but it did not capture any interaction between officers and Mr Edwards. It showed that the first officers were at the back of Barclays Bank at 9.22pm, the police van followed at 9.25pm, and the van then left at 9.28pm.
45. Mr Edwards was then transported to Bury St Edmunds Police Station. On route, PC Moore explained he was kicking the rear plastic and metal cage divider and shouting.
46. PS Francis and PS Gilbert were the two custody sergeants on duty at Bury St Edmunds Police Station when Mr Edwards was brought into custody, Mr Trask and Ms Giles were the two detention officers. D159 D164
S31 47.
PS Francis, PS Gilbert, and Mr Trask all explained that they remembered hearing on the police radio that officers had been searching for Mr Edwards, and then a request had been made to bring him into custody through the side entrance. PS Francis has explained that this entrance is used mainly for bringing people into custody that may be violent, because there are fewer steps up to the cell block from that entrance, and it is right next to the cells so a detainee can quickly be put into a cell if necessary.
48.
Mr Trask and PS Francis remembered being told that Mr Edwards had been violent, and had prepared the drunk cell prior to Mr Edwards ’s arrival. They have explained the drunk cell is closest to the side entrance and has a low bed to prevent a detainee falling from a height. As an additional precaution they also placed the mattress on the floor. D138 49.
At 9.34pm the CCTV from Bury St Edmunds Police Station showed that PS Francis, PS Gilbert, and Mr Trask made their way to the custody side entrance and to the police van parked outside. PS Francis opened the back door of the van, and with assistance from Mr Trask, helped Mr Edwards out of the van. They have explained that Mr
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Edwards appeared intoxicated, was unsteady on his feet, and smelt of alcohol. However, he was compliant as PS Francis and Mr Trask helped him out of the van and up the steps into custody.
50.
The CCTV showed that PS Francis stopped just as they were passing the drunk cell. He has explained he asked Mr Edwards if he was going to behave or if he needed to go straight to the cell. Mr Edwards replied he was going to be fine. He was then helped down the cell block to charge room two.
51. The CCTV showed that Mr Edwards was visibly unsteady on his feet and was being supported either side by both PS Francis and Mr Trask. In interview they both explained that although they were supporting Mr Edwards, he was still walking under his own steam.
52.
PS Francis has explained that Mr Edwards was placed on a bench in the charge room. The bench was just out of shot of the CCTV, although occasionally Mr Edwards could be seen moving into shot. The CCTV showed PC Bell and PC McNee were also present in the charge room, and the reasons for Mr Edwards ’ s arrest were relayed to PS Francis. PS Francis then started to book Mr Edwards in. He has said that he remembered that on a previous occasion when he had booked Mr Edwards into custody, there had been problems with alcohol. He also identified, by checking information held on the Police National Computer, that Mr Edwards had problems with alcohol and that he took methadone.
53.
PS Francis explained in interview that when he tried to book Mr Edwards in it was apparent he was heavily intoxicated, unable to respond to questions very well, his speech was slurred, and he could smell alcohol from him from across the charge room.
54.
PS Francis explained that he quickly formed the opinion that Mr Edwards would not be able to answer his questions, and decided he needed to be placed in a cell pending a medical assessment to
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determine his fitness to be detained. S20 55.
Whilst Mr Edwards was in the charge room with PS Francis, Mr Trask has explained that Ms Giles was in the custody room with him. Mr Trask explained that Ms Giles told him that she knew Mr Edwards, and due to her connection to him did not think it would be appropriate for her to look after him. Mr Trask therefore took responsibility for Mr Edwards, and Ms Giles had no involvement in his care.
56.
Mr Trask has said that he called for a healthcare professional whilst Mr Edwards was still in the charge room. He explained in interview that the normal protocol is that the custody sergeant would ask the detention officers to call for a healthcare professional if they considered one was required. However, from his experience, he knew that Mr Edwards was going to need to see a healthcare professional, and thought he would save time by calling straight away. D76
57.
The CCTV showed that Mr Edwards was searched in the charge room by PC Bell and PC McNee to ensure he did not have anything on him which could be used to harm himself or other people. Mr Edwards made several groaning sounds during his time in the charge room and was told by officers on a number of occasions to stop struggling in his handcuffs.
58.
The CCTV showed that at 9.46pm Mr Edwards, with assistance from PC Bell and PC McNee, was taken from the charge room to the drunk cell. The CCTV showed Mr Edwards was still unsteady on his feet. In interview Mr Trask explained that he considered Mr Edwards appeared more drunk than when he had first arrived, but PS Francis thought Mr Edwards appeared the same as he had been earlier.
