§ Motion made, and Question proposed, That this House do now adjourn—[Mr. Brooke.]2.31 pm
§ Mr. Clinton Davis (Hackney, Central)
On 26 June 1980, the decomposed remains of the body of Matthew O'Hara, aged 41, were discovered in his home in Hackney. It was thought that he had been dead for some five weeks and that the cause of death was complications arising from diabetes, from which he had suffered since 1959. However, because of the condition of the corpse, the post mortem was inconclusive.
That was the tragic end that befell a man who, according to his friends, was intelligent and articulate, albeit that he had strong idiosyncratic views.
Perhaps it was this awkwardness that accounted for his being imprisoned for seven days for contempt of court in withholding his name at a hearing for rate arrears on 12 March 1980. On that day, he was sent to Pentonville prison. Four days later, on 16 March, he was rushed to the Royal Northern hospital suffering from severe vomiting of blood. There it was diagnosed that he was a diabetic in a severe state of ketosis, which I understand is a dangerous build-up of poisons in the body resulting from lack of insulin.
The mystery of what happened to Mr. O'Hara between 12 and 16 March remains unresolved. Regrettably—and I must say this—the Home Office has not proved very helpful. It has refused to answer what I believe to be highly relevant questions. As a result, it has heightened suspicions of a cover-up. That in itself has led to the tabling of early-day motion 139, which has been signed by 66 hon. Members of the House, and indeed to this Adjournment debate.
Was there any connection between Mr. O'Hara's death on 26 June and what transpired in prison between 12 and 16 March? We may never know. The prime witness is dead. But close friends, who stand in the place of his next of kin, want to try to ascertain what actually happened at Pentonville prison.
In my view, it is incumbent upon the Home Office to be frank and open and to do its best to demonstrate that suspicions of a cover-up are misplaced.
Let me say at once that I am not denying the possibility of an innocent explanation. Nor do I doubt that the prison medical staff operate under acutely difficult conditions and have a pretty thankless task.
What I am objecting to is the cloak of secrecy which has clothed these events, and the somewhat dismissive manner in which Lord Belstead, the Minister concerned, had chosen to conduct his correspondence with me.
My interest in this case arose long before Mr. O'Hara's death. It was on 21 March 1980 that I first wrote to the Minister enclosing a letter which I had received from Mr. O'Hara's friend, Mr. Andrew Roberts, asking for the case to be investigated urgently.
Mr. Roberts told me that he had visited Mr. O'Hara on 17 March at the Royal Northern hospital. He wroteI found Mr. O'Hara in a horrifying condition. He seemed to have been destroyed physically and mentally (in that his spirits which are usually high were very low). He has considerable difficulty speaking but after two visits by myself he has managed to tell me that he asked for insulin in Pentonville, and was refused it. He feels that his body is now clinging to life by a thread, 591 supported only by the hospital's drip-feed system. I would like to know what happened in Pentonville during the three days that Mr. O'Hara was there.I do not believe that to have been an unreasonable request from a close friend.
On 7 May, nearly seven weeks later, the Minister replied to my urgent letter. He said that Mr. O'Hara was seen by a prison doctor on arrival at Pentonville but refused to answer any questions put to him, including his name and age. He was sent to the prison hospital for mental observation because, as the noble Lord said in a later letter, of his"unco-operative manner and behaviour". He said that Mr. O'Hara had told the prison doctor that he was not receiving treatment and denied any illness. The following day, a urine test for sugar and acetone proved negative. Mr. O'Hara was later discharged from the prison hospital.
The noble Lord wroteOn 16 March, Mr. O'Hara complained that he felt ill and had vomited a copious amount of blood and the diagnosis of bleeding from a peptic ulcer was made".He was sent immediately by ambulance to the Royal Northern hospital, and the reasons for his concealing the fact that he was a diabetic from two prison doctors and the medical staff at the Royal Northern hospital are not known.
