February 2015

1st – 14th February 2015

Hello Friend

If you have read my previous blog, you will be aware that I had a heart attack about 15 months ago. Up until now, I haven’t gone into too much detail about the circumstances surrounding the incident. However, the Prisons and Probation Ombudsman ( PPO ) have just completed the report on their investigation and have upheld my complaint. Read on…

Heart Attack

“ It’s not that I am afraid to die. I just don’t want to be there when it happens “
( Woody Allen. ‘Death’, 1975 )

On 17th October 2013, I suffered a Myocardial Infarction (MI), otherwise known as a heart attack.

Over the preceding year or so I had a variety of symptoms, including: breathlessness; chronic fatigue; and, three weeks before my MI, angina. The symptoms were consistently diagnosed as anxiety ( which I didn’t buy into ) and in the case of my angina attack, indigestion ( which I really didn’t buy into – Gaviscon was prescribed! ). Bearing in mind that I have a history of of Ischaemic Heart Disease from
frustrating. I knew they were wrong but try and convince a health “ professional “ of that.

This was a the timeline of 17th October 2013:

I awoke with a dull ache in my chest which slowly increased in intensity over the following 90 minutes.

I informed wing staff that I was experiencing severe chest pain. Instead of immediately taking me to see a nurse, I was told to wait at the front of the queue on the wing as there was someone else at the medication dispensing hatch. At this point I was well into the grip of my MI. however, despite the intense pain, I was on my feet and calm and collected. Clearly prison staff have no training in this area. Perhaps their experience is based on TV and film representations. You know the ones – the guy clutches his left arm in pain and drops to the ground. Gladly, the reality is somewhat less dramatic but no less serious.

The first nurse I saw took an ECG and grumpily diagnosed me with ( yes, you’ve guessed it ) anxiety.

Fortunately for me, I was allowed to see the specialist cardiac nurse. She gave me another ECG and put me on oxygen.

After sending down the ECG results on the telephone, the cardiac nurse called the ambulance. It’s not an overstatement to say that she saved my life. She was the only one to take me seriously. So, thank you.

I’m not ashamed to admit that I broke down at that point. Although I already knew I didn’t want to hear. I thought that was it – game over. Going through the past 11+ years of pain and sorrow without reaching the end had all been for nothing. There is some in my life who is and always will be the “light in my eyes .” The thought of never seeing “some”again, who I deeply love and care about, and who has a profound affect on my life, was just too much to bear. “Hope” had returned to my life but I saw all my dreams of a post – appeal life (2017?) filled with laughter, love, and lots and lots of cuddles (oh, how I miss those), evanescing into the intangibility of nothingness ( as I was about to if that ambulance didn’t arrive soon!).

09:20 The paramedics arrived at Wakefield.

It took a further 10 minutes for them to navigate through the various prison protocols before they reached the treatment room. The pain I was continuing to suffer was nauseating in intensity and had radiated to my jaw and down my left shoulder and arm. Within minutes the paramedics had assessed the situation and were ready to ‘blue-light’ me to hospital. Despite clearly being in a great deal of pain and emotional distress, and the cardiac nurse’s assessment of my condition being serious’ Oscar 1
( this is the officer who decides where and when prisoners are allowed to go ) would not allow me to get into the ambulance until he had located prison clothes for me to get changed into. This is perhaps the least important of the various security measures they take before allowing a prisoner transfer out of the prison. The police would have been informed so they could escort the ambulance, there is a 3 officer escort, and I would be handcuffed and on a second handcuff with an escort chain attached to one of the officers ( all whilst in the grip of an MI! ) I hope you can see just how crazily overboard they go for someone with no criminal connections, no history of escape or absconding, and no violence. Like prison clothes would make the escort more secure.

After prison clothes had been located and brought to the treatment room, I was forced to get changed whilst continuing to be in the grip of my MI. Only then would Oscar 1 allow me into the ambulance.

One hour and 20 minutes after they arrived at Wakefield to attend an emergency call, the ambulance leaves the prison and I am ‘blue-lighted’ to hospital.

Anyone who knows anything about MI knows that the longer it is before the patient gets to hospital the more likely they are to go into full cardiac arrest and possible death. Even if this does not happen, their heart is being starved of oxygen which can kill off parts of the heart muscle . This will lead to a compromised pumping action and possibly a lifetime of debilitating heart failure. All this risk for prison clothes.

On 12th January 2014, I submitted a written complaint about the delay. Oscar 1 replied stating:

“[ … ] At no point was the dispatch of the escort delayed by prison staff any longer than was necessary for security procedures to be carried out .”

It took him from 9:11am up to nearly 10:30 to locate prison clothes – 1 hour and 19 minutes.

I submitted an appeal ( second stage complaint ) highlighting the fact that Oscar 1’s response was vague and no explanation was given for the 1 hour and 19 minutes from emergency call to being allowed in the ambulance. The Residential Manager replied:

“[ … ] As a High Security Establishment we have certain procedures to follow. That said, this does not override [ sic ] our duty of care [ … ] I apologise [ … ]” But still no explanation for the 1 hour and 19 minutes.