59.
It can be seen that Mr Edwards was then placed on the mattress in the drunk cell. PC Bell, PC McNee, and PS Francis then searched Mr Edwards again and his shoes and top were removed. Mr Edwards was then left in the cell, lying on his right hand side in the recovery position. IPCC Final Report Mr Robert Edwards
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D53
60.
The CCTV showed that PS Francis returned to the charge room at 9.50pm, and he explained he completed the custody record for Mr Edwards. First he completed the risk assessment section. This is used to assess the risk a detainee may pose to themselves or others whilst in police custody. It can be seen from the form that it is split into ‘Self Assessment’ and ‘Custody Officer Assessment’. The Self Assessment is based on a series of questions the custody officer asks the detainee, and the Custody Officer Assessment is based on the custody o fficer’s own observations.
61.
It can be seen on the form that the Self Assessment part was not completed. Under this section it can be seen that PS Francis recorded that Mr Edwards was not capable of understanding or answering, he was very intoxicated, could not stand, and could not understand what was being said.
62. Under the Custody Officer Assessment it can be seen that PS Francis recorded that Mr Edwards was taken straight to a cell. He also wrote Mr Edwards was brought to the charge room initially but was too intoxicated to answer any questions; had markers for alcoholic and methadone user; was very intoxicated and unable to stand or walk; needed to be seen by a healthcare professional to assess his fitness to be detained; and had been in custody before. D159
63. When asked in interview why Mr Edwards was not taken to hospital straight away when he arrived at Bury St Edmunds Police station, PS Francis explained that this was a decision he made based on his experience. He considered that Mr Edwards was drunk, had to go on 30 minute rousing checks, and had to be seen by a medic to assess his fitness to be detained and interviewed. He said it was his view that Mr Edwards did not need to go to hospital at that stage. When asked why he had recorded that Mr Edwards was unable to stand or walk on the custody record, PS Francis explained that he had meant unable to stand or walk ‘ unaided ’ . He explained he did not deal with people who are drunk and incapable, if Mr Edwards had been drunk and incapable
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he would have been taken straight to hospital. 64.
The medical form which is part of the electronic custody record showed that PS Francis had recorded: ‘DP is an alcoholic and methadone user. Currently very intoxicated but has fitted previously, fitness to detain and interview’ as his reason for requesting a healthcare professional.
65. It can be heard and seen on the CCTV that at 10.05pm PS Francis informed Mr Trask that Mr Edwards was very intoxicated and on half hourly rousings. He explained to Mr Trask that he had looked at Mr Edwards
’ s warning signs on his record and seen that he was a methadone user and alcoholic. He further explained that Mr Edwards had been sick in police custody before and was taken to hospital. He informed Mr Trask that they needed to keep an eye on Mr Edwards as he was
‘ fairly well gone ’ . 66.
The CCTV showed at 10.14pm Mr Trask went to Mr Edwards ’ s cell to carry out a check on him. When he entered the cell Mr Edwards was still lying on his right hand side in the recovery position. Mr Trask walked over to Mr Edwards, bent down to his left hand side, and attempted to rouse him. He then left the cell. Mr Trask was in the cell for approximately 29 seconds.
67. In interview Mr Trask explained he had experience of rousing people and had been trained in how to rouse detainees. From his experience he knew that Mr Edwards was not going to rouse properly. When he entered the cell Mr Edwards was snoring, but he described the snoring as being like a drunk person sleeping rather than a gasping for air. He asked Mr Edwards how he was but did not get a response. He then tried prodding Mr Edwards a bit and may have also pinched his ear, but Mr Edwards was ‘
. However, he did remember that whilst he was shaking Mr Edwards ’ s shoulder he tightened up, and that indicated to him that Mr Edwards was still ‘
’
68. Mr Trask explained that he did not record this cell visit on Mr IPCC Final Report Mr Robert Edwards
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Edwards
’ s custody record because this visit led straight into the medical assessment by the healthcare professional.
69. The CCTV then showed that Mr Trask returned to the charge room and told PS Francis that his check had not been a proper rousing check. He explained Mr Edwards was breathing, laying there, he had vomited, but he was in the right position and there was nothing in his mouth. It can be seen that PS Gilbert was also present during this conversation and asked whether Mr Edwards was in the recovery position. Mr Trask confirmed that he was, that Mr Edwards was breathing and had given him a couple of grunts. PS Francis then put on some gloves, commented that Mr Edwards was ‘
intoxicated ’ , and left the charge room to go to Mr Edwards ’ s cell with Mr Trask.