It is common ground that Mr. O'Hara discharged himself from hospital on 19 March, when in all probability he was still suffering from ketosis which, I am advised, can also have have an effect on a person's rationality. Shortly afterwards, he was found in his home by two friends, Councillor Richard Gee, one of the Hackney councillors, and Mrs. Roberts. On 21 March he was admitted to Hackney hospital suffering from a severe diabetic crisis and other serious conditions. He left hospital on 30 April, when he appeared well.
I hasten to add, in parenthesis, that no complaint is made of the treatment which was afforded to Mr. O'Hara at the Royal Northern hospital. As a result of comments which I received from Mr. Roberts in response to the Minister's letter, I wrote to the Minister again on 3 June. By that time a number of salient points were in serious dispute.
Mr. Roberts asserted that Mr. O'Hara had told him that he had reported his diabetes to the prison authorities—to a number of people there. He reported that Mr. O'Hara had told him that he had asked for insulin but had received none; that Mr. O'Hara had said that he had been struck in the stomach by a prison officer angry at his lack of co-operation, which had precipitated the bleeding; and, further, that he had complained of vomiting blood at least 24 hours before being sent to the Royal Northern hospital.
In his letter of 3 July, the Minister denied the assault. But he had to resile from the obvious error in his earlier letter that Mr. O'Hara had concealed his diabetes from the Royal Northern hospital, because it was clear that at the time of admission Mr. O'Hara was in a coma.
What was the view of Mr. O'Hara's own doctor, Dr. Michael Smith, about the most important issue which was in dispute, namely, that relating to Mr. O'Hara's alleged sudden deterioration on 16 March?
Dr. Smith had been sent a copy of the Royal Northern hospital's discharge summary. That said that Mr. O'Harawas said to have had haemotemesis (vomiting blood) 36 hours before admission.592 Of that, Dr. Smith saidThat he was seriously ill on the 16th of March seems indisputable. He was suffering from ketosis, and this condition takes time to develop. It does not come out of the blue, so he must have been exhibiting symptoms of illness, I would have thought, for a day or so before he was transferred to the Royal Northern hospital; on the facts given to me. I would find it difficult to believe that he was not neglected, even working on the charitable assumption that he successfully concealed the fact that he was a diabetic from all medical authorities that he came in contact with.Equally significant is the conflict between the assertions of the Minister, who said that it was on 16 March that Mr. O'Hara spoke of vomiting blood and that he was immediately removed to hospital, and the Royal Northern hospital's discharge summary which recorded that this had happened some 36 hours before admission.
Again, what accounts for the negative urine test? It appears that Mr. O'Hara had taken no insulin since 11 March, and the sample was taken 36 hours later. Yet it is common ground that Standard Monotard MC insulin has an active duration of only 24 hours, because that is what the Minister said in a letter to me of 3 July 1980.
Despite these obvious doubts, the Minister said that he was satisfied on the evidence before him that everything that could have been done for Mr. O'Hara in the prison had been done. But that evidence was available only to him, and I was not so easily satisfied. It was because I and Mr. O'Hara's friends did not have access to the information relied on by the Minister that I resolved to write to the Minister and put to him 38 pertinent questions concerning the events between 12 and 16 March, trying to elicit the facts.
I was told that the Minister would not provide me with that information. He said"I am not prepared to attempt to give detailed answers to the list of questions which Mr. Roberts has put". Mr. Roberts, Mr. O'Hara's friend, had put them to me, and I had sent them on to the Minister.
What was so terrible and so irrelevant about the questions posed to the Minister? Let me rehearse some of them. When was Mr. O'Hara received at the prison and then into the prison hospital? Who interviewed him, and when? What record was kept relating to the questions asked and the answers given? Were fellow prisoners asked about these issues? What physical examination of Mr. O'Hara's body was made? Were any marks or bruises observed? In what way was Mr. O'Hara aggressive and unco-operative? If he was, what was done about it? What records were kept? If, as the Minister asserts, he was referred to the prison hospital because of anxiety about his condition, what was suspected? What do the medical records show? How, if he was unco-operative, was it possible to measure his pulse and blood pressure? Was there any resistance to the taking of urine samples? When were they taken? Why cannot the Minister particularise the analysis and the methods used? Why was only one urine test taken when it seems that the medical staff suspected Mr. O'Hara of concealing an illness? Above all, what treatment was provided between his transfer to a normal location in the prison and 16 March when he was sent to the hospital?
