§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Durant.]
§ 1.9 am
§ Mr. Roy Galley (Halifax)The treatment of my constituent, Mr. Keith Mulcahy, in Her Majesty's prison, Frankland, gives cause for concern on a number of issues. It is a long saga, and I shall seek to be concise.
In December 1983 Mr. Mulcahy was sentenced to fivei years imprisonment for offences of burglary and handling stolen goods. After periods in prisons in Leeds and Liverpool, he was transferred to Hull prison. There, in April 1984, he asked to be segregated for his own protection under rule 43 since he had been threatened by other inmates who were aware that he had given certain information about criminal activities to the police.
As Mr. Mulcahy was not prepared to return to normal location arrangements at Hull, he was transferred to Frankland prison in May. Again he applied for rule 43 protection, since he was allegedly intimidated by other inmates who had heard that he had passed information to the police. He was again segregated. At this stage he caused some difficulties for the prison authorities because he wished for the added protection afforded by rule 43 but did not wish to associate with sex offenders and violent criminals who were held under that rule. He also found that the constraints of rule 43 confinement were irksome. In effect, he sought to be placed on normal location, while retaining the protection of rule 43. Of course, it was impossible to provide such arrangements for inmates with the limited accommodation and facilities available to the prison. Therefore, it can be seen that Keith Mulcahy was not an easy prisoner to manage. There were apparently other incidences where he had been unco-operative, and no doubt prison staff regarded him as a nuisance.
On 21 January 1985 Mr. Mulcahy was taken to the hospital wing of Frankland prison, complaining of chest pain. On 22 January he sought to return to normal location, but the prison doctor insisted that he remain in hospital for observation, which Mulcahy did against his wishes. Precisely what occurred as the period of observation was coming to its end on 23 January is somewhat lost in the mists of confusion. Prison officers claim that while in the hospital wing Keith Mulcahy was threatening to smash up his cell. Mr. Mulcahy denies that. There appears to have been some dispute about access to his record player. What certainly did occur was that a decision was taken to move him into a stripped cell. He went willingly to that cell, and there an incident occurred. Mulcahy claims that he was attacked by an officer. The officer and his colleague maintain that Mulcahy attacked one of them and had to be restrained. That was the subject of a board of visitors' inquiry later in the year. Keith Mulcahy was found guilty and punished with loss of remission.
Although I remain suspicious about those events, I do not wish to dwell upon them and must accept the hoard of visitors' conclusion on this aspect of the case. I am primarily concerned with what happened after the violence. Without giving his consent, Keith Mulcahy was forcibly injected with the drug paraldehyde, which is a strong sedative, and injections of the drug are considered to be painful. The maximum recommended dosage set out in the British National Formulary is 5 to 10 ml, no more than 5 ml at any one site. Keith Mulcahy was given 20 ml. 873 He claims that he was injected in two different places, but according to the doctor there was one injection of 20 ml. It is also claimed that later on 23 January another injection, perhaps of another drug, was administered.
The role of the prison doctor is subject to disputed evidence, but there do appear to be some irregularities. Mulcahy was not examined immediately prior to the injection. The doctor's adjudication of fitness for punishment appears, at best, to have been haphazard. In evidence to the board of visitors the prison doctor admitted that he had given instructions while Mulcahy was in the hospital wing that he could be removed to a stripped cell if he became angry or truculent. It appears that hospital officers were given a relatively free hand by the doctor. It was stated that there was no need to refer to the doctor before a decision was made to remove him to a stripped cell.
The doctor claims that he visited Mulcahy in the stripped cell at 14.30 on 23 January, at about the time the injection was given. The prison officers all stated that the doctor was not present, and at the board of visitors' inquiry the doctor accused the hospital officers of telling lies.
There are a number of central questions in this case. Keith Mulcahy claims that he did not give his consent to the injection and, manifestly, he would not have done so. The usual ethical rules that are applicable in the prison medical service are that treatment without consent is not given unless a person is a danger to himself or others. There has never been any suggestion that excessive violence emanating from Keith Mulcahy occurred on 23 January, and there are no well-founded grounds for giving an injection without consent in this case. The prison doctor said at the board of visitors' inquiry that administering a drug such as paraldehyde without consent would be "tantamount to assault." Why, then, was the injection administered without consent?
The second question is whether the rules relating to the adjudication of fitness for punishment were adhered to. It cannot be acceptable for a prison doctor to give carte blanche approval to removal to a stripped cell without carrying out a prior examination immediate to that removal, purely on the ground that the prisoner could become angry or truculent.
Why is it that paraldehyde was administered when its use has been voluntarily restricted by doctors in the National Health Service in recent years and it has not been used in institutions such as Broadmoor for almost 20 years? Why was the dosage administered in one place at least four times the recommended maximum dosage? Under what circumstances are behaviour controlling drugs administered?
During its current inquiry into the prison medical service the Social Services Select Committee has consistently been told that such drugs are rarely, if ever, used for behaviour controlling purposes. These are the essential points of concern, but there are other issues. However, this evening I shall not seek to enter into too much detail on them.
Keith Mulcahy was bruised after the incident on 23 January. Why was no full investigation of that bruising carried out, but only a cursory observation by the prison doctor? On his subsequent transfer to Durham prison on 24 January. why was there no medical examination, as is normally the case on the reception of a new prisoner? In 874 July 1985, while in Durham prison, Keith Mulcahy undertook a hunger strike. On the fourth day of it he was again transferred to a stripped cell.