70. In interview PS Francis explained he did not remember this conversation with Mr Trask, although acknowledged it must have happened because it was captured on CCTV.
71. The CCTV showed that at 10.16pm PS Francis and Mr Trask entered Mr Edwards ’ s cell. Mr Edwards was still laying on his right side on the mattress in the recovery position. Mr Trask attempted to move Mr Edwards further onto the mattress. They were then joined in the cell about a minute later by the healthcare professional Jillian Kells- Sanders who had just arrived at Bury St Edmunds Police Station. PS Francis has explained that he told her that Mr Edwards was intoxicated and was in custody for an assault. S13 D119
72.
The CCTV showed Ms Kells-Sanders knelt down to the left of Mr Edwards. She has explained she was a little wary of him because she had been told he was aggressive. She explained he was showing no signs of shortness of breath, wheezing, or snoring. If he had, he would not have been fit to be detained. She said that she shook Mr Edwards and asked him to open his eyes, which he did. She got a strong regular pulse from his wrist which showed his heart was pumping, and
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linking that to his pink skin, she knew ‘ cardio-vascularly ’ he was stable. She said that she asked Mr Edwards where he was and he responded that he was in the police station. From this she knew neurologically he was orientated as to where he was. She checked his pupils with a pen torch and they were equal and reacting, and this indicated Mr Edwards did not have a head injury. She checked his head for blood, bumps and bruises but did not find any. She asked him what he had drunk and he did not respond. However, based on her experience of dealing with alcoholics, she had not expected him to respond to that question. When she asked him about his methadone Mr Edwards did respond, said he was on 80mls a day, and that he had taken his dose for that day. She explained Mr Edwards was trying to get up on his right elbow and was retching, and she attributed that to his excessive use of alcohol. She considered that Mr Edwards was fit to be detained in custody as he had a good pulse, good breathing, good colour, was able to state where he was, and was lying on his side in the recovery position.
73.
The CCTV from the cell did not have any audio, but it did show Ms Kells-Saunders examining Mr Edwards including checking his pulse, looking into his eyes with a torch, shaking him, and pinching his ear lobes. Mr Edwards moved on several occasions after being shaken, and at one point looked directly at Ms Kells-Saunders and appeared to be saying something to her.
74.
In interview Mr Trask explained that Mr Edwards was still snoring during the medical assessment. He also said that in his opinion Mr Edwards was not roused during this assessment. He explained that if this had been a check he was conducting, and he had got the same responses that the healthcare professional had got, he would have informed the custody sergeant that it was not a proper rousing.
75.
In interview PS Francis explained that Mr Edwards was not snoring, he was roused by the healthcare professional, and although he is not medically trained, he thought the assessment seemed fine.
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The CCTV showed that at 10.22pm, following the assessment, all three left the cell and headed back to the charge room. Then, for several minutes, Ms Kells-Sanders and PS Francis have said that they looked at Mr Edwards ’ s previous custody records to see if there was any medical history that may be relevant to his medical assessment. From this they found Mr Edwards had a history of depression, alcoholic fits, and had previously been admitted to hospital because he was withdrawn from alcohol.
77.
Ms Kells-Sanders then recorded the following on Mr Edwards ’s
medical form at 10.30pm:
‘ FTD if DP becomes difficult to rouse please transfer to A&E if D/P begins to withdraw please call as D/P has a history of withdrawal fits. Medical review for 0800 or earlier if custody staff have any concerns.’ She also recorded that Mr Edwards should be visited and roused every 30 minutes. D119
78. In Ms Kells-Saunders notes, which were not provided to the custody staff, she also recorded her instructions were that ‘
up D/P answers appropriately if becomes difficult to ro use = A+E’
79. PS Francis explained in interview he was aware of the advice given by Ms Kells-Sanders both through the verbal instructions she gave, and what she wrote on the medical form. He was happy that she had agreed Mr Edwards could remain on 30 minute rousing checks because it showed he was safe to be at the police station at that time.
80.
When asked, Ms Kell-Saunders explained that if she been told that Mr Edwards had a tendency to vomit in his sleep when intoxicated she still would have thought him fit to be detained because he was in the recovery position, and she had asked for 30 minute rousing checks to be done. D181
D156 81.