I now ask an additional question. How does the Minister deal with the conflict between the discharge report of the Royal Northern hospital and the Minister's own evidence relating to the development of ketosis? The fact is that ketosis takes some time to develop. Its symptoms include some loss of rationality. Can it be said 593 to be clear beyond reasonable doubt, therefore, that Mr. O'Hara received proper treatment, that he concealed his diabetes, and that there was no negligence on the part of the prison staff?
All these questions deserve more than the dismissive approach and response from the Minister in his letter of 14 June.
What medical confidentiality was to be breached—this was an argument relied upon by the Minister—when it was those closest to Mr. O'Hara who wanted to satisfy themselves of fair play? If the Minister relies on that argument, how did it come about that Sir Harry Boyne, the chairman of the Pentonville board of visitors, was able to reveal selective extracts of the medical records in a letter to what I assume to be an underground newspaper, the Islington Gutter Press, in October 1980?
The Minister says that the questions which I am seeking to have answered are the sort of detail which no organisation could be expected to record. Is he serious about that? How is that consistent with the argument that the Minister has carried out the meticulous investigation which the case demands? He must have addressed himself to the sort of questions which I have raised, if that were so.
If errors have occurred, let this Minister, for whom I have a high regard, be open to a request for a further inquiry. If they have occurred, let him admit it so that a repetition can be avoided. The Minister now has the opportunity to compensate for the way in which his colleague in another place has dealt with that matter, which I regard as unsatisfactory and wholly insensitive. Let him be open and cast aside the veil of secrecy. Let him reveal in detail why he has come to those conclusions. Failing that, let him welcome and offer full disclosure and support to any reference which might be made to the Parliamentary Commissioner. That, in essence, would also provide a full, independent and just investigation into the matter. It might clear up the doubts, one way or the other. That is my hope, and that is my reason for raising this Adjournment debate today.
§ The Minister of State, Home Office (Mr. Patrick Mayhew)
There is no veil of secrecy. Therefore, I cannot comply with the request of the hon. Member for Hackney, Central (Mr. Davis). I do not recognise my noble Friend the Under-Secretary from the hon. Member's description of his part in that correspondence. No one who knows my noble Friend could recognise him from that description. I am grateful for the opportunity to put straight the record of this tragic and difficult matter.
The medical treatment of prisoners is a matter of legitimate public interest, but some of the reports on the case which have been made in the press and elsewhere have not been accurate. I shall first give a full account of the facts of the case.
Mr. O'Hara was committed to prison for seven days on 12 March last year for contempt of court following a refusal to answer questions. When he arrived at Pentonville he was weighed and was given a routine medical examination on the evening of 12 March. As the records made at the time show, Mr. O'Hara refused to answer any of the questions which the doctor put to him, and the examination was effectively confined to such physical matters as his pulse rate. The doctor considered594 that Mr. O'Hara's mental state should be more closely examined and arranged for him to be admitted to the hospital wing of the prison.
He was accommodated in a single room. As a routine procedure on admission to the hospital wing, the doctor also arranged for Mr. O'Hara's urine to be tested for any abnormalties. That was done in the hospital wing by the standard lab stick procedure. The hospital wing at Pentonville is more aptly to be described as having the nature of a sick bay than that of a hospital.
It has been suggested that the decision to admit Mr. O'Hara to the hospital wing means that he had been diagnosed as mentally ill. That is not so. The doctor merely thought that Mr. O'Hara should be observed for a longer period than was possible on reception. The following morning Mr. O'Hara was examined by another medical officer, who spent an hour talking to him. The record made at the time of this examination shows that Mr. O'Hara specifically said that he had no history of treatment for physical or mental illness, he had not been in hospital and he was not currently taking medication. The doctor considered that, although Mr. O'Hara might be rather eccentric, he was not suffering from any mental illness. By that time the results of the urine test were available and had not shown any abnormality. The doctor considered that Mr. O'Hara was well and arranged for him to be discharged from the hospital wing to ordinary location in the prison in the afternoon of 13 March.