The’ Health Service for Prisoners’ standard requires prisons:

“ To provide prisoners with access to the same range and quality of services as the general public receives from the National Health Service ( NHS )”

“Health Services

Expected outcome : [… ] The standard of health service is provided is equivalent to that which prisoners could expect to receive elsewhere in the community.

[ … ]

2.56 In emergencies, the ambulance service was said to be very responsive; we observed a prompt response when a prisoner complained of persistent chest pain [ … ]”
Well, everything is ‘prompt ‘ when there is an inspection.

The Bromley Briefings:

“ In 2013 there was 129 deaths from natural causes, a 5% increase on the previous year. The number of deaths from natural causes has more than doubled since 2000.”
( reference missing )

Very nearly 130 deaths from natural causes.

Extracts from the PPO report.


8. [ … ] The Head of Healthcare [ … ] stated that in his opinion Mr Coutts should have been dealt with more quickly [ … ]

10. [ … ] The ambulance arrived promptly but Mr Coutts was still waiting for the ambulance to depart at 9.30am. [ cardiac nurse ] raised her concern with [ Oscar 1 ], on two occasions but [was] told that Mr Coutts was a high security prisoner , who offended in in his own clothes and was therefore required to change into prison clothes [ … ]”

Maybe you can see why I refer to the ‘absurdities of prison life.’ So was he saying that if he had a prisoner who had ‘ offended ‘ in prison clothes he would be forced to change into his own clothes.

11. [ the cardiac nurse ] told the investigator that it was not in her opinion appropriate for Mr Coutts to change into prison clothing and this increased his anxiety in an already stressful situation. She stated that in her professional opinion any delay in responding to heart attack symptoms can be detrimental and wanted to get Mr Coutts out as soon as possible [ … ]


17. [… ] the head of healthcare and a specialist cardiac nurse have both stated that the length of time taken to get Mr Coutts out of the prison and to hospital was too long, and the major delay was the requirement to change clothing.

18. [ … ] the specialist cardiac nurse, states that making Mr Coutts change into prison clothing caused him further anxiety and an unnecessary delay in leaving the prison. [ She ] raised her concern on two occasions with [ Oscar 1 ], but she was told it was a security matter, and her advice was not taken.

20. [ … ] In light of this information, I am satisfied that Mr Coutts did not receive the medical treatment he required in a timely manner. When the ambulance arrived, Mr Coutts had to change into prison clothing, while in severe pain increasing his anxiety in an already stressful situation. This delayed the ambulance leaving the prison and medical treatment by about an hour. I therefore uphold Mr Coutts complaint concerning this matter. Ultimately
[ Oscar 1 ] made an unreasonable and unnecessarily risky decision not to follow [ the cardiac nurse’s ] advice and insist Mr Coutts change into prison clothing before he was allowed to depart for hospital.

[ … ]

Fast Check and Advanced Disclosure with the Prison.

22. The draft report was sent to the prison for checking of facts and to allow [ Oscar 1 ] to make representations to the PPO, given the draft findings were critical of his actions.

[ Oscar 1 ] responded with a letter which made the following points:

( i ) on arrival at the centre he was briefed that Mr Coutts was listed as a known manipulator, a danger to females, and a standard risk Cat. 1 prison [ see my previous blogs ].

( ii ) he sought guidance from the cardiac nurse’s manager [ … ] who advised Mr Coutts was capable of changing clothing [ in reply to an application from me this senior nurse responded by stating, “ I do not recall [ Oscar 1 ] asking for advice about your change of clothing” ]

( iii ) he therefore did not overrule the cardiac nurse, rather sought guidance from her manager [ clearly he did overrule her ]

( iv ) the ‘delay’ caused by the change of clothing was not over an hour but no more than ten minutes [ 10 minutes ?! )

( v ) at all times he balanced his duty of care to “ Mr Coutts, staff and the public” [ really ]

In all my life, I have never encountered so much institutionalised dishonesty than what I have encountered in the prison environment. In this case, this particular officer firstly attempts to dehumanise me to the PPO and also appears to be implying that I might have been faking my heart attack as I was “ listed as a known manipulator “. He then claims a conversation took place with a senior nurse regarding changing into prison clothing. She has no recollection of this conversation. His next claim was that he “did not overrule the cardiac nurse “. Well, she advised him twice of the urgency of the situation and not to force me to get changed into prison clothes. He dismissed her advice. His next claim is the most brazen act of dishonesty. Despite all of the evidence supporting the times, i.e. 1 hour and 19 minutes from emergency call to allowing me onto the ambulance, this officer attempts to “ front it out “ by claiming it was “ no more than 10 minutes”. I won’t even dignify this distortion of ‘duty of care’ with any comment.

Conclusion and Recommendation

24. [ … ] making [ Mr Coutts ] change into prison clothing before leaving [ for ] hospital was a significant error of judgement, and placed Mr Coutts’ health at risk more than was necessary or reasonable.

[ … ]

26. [ … ] I remain of the opinion that [ Oscar 1 ] made a poor decision in not following the advice of the specialist cardiac nurse and causing a delay to Mr Coutts admittance to hospital.