The CCTV showed that at 10.31pm PC Huntley arrived at the custody IPCC Final Report Mr Robert Edwards
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and was one of the detention officers taking over from Mr Trask and Ms Giles. She explained Mr Trask handed over the details of Mr Edwards to her and she remembered being told that Mr Edwards was; in custody for an assault against his partner, was very drunk when he came into custody and went straight to cell; was a methadone user; had been difficult to rouse, and that Mr Trask had concerns about him following his cell check. The CCTV showed that Mr Trask and PC Huntley then went to Mr Edwards ’ s cell. 82.
In interview Mr Trask explained that in the three years he had been working at Bury St Edmunds Police Station he had never been concerned enough about a detainee that he felt he needed to take the incoming detention officer to see the detainee in their cell as part of a shift handover. The reason he did so this time was because Mr Edwards was not responding, and he did not know what the outcome of the medical assessment was going to be at that stage.
83. In interview PC Huntley explained that following the handover, Mr Trask was going to conduct a cell visit before the end of his shift and asked her if she wanted to go down to the cell with him. Mr Trask had described Mr Edwards as quite aggressive and difficult to rouse, which was why a medical assessment had been carried out. She thought this would be a good opportunity to go and see what Mr Edwards was like.
84.
At 10.35pm the CCTV showed that Mr Trask and PC Huntley left the custody room and went to Mr Edwards ’ s cell. Mr Trask entered the cell whilst PC Huntley stood in the open doorway. Mr Edwards was still lying on his right hand side in the recovery position. Mr Trask bent down next to Mr Edwards and shook his shoulder, then turned to PC Huntley and shrugged. Mr Trask then walked out of the cell briefly, before walking back in with PC Huntley who was again standing in the doorway. Mr Trask bent down to look at Mr Edwards again. They then both left the cell and returned to the custody room. PC Huntley and Mr Trask were in the cell for approximately 34 seconds. On returning to IPCC Final Report Mr Robert Edwards
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the custody room, Mr Trask recorded on Mr Edwards ’ s custody record at 10.37pm, under a rousing check pre-formatted entry box: The
85. The pre-formatted rousing check box contains the following prompts, which appear above the space where detention officers can enter the outcome of their rousing check:
86. In interview Mr Trask explained he remembered during this visit he was trying to talk to Mr Edwards and touch him, but he was not responding. However, when he pulled on his shoulder Mr Edwards was tightening up and resisting, so he considered he was fine. Mr Trask said he saw that Mr Edwards had mucus hanging down from his nose. He had a good look at this, and informed PC Huntley it was clear. He explained that if it was white or cloudy it could have indicated Ketamine or Cocaine ingestion.
87.
In interview PC Huntley explained that she also saw the clear mucus from Mr Edwards ’ s nose. PC Huntley said that Mr Edwards was not responding verbally to Mr Trask who was talking to him. She added that Mr Trask then stood up and told her that was how Mr Edwards had been when he was seen by the healthcare professional, and that was the response he had received from Mr Edwards when he conducted his first cell visit. When asked about her risk assessment of Mr Edwards at that stage she explained; he was lying on his right hand side in the recovery position; he was not a strange colour such as blue or pale and she could see his face and mouth clearly and that he had not been sick. She explained that Mr Edwards was snoring, but she and her partner snore and she thought this just sounded like regular IPCC Final Report Mr Robert Edwards
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snoring. She explained that Mr Edwards concerned her because of the state he was in, but there was nothing to indicate to her that his condition had changed from the time the healthcare professional had seen him.
88. In interview Mr Trask explained that this was never intended to be a rousing check, it was just an additional part of his handover to PC Huntley. He wanted to document somewhere on the custody record that he had been to the cell with PC Huntley, and as Mr Edwards was on rousing checks, he thought that was the best option. However, in hindsight, he considered that he should have just recorded this in a free-text box entry so there was no doubt about whether this was a rousing check. He explained his entry was an accurate reflection of the condition Mr Edwards was in. When asked why he did not inform the custody sergeant that Mr Edwards was snoring when he went to the cell, Mr Trask explained that his condition had not changed from when the healthcare professional had seen him, and PS Francis had been present during that. Therefore he did not consider it necessary to inform PS Francis that Mr Edwards was in the same condition as he had been fifteen minutes earlier. D165
89. At 10.39pm the CCTV showed that Mr Brackenborough arrived in custody. He was the other night turn detention officer working an 11pm-7am shift. He received a handover from Ms Giles. In interview Mr Brackenborough said he did not remember the details of the handover that he received, but did remember that Ms Giles did not hand over the details of Mr Edwards to him.