During his time in the hospital wing Mr. O'Hara was, of course, seen by members of the wing staff. He specifically told them as well that he had no physical disability, that he was fit and well and that he did not require any medical investigation or treatment. I appreciate that Mr. O'Hara's friends will find it difficult to understand, as indeed do I, why Mr. O'Hara should have chosen to conceal the fact that he was a diabetic and needed insulin from the medical staff at Pentonville. Obviously I cannot explain this behaviour, and I can only point out that Mr. O'Hara was in every way unco-operative while in Pentonville to the point of refusing to give his first name and his date of birth.
It is also relevant—and it is an element in the tragedy of this case—that Mr. O'Hara denied at the same time any history of mental illness, whereas the letter from his friend Mr. Andrew Roberts to the hon. Member for Hackney, Central of 15 July 1980 implies that on the contrary Mr. O'Hara had a history of psychiatric treatment.
Let me say a few words about the urine test which proved negative. First, I understand that there is no reason to suppose that any confusion of one sample with another took place. Secondly, I understand that there is a form of insulin which is long acting, and if Mr. O'Hara had taken that before being sent to prison the effect could have persisted so that there would have been at the time he gave the sample no indication that he may have been a diabetic.
From the time when Mr. O'Hara was moved to a normal location in the prison he was in a double cell and was on a normal diet. He made no complaint of any kind until 8.15 on the morning of 16 March. He then said that he had vomited blood. That was reported by telephone to the hospital wing. Mr. O'Hara was immediately seen by a member of the medical staff. As he seemed most unwell an ambulance was called. It arrived at 8.45 and he was removed to the Royal Northern hospital. This, too, was the 595 first report received by the medical staff that anything was wrong with him, since he was placed on normal location in the prison.
No complaint that Mr. O'Hara had been assaulted was made at any time to any member of the prison staff. In a large, busy, crowded prison such as Pentonville, the place where a prisoner's health can be kept under close observation is the hospital wing. Mr. O'Hara had succeeded in satisfying the medical officers that he did not need to be kept under observation, and accordingly he had been discharged from the hospital wing.
In the rest of the prison, the health of the prisoners cannot be kept under the sort of close observation that is possible in a hospital. Naturally, if it became apparent to the staff that a prisoner was ill, a member of the medical staff would immediately be called. Generally, however, prisoners, like other people in the community, are expected to approach the medical staff when they feel unwell. That is entirely reasonable. Moreover, if a prisoner who is knowingly unwell still does not approach the doctor of his own accord it seems improbable that he would consent to any necessary treatment, and doctors in prison as elsewhere cannot treat patients without their express or implied consent.
When Mr. O'Hara was transferred to the Royal Northern hospital he then ceased to be the responsibility of the staff of Pentonville. From that hospital's discharge report, which has already been quoted by the hon. Member for Hackney, Central, it appears that when he was admitted he gave no information about any past medical treatment or history. Tests revealed, however, that he was a diabetic, and he was given the appropriate treatment. His condition began to improve and he was moved from the intensive care unit to a general ward.
The hospital reported—this has been referred to by the hon. Member for Hackney, Central—that Mr. O'Hara, having at first been lethargic and having given slow and confused answers, became increasingly aggressive and unco-operative. The staff had some difficulty in persuading him to commence subcutaneous insulin treatment, and on 19 March he refused to accept the dose of insulin prescribed or any dose and discharged himself from the hospital against medical advice. We also understand that a few days later Mr. O'Hara was admitted to another hospital as he was again most unwell. He remained there for some time, but again eventually discharged himself against advice.
Mr. O'Hara was unfortunately found dead at his home on 26 June last year. His body was decomposed and it seems that he may have died a month or five weeks previously, which takes us back to about 20 May, which was some considerable period after his release from prison on 16 March. The decomposed state of the body was such that the post mortem did not determine the cause of death and the inquest returned an open verdict.