[ … ]

28. [ … ] Mr Coutts made a potentially useful suggestion about the availability of prison clothing which I have recommended the prison consider.

29. I therefore recommend, that, within three weeks of the date of this report, the Governor of Wakefield.:

Send a written apology to Mr Coutts for the decision to make him change into prison clothing before he could be taken to hospital.

Gives formal ‘ advice and guidance ‘ to [ Oscar 1 ] that he showed a lack of judgement in this case and must better balance security risk against prisoner health when making decisions in the future.

Considers whether a range of different sizes of prison clothes should be kept permanently in healthcare and primary care centres to speed up the process should a prisoner be required to change into prison clothes before being sent to outside hospital.

[ … ] 25. February 2015.

Getting to hospital was only the first part of this saga. Read on…


The Bromley Briefings;

“ In 2010-11 The Prisons and Probation Ombudsman called for a formal revision of
restraints policy relating to seriously ill prisoners. Such a review has not taken
place [… ]”
( Prisons and Probation Ombudsman ( 2012 ) Annual Report 2011-12, London:
Prison and Probation Ombudsman )

The standard ( D ) cuffs were first applied whilst I was still having my MI. Because my wrist are , what shall we say…dainty, inserts had to be used. I was then also handcuffed with a ratchet cuff attached to a 2.5 metre closet chain. These stayed on during my transfer by ambulance and, bar what I have detailed below, for the entire 6 days and 5 nights I was in hospital.

I was double- cuffed for the first day whilst eating food. Despite the risk assessment allowing for the D cuff to be removed.

By the second day I was already experiencing pan in my wrists from the handcuffs. I raised the issue several times with the prison officers who variously attended as my ‘ bed watch ‘,
As well as a governor. At no point were the handcuffs adjusted to alleviate the pain or was I offered any pain relief. The pain increased daily and at one point the D cuffs on my right wrist were so tight they left deep grooves. This was the day my right hand went numb.

The D cuff only ever came off when I went to the toilet, had a shower, ate, and during my operation. Having the closet chain on and an officer present in the operating room was pretty degrading and humiliating. I have to say. Particularly that I was heavily sedated, on anti-clotting medication with an incision open into my radial artery ( this was an angioplasty operation ).

Immediately after my operation, the duty governor instructed my bed-watch to double cuff me, not with a D cuff and a closet chain but with 2 sets of D cuffs. As I had an unclotted artery on my wrist, my bed-watch were not comfortable doing this. It was unclear why this governor wanted this change in the handcuffing protocols. However, such was his determination, he travelled to the hospital in a failed attempt to facilitate his request. Medical staff would not allow it as this would have risked an uncontrolled bleed from my artery.

Because my upper body had to be unclothed during my operation and I remained on the closet chain, I was unable to re-clothe myself. I was moved into a public recovery ward and when I went to the toilet, on more than one occasion, I was taken half – naked in front of a female officer, hospital staff and the public. This was more degradation and humiliation.

As a side note, as a result of my hand cuffing, none of my medical consultations were done
out of earshot of my bed-watch ( which they are meant to be ).

The usual denials and justifications were made in response to my written complaint. However, a security CM ( Custody Manager ) to my second stage complaint on 30th January 2016 and stated:

“ [ … ] There were also occasions where the governor, conducting the daily
management checks, inspected the restraints, along with medical staff
[ my emphasis ], and deemed the level of restraints, and application, to be

Putting to one side the fact that medical staff are not in a position to deem the level and application of restraints appropriate, this is another complete fabrication. No medical staff examined the cuffs.

The final part of this saga…

Next of Kin

On 3 occasions I requested that my next of kin ( my Mother ) be informed of my condition. On my return to HMP Wakefield on 22nd October 2013 , I telephoned my Mother who told me that she had received no contact from HMP Wakefield regarding my condition. She was terribly upset that the prison had little regard for her.

Again, the usual denials and justifications were made in response to my written complaint. However, the prison have an obligation under the provisions of The Prison Rules 1999,
22 ( 1 ) to inform a prisoner’s next of kin should they become seriously ill.

So the moral to this story is not to have a heat attack in prison. I’ll see what I can do about that. The next step is civil action, I’ll keep posted.

Scrabble Club

In my ‘1st – 15th January 2015 ‘ blog I wrote about applying for the Friday morning Scrabble club, which is held at the library.

Well, I did apply. Guess what? Just when you think it cannot get any more farcical in here, my application was declined at the Activity and Allocation Board on security grounds. Of course, these ‘ security grounds ‘ were not disclosed.

What did they think I was going to do. Hit someone over the head with a Scrabble board? Use an elastic band as a slingshot to fire a Scrabble tiles at people’s faces. Or maybe, get a 7 letter across 2 triple word squares, score 200+ and run around the library shouting, “ I got a 7letter word across 2 triple squares and scored 200+.”

It’s these little absurdities that keep my spirits up. The more ridiculous the decisions, the more ridiculous they look.

I’ve submitted an application to find out what these ‘ security grounds ‘ are and the rational behind their decisions to decline my application. I’ll keep you posted.

Phew! That was a long blog . Be happy, be safe, see you next time.
Graham Coutts, 19th February 2015

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