90. At 10.41pm Mr Brackenborough, Ms Giles, Mr Trask, and PC Huntley were all in the custody room. The following comment from Mr Brackenborough was recorded on the custody CCTV system: Mr Brackenborough: Apparently he’s in the recovery position. I’ll shout, if he goes ‘eh’ that means he’s alright. Unknown: What are you talking about? IPCC Final Report Mr Robert Edwards
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Mr Brackenborough: Doing the Edwards. 91.
In interview Mr Brackenborough said did not remember making this comment. Mr Trask and PC Huntley also did not remember this comment being made. Mr Brackenborough explained he must have been joking as that is not how he conducts cell checks, and explained the person has to respond to what you are saying.
92. The CCTV showed that at approximately 10.44pm Ms Kells-Saunders walked into the custody room and informed Mr Brackenborough a number of things about Mr Edwards. She explained that he was breathing nicely; had a good strong heart rate; and had taken his methadone. She also explained that Mr Edwards had fitted previously, and that he would need to go to hospital if he became difficult to rouse. She then explained that Mr Edwards was in for a review in the morning, but if they wanted her back just give her a ring. The CCTV showed that PC Huntley, Ms Giles, and Mr Trask were also in the custody room when this information was provided to Mr Brackenborough.
93. PC Huntley explained in interview that she was aware of the healthcare professional ’s assessment, and must have also looked at Mr Edwards’ s medical form. She explained that she knew if Mr Edwards deteriorated from the check she and Mr Trask had done then he should be taken to hospital.
94.
At 10.45pm PC Huntley wrote on Mr Edwards ’ s custody record , ‘I have been given a handover and now take over as D/O.’
95. The CCTV showed that at 10.47 Mr Trask left custody, and at 10.49pm PS Whitehead arrived in custody. PS Whitehead was the night turn custody sergeant, working an 11pm-7am shift.
96.
At 11.01pm PS Whitehead then joined PS Francis in charge room 2, and PS Francis conducted a handover of all the people in custody, which was recorded on the CCTV. It can be seen and heard that this
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involved explaining why they were there, what was happening with each investigation, and any other custody related matters that needed explaining. It can be heard that PS Francis explained why Mr Edwards was in custody, and the potential offences they were considering. He then talked about Mr Edwards ’ s welfare and explained the following; Mr Edwards was an alcoholic, methadone, and heroin user; he had tried to book him in but Mr Edwards was ‘ too pissed ’ and therefore had to be taken to a cell and put in the recovery position; Mr Edwards had initially been put on 30 minute rousing checks; Gillian Kells-Saunders, the healthcare professional, had seen him and managed to rouse him
; she had said there was nothing she could do for him at that time, but his pulse was OK, his pupils looked alright, his heartbeat and everything was fine; she had advised he should remain on 30 minute rousing checks unless he deteriorated; and he had been put in for a medical review in the morning. PS Francis informed PS Whitehead that Mr Edwards had not been fully risk assessed because he could not ask him any questions, and he had not had his rights and entitlements. He explained that Mr Edwards had been in custody a number of times, about three or four times, and on a previous occasion, Mr Edwards had acute withdrawal and had to go to hospital. He also informed PS Whitehead that Mr Edwards had been a bit sick but he had been placed in the recovery position.
97. PS Francis explained in interview that following this handover, PS Whitehead and PS Gilbert were then responsible for the detainees. His understanding is that when he handed over he ceased to be a custody sergeant. He explained that in this situation, when there are three custody sergeants, the outgoing sergeant who hands over becomes an extra resource. That sergeant could go out on patrol, or could remain in custody and help out either with the detention officers, or sometimes during busy periods could help out with booking people in and bailing people. PS Francis explained that on this occasion he logged on to a terminal in the custody room and remained in there. He did not remember specifically what he did after that. The CCTV shows he was
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mainly then sat at a computer terminal in the custody room. D170 98.
PS Whitehead explained in interview that he did not take over responsibility for Mr Edwards following the handover from PS Francis. He explained that he would be responsible for booking in new detainees, and then be responsible for them. He explained that PS Francis and PS Gilbert were still going to be on duty for a good period of time, and although all the sergeants were responsible for Mr Edwards, they would have more responsibility for the existing detainees. He explained that this made more practical sense when there is an overlap of shifts, as the sergeants on the earlier shift would have the first hand experience of booking those detainees in. However, PS Whitehead explained that there still needed to be a briefing for the incoming sergeant so they knew about the current detainees in case they needed to help out.