There was absolutely nothing to suggest that Mr. O'Hara's death was in any way related to the few days that he had spent in prison. Indeed, I understand that evidence was given at the inquest that in early May Mr. O'Hara seemed almost fully recovered and was leading a normal life. That evidence was given by his friend, Mr. Roberts.
596 I am sorry to have detained the House for so long, but I wished to give a full and detailed account of what, on any view of the matter, could only be regarded as a very sad case.
The prison service has considerable experience of dealing with those who suffer from diabetes. If Mr. O'Hara had told any member of the staff of his condition, I should hardly need to say that he would have been given the necessary treatment. Contrary to some allegations that have been made, Mr. O'Hara did not tell anybody that he was a diabetic. I am sure that hon. Members appreciate that a full and accurate medical history from the patient is essential for diagnosis. Without that, the doctors could not be expected, having regard to the outcome of the urine test, to have diagnosed Mr. O'Hara's condition.
Unfortunately, the staff at Pentonville prison has been publicly critised about Mr. O'Hara's treatment. As will be apparent from the history that I have given, we believe that that criticism is neither justified nor fair. I should like to reply to the hon. Gentleman's complaint about his correspondence with my noble Friend the Under-secretary. The hon. Gentleman was particularly critical of the reply to his letter in which he had forwarded a list of 38 extremely detailed questions, which had been prepared by Mr. Roberts. The hon. Gentleman suggested that my noble Friend's refusal to answer those questions point by point meant that we were hiding something. I am sorry to say that he spoke about a cloak of secrecy. In addition, he complained in trenchant terms about the way in which my noble Friend dealt with this matter.
I regret that those suggestions and criticisms have been made. The hon. Gentleman knows that my noble Friend wrote to him on several occasions and that he gave a very detailed account of the events in Pentonville prison last March, which answered many of the questions in the list. Many of the remainder could not possibly be answered. For example, the prison service does not, and could not possibly, make a transcript or verbatim record of all conversations between the staff and inmates.
Having regard to the course that the matter has taken, I have incorporated such additional detailed information into my speech as is available. We have been criticised for not releasing the contemporary medical records. We have fully explained their contents. However, we consider that we are prevented from releasing the actual documents because of the medical ethic of confidentiality, to which the medical profession and the prison department attach great importance.
I appreciate that the man is dead and has no family or next of kin. However, I am advised—I well understand the reason for it—that the medical ethic of confidentiality, with its bearing on the freedom that patients have to make a complete statement of all relevant matters to their doctors, is regarded as matter of great importance. However, much has been said about the secrecy in which the Home Office has approached this case. There has been unjustified criticism. All records, including medical records, would be open to the Parliamentary Commissioner, were he invited to consider this case. We would welcome such an invitation. My right hon. Friend the Home Secretary has the fullest confidence in the staff of Pentonville prison. He is fully confident that they did all that was practicable to help this unfortunate man in the very difficult circumstances which he presented to them.
§ Mr. Clinton Davis
May I say to the hon. and learned Gentleman that, while I do not necessarily agree with the substance of many of his remarks, I welcome the suggestion that he has made—which I took up in my own speech—that he would fully co-operate with the Parliamentary Commissioner. Perhaps that is the route through which we should now travel.
§ Mr. Mayhew
I am grateful to the hon. Gentleman for that intervention. I hope that everybody who knows the Home Office, and knows the very difficult jurisdictions that it has to exercise, will accept that it is only anxious to achieve a fair balance between the very many conflicting interests which present themselves to it. This 598 is a case in which more than one interest has to be served. We want to be open in everything we do, particularly in a case where it is said that a death may have resulted from treatment in prison. On the other hand, there is a very important interest, in connection with medical confidentiality, that equally has to be observed.
I am glad that the observation I made has been received in that spirit by the hon. Gentleman. It is not for me to say what steps should be taken, but I reiterate that any opportunity that would enable the Home Office to dispose once and for all of this quite unfounded charge of secrecy would be welcome to it.
§ Question put and agreed to.
§ Adjourned accordingly at Three o'clock.