99. PS Whitehead explained he then logged onto the custody computer system and looked at Mr Edwards ’ s medical form. From the information shown he said he could see it was clear Mr Edwards had a medical issue, although he said he thought the main factor on the medical form was that Mr Edwards was fit to be detained, and he needed 30 minute checks. He explained that if he had had more time he may have gone into more detail and looked at the actual entries on the custody record.
100. PS Whitehead explained that he did not personally conduct a cell check on Mr Edwards for two reasons because he had someone else to book in, and because the detainees had previously been seen by the sergeants responsible for them. He said he would have conducted cell checks when the other custody sergeants had finished their shifts and he took over responsibility for their detainees.
101. The CCTV showed that at 11.03pm PC Huntley went to Mr Edwards ’ s cell. She entered the cell, bent down to Mr Edwards ’ s left hand side and shook his shoulder a couple of times. She then left the cell and
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returned to the custody room. PC Huntley was in the cell for approximately 13 seconds. On returning to the custody room, she made the following entry on Mr Edwards ’ s custody record at 11.06pm, under the preformatted rousing check prompts; The detainee’s response was to move his head and snore loudly.
102. In interview PC Huntley explained she knew what a rousing check was. She said that when she went down to Mr Edwards ’ s cell she opened the cell hatch window and saw that he was in the same position as before. She recalled that she opened the door, went in and knelt down in front of Mr Edwards near his shoulder and gave him a couple of shakes. She did not remember exactly what she said to him, but she said he did not respond to her command ‘
’ or
any of the other verbal commands she used. However, she explained that Mr Edwards was in exactly the same state as before, his colour was the same, the mucus was the same, his mouth was clear, there was nothing on the floor, and there was nothing on his face. She explained he was still snoring loudly, and the snoring was regular. She said there was no indication he was struggling to breathe, his chest was going in and out. She described this visit as almost a carbon copy of Mr Trask ’ s visit. She also described Mr Edwards as being solid, and that there was a strength in his shoulders when she was shaking him. She explained that at one point he actually pulled away from her and she took that to be a response to the question she had asked him.
103. PC Huntley stated that she did not consider that there had been a change in Mr Edwards ’ s condition that gave her concern. She said he was difficult to rouse, as difficult as Mr Trask and the health care professional had found. PC Huntley explained that if somebody was easy to rouse you would get a verbal response from them. She explained she had to give Mr Edwards a few hard shakes and he pulled away. She believed that he was choosing not to verbally respond, and said the healthcare professional did not get any responses to general questions. She said that maybe if she had asked
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something about methadone then maybe he would have responded, as that was the only time the medic got a response.
104. PC Huntley did not view Mr Edwards ’ s snoring as a risk, and thought that the ‘resistance’ he showed to her shaking him was an adequate response. She acknowledged that she should have got a verbal response but added you can not get a coherent response from someone like that.
105. The CCTV showed that at 11.30pm Mr Brackenborough went to Mr Edwards ’ s cell. Mr Edwards was still lying on his right hand side in the recovery position. Mr Brackenborough leaned into the cell towards Mr Edwards, then left the cell, and returned to the custody room. Mr Brackenborough was in the cell for approximately 5 seconds. On returning to the custody room he made the following entry on Mr Edwards ’s
custody record at 11.34pm, under the preformatted rousing check prompts; To mumble and carry on snoring.
106. In interview Mr Brackenborough explained that he knew what a rousing check was, and the level of the check very much depended on the person being roused. He added that when he conducted this visit he could hear Mr Edwards was snoring from outside the cell. He explained that he unlocked the cell door, and said to Mr Edwards ‘alright Mr Edwards, how are you, how are you doing?’ He said he bent down because Mr Edwards was in the recovery position on the floor. He said that Mr Edwards opened his eyes and looked at him, and he murmured/mumbled, and that indicated to him that Mr Edwards was fine. He did not need to shake him to rouse him, and he considered this was a proper rousing check. Mr Edwards then carried on snoring.
107. Mr Brackenborough said he was happy that Mr Edwards was OK; he was snoring as a normal person would snore, and explained there is a different kind of snore when someone is unwell. Mr Brackenborough explained he could clearly see Mr Edwards’ s face from where he was standing and could see he was breathing fine. He said that if he had
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not been happy with the response from Mr Edwards he would have taken further steps to rouse him.
108. Mr Brackenborough could not answer whether Mr Edwards had got better or worse from earlier checks. He said he had not considered that the healthcare professional must have been able to speak to him during her visit. Mr Brackenborough accepted that Mr Edwards was not talking coherently, but said a person who had drunk a lot could not be roused and talk coherently.
109. It can be seen from the custody record that at 11.27pm PS Whitehead wrote that he was now the custody officer, and a handover had been taken from PS Francis. He wrote that the risk assessment had been reviewed and Mr Edwards’ s detention was still necessary at that time. He wrote that he had participated in a shift briefing relating to the detainee.
110. The CCTV showed that at 12.00am Mr Brackenborough went to Mr Edwards ’s cell
. He was still lying on his right hand side in the recovery position and a small amount of fluid had appeared around his head next to the mattress. It can be seen that Mr Brackenborough stepped into the cell, slightly further than previously, and leaned towards Mr Edwards. He then left the cell and shut the cell door. Mr Brackenborough was in the cell for approximately 10 seconds. It can be seen that he then returned to the custody room and the custody record showed that he had written at 12.03am, under the preformatted rousing check prompts; to mumble OK.
111. In interview Mr Brackenborough explained that he bent down so he could see Mr Edwards ’ s face. He said he went a little further into the cell than the previous check and Mr Edwards was not snoring, he added that Mr Edwards opened his eyes and said ‘OK’. He said that Mr Edwards was still in the recovery position on his right side, with his face on the right, on the mattress on the floor and feet towards door. Mr Brackenborough explained that Mr Edwards ’ s colour was fine. He IPCC Final Report Mr Robert Edwards
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said it is not unusual for someone who has been drinking and who is a drug user to be in that state, and he was satisfied with the response he received. Mr Brackenborough explained that he has previously dealt with people who have snored and had medical problems, and Mr Edwards was not like that.
112. The CCTV showed that at 12.30am Mr Brackenborough went to Mr Edwards ’s cell, Mr Edwards was still lying on his right hand side in the recovery position. It can be seen that the fluid around Mr Edwards head had grown. Mr Brackenborough walked into the cell and up to Mr Edwards, and bent over towards him and shook him several times, before shutting the cell door and returning to the custody room. The custody record showed that at 12.33am, he wrote under the preformatted rousing check prompts; to mumble yeah. Then continued
113. In interview Mr Brackenborough explained that during this cell check Mr Edwards looked different and did not respond to voice commands at all. His colour had changed and looked pastier. He was snoring that time and it was not a normal snore, it was raspier. He explained that Mr Edwards did not open his eyes straight away this time. He had to shake him, not overly hard, but more than a gentle shake to get a response he needed and for him to open his eyes. Mr Edwards eventually mumbled ‘yeah’. Mr Bracke nborough noticed that Mr Edwards ’
Brackenborough did not notice any vomit on the floor.
114. Mr Brackenborough explained he was not happy with Mr Edwards’ s condition, he was someone who had deteriorated from being roused by voice commands 30mins ago and not snoring, to someone snoring in a totally different way, sweating, and who had to be physically roused to get a response.
115. Mr Brackenborough explained that following this check he went back to the custody room and sat at his terminal. PS Francis was sat at the IPCC Final Report Mr Robert Edwards
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terminal next to him. He informed PS Francis that he had more problems with the drunk cell. He asked PS Francis how difficult to rouse did Mr Edwards need to be before they had to take him to West Suffolk Hospital, because that was the instruction on the medical form given by the healthcare professional. Mr Brackenborough explained that he went through exactly what had happened. He said he told PS Francis how Mr Edwards was sweating which he had not been during the first two checks, and that on those checks Mr Edwards roused without actually being touched. He told him he was worried because Mr Edwards ’ s condition had changed. However, the decision was made that they would see how he was at 1am.
116. When asked whether he thought Mr Edwards should have gone to hospital at that stage, Mr Brackenborough said he was not sure.
117. There is no CCTV audio recording of this conversation, but the CCTV did show that Mr Brackenborough returned to the custody room after his cell visit, walked towards the kitchen area, and turned and spoke to PS Francis. He then returned to his terminal and PS Francis was sitting next to him. In interview PS Francis said he had no recollection of this conversation, but also said he did not know of any reason why Mr Brackenborough would make it up. He did not know why Mr Brackenborough was coming to him and not PS Whitehead. PS Francis stated he did not recall receiving any further information about Mr Edwards and his condition until the conversation in the custody room at around 12.50am. D123 118. It can be seen on the CCTV that at 12.48am a conversation about Mr Edwards ’ s condition took place in the custody room. PS Gilbert, PS Francis, PS Whitehead, PC Huntley, and Mr Brackenborough were all present during this conversation. The following is a transcription of that conversation: PC Huntley: Is the Doctor going to see that drunk man then is he? IPCC Final Report Mr Robert Edwards
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PC Huntley: No the drunk man I said, is he going to see him as well? Whitehead: No, just the drugs. Brackenborough:
Whitehead: I have to say a drunk drunk isn’t he? Gilbert: He’s just sort of splayed out (laugh s) Brackeborough: It looks like he’s fallen off a building doesn’t it? Gilbert: It does doesn’t it Brackenborough: But he’s sweating like anything. You can tell he’s absolutely soaked. His face is sort of …. puddle of sweat. Francis: He’s alright really Whitehead: Yeah sounds like a picture of health Francis
Brackeborough: She said if he gets really difficult to rouse then take him to A&E.
119. The doctor referred to during the above conversation is Dr Dorsett. He had just arrived in custody at this time to see another detainee in custody in order to take a blood sample.
120. In interview PS Francis explained he remembered Mr Brackenborough saying that Mr Edwards was wet and sweating but he was not overly concerned at that time. He explained it was not unusual for people that had drunk large amounts of alcohol to sweat. He thought the rousing regime was in place and being done properly and the detention officers were getting responses from Mr Edwards. He explained that if there
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had been an issue it would have been picked up during the checks. He also had advice from the healthcare professional that Mr Edwards would not have problems with withdrawal during the evening. PS Francis did not consider the information provided by Mr Brackenborough represented a deterioration in Mr Edwards ’ s
who had taken alcohol on board to sweat it out whilst sleeping.
121. In interview Mr Brackenborough was asked what he meant by his comment ‘if he gets no better’. He explained that he was concerned about Mr Edwards’ s condition, and if he had not improved from the last time he checked him, he would get assistance.
122. In interview PS Whitehead was asked about this conversation, and he explained that he knew Mr Edwards was not well and also that sweating is something they would look out for. He said he had not heard previously that Mr Edwards was sweating, but did not know whether that was a deterioration in his condition. He said Mr Brackenborough and PS Francis would have known what his condition had been earlier so would have known whether this was a deterioration. PS Whitehead also knew that Mr Brackenborough was going to do another check.
123. When asked about his comment, ‘he’s a picture of health’ , PS
Whitehead explained that clearly Mr Edwards was not a picture of health, but on the information he had, he did not consider that Mr Edwards needed to be seen by a healthcare professional again. He explained that Mr Edwards would have needed to see a healthcare professional if he had not seen one earlier, or if it was known that he was not sweating before. PS Whitehead also explained that some of his attention during this conversation may have been taken up by him looking at his detainee on the CCTV. S31 124. PS Gilbert explained in his statement that some of the comments made during this conversation were private office humour, and were IPCC Final Report Mr Robert Edwards
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not in any way making light of Mr Edwards ’ s situation. He explained that he did not have any concerns about Mr Edwards ’ s current level of care at that time, otherwise he and his colleagues would not just have been sitting there. If there were any concerns at all at that time then they would have ensured the doctor intervened. He was satisfied that Mr Edwards was on the most suitable care plan with 30 minute rousings and to call 999 if his condition deteriorated.
125. The CCTV showed that at 12.59am Mr Brackenborough went to Mr Edwards ’ s cell. He walked up to Mr Edwards and shook him several times. He then stood looking at him for a while before shaking him again. He then left the cell and went back to the charge room and requested assistance. Mr Brackenborough was in the cell for approximately a minute and a half.
126. In interview Mr Brackenborough explained that he had even more trouble rousing Mr Edwards than previously. However, he did manage to rouse Mr Edwards who told him to ‘
’ . Mr Brackenborough explained this was not recorded on the custody record due to what happened subsequently, and he did not want to put it on a couple of hours later. Mr Brackenborough explained he was not happy with Mr Edwards
’s condition at all, so went back to the custody office and asked PC Huntley to put the 1am check on the other prisoner he had checked, and asked PS Francis to come back to the cell with him.
127. This was the last cell check conducted on Mr Edwards. In interview PS Francis stated he was not aware of any of the checks carried out on Mr Edwards following the healthcare professional assessment. He did not recall seeing anything on the CCTV, nobody told him about any of the checks, and he did not recall reading any of the custody record entries in relation to any of the checks.
128. In interview PS Whitehead explained that he did not see any of the entries about any of the checks that had been carried out on Mr Edwards. |