If half of what he tells me about the conditions in which he was held in that stripped cell are true, those circumstances are appalling. Prisoners are rightly deprived of their liberty, and one would not wish them to live in a holiday camp atmosphere, but there is no need to treat them as brute beasts. In November 1985 I received a petition signed by more than 70 prisoners at Frankland complaining about the treatment of prisoners at the prison and suggesting that there had been at least one other incidence of forcible injection of drugs.
All that seems to merit the fullest, most thorough, independent inquiry into the case of Keith Mulcahy and the circumstances at Frankland. There is still a great deal of conflicting evidence and many points of dispute. I hope that I have been careful to make no direct allegations unless there is substantial evidence. However, I complain unreservedly about the delay by the Home Office in this case. After corresponding over the months on several points of detail, I wrote to my noble Friend Lord Glenarthur on 31 July 1985 asking for a full inquiry. Repeated requests over the next few months for information about progress produced little result. Eventually, on 19 February, my noble Friend wrote to say that a formal investigation was in hand and that by that time all concerned had been interviewed and a report was being drawn up. That was three and a half months ago.
I hope that my hon. Friend can understand my impatience in the matter. It is more than 10 months since I first asked for an inquiry'. It is more than three months since the inquiry was substantially completed. One would not wish, in such cases, to sacrifice thoroughness for speed—one understands the pressures and problems of the Prison Department — but there has to come a point when, if there is no action, tolerance turns to suspicion. I hope that my hon. Friend will be able to answer completely the points that I have raised.
§ The Minister of State, Home Office (Mr. Giles Shaw)There can be no doubt that my hon. Friend the Member for Halifax (Mr. Galley) has raised a serious matter in relation to his constituent and to the petitions which he has already placed before the House. He raised the matter in the form of the allegations about actions of the staff of Frankland prison. I assure my hon. Friend, on behalf of my noble Friend the Parliamentary Under-Secretary of State, that he and the Department understand the extreme gravity of the matters disclosed regarding the prisoner Mr. Mulcahy.
It is right for me to go into the background detail of the affairs of 21 and 22 January regarding Mr. Mulcahy, who has been in Frankland prison since May 1984. On the evening of 21 January 1985, Mr. Mulcahy was admitted to the prison hospital, complaining of pains in his chest. When he saw the medical officer, Dr. Bhattacharya, on the morning of 22 January, Mr. Mulcahy asked whether he could return to ordinary location, but Dr. Bhattacharya felt that he should remain in the hospital under observation for a further 24 hours as the cause of his chest pain was still unclear. Mr. Mulcahy was unhappy at being kept in the hospital and threatened to cause trouble. Dr. Bhattacharya therefore made a note that, if Mr. Mulcahy caused trouble, 875 he should be placed in a stripped cell, which is a room in the hospital adapted to remove or modify features capable of being used by a patient to harm himself.
On 23 January, at around 12.30 pm, Mr. Mulcahy rang the bell in his cell and asked the hospital officer who attended for a record player. When this was refused, Mr. Mulcahy became abusive and demanded to see the governor. Staff agreed to arrange this in the normal way when the governor took applications the next morning. But at about 2.15 pm, Mr. Mulcahy again rang his bell and demanded to see the governor at once. He said that he was not prepared to wait until the morning and threatened to smash up his cell.
Staff therefore moved Mr. Mulcahy to a stripped room in accordance with the medical officer's instructions. Once in the stripped room, Mr. Mulcahy was asked to remove his clothes in accordance with the normal practice. At that point, he suddenly attacked one of the hospital officers, punching him in the face, and had to be restrained by the other officers present.
Mr. Mulcahy was later charged with a disciplinary offence, as my hon. Friend has related as a result of that assault. I shall return to that aspect of the case in a minute. While Mr. Mulcahy was being restrained, a hospital officer went to see Dr. Bhattacharya and explained the situation to him. He authorised the injection of 20 millilitres of paraldehyde, a tranquilliser. Mr. Mulcahy was held down by staff while this injection was administered in the buttocks. This was at about 2.30 pm. Mr. Mulcahy was then placed on special watch; that is, staff were required to observe him at intervals of not more than 15 minutes. He was observed to quieten down during the afternoon and evening. He was seen by the chief officer at 6.30 pm and by a member of the board of visitors at 6.45 pm. Dr. Bhattacharya saw him again at 7.30 pm and noted that he had some slight abrasions and bumps, consistent with the account given of the incident by staff.
At about 9.20 pm, Mr. Mulcahy began banging on his cell door and shouting. He told the hospital officer who came to see him that he had vomited blood and that he wanted to see a doctor. The hospital officer telephoned the duty doctor—a part-time medical officer with a practice outside the prison—at his home. The part-time medical officer authorised an injection of 100 milligrammes of pheno-thiazine, which is also a tranquilliser, and said that he would come into the prison if his condition worsened. When the hospital officer attempted to administer the injection, Mr. Mulcahy tried to knock the syringe from his hand, and had to be restrained by three other officers who had been summoned to assist him. After the injection was given, the 15-minute watch was maintained and Mr. Mulcahy calmed down.
This bare description of events obviously raises a series of questions. Indeed, my hon. Friend rightly highlighted them in his speech. I want to deal with them in order and explain what action we have taken. But my hon. Friend will recognise that some of the action that we have taken has sought to answer the questions that he posed. I refer, of course, to the inquiry, whose conclusions he is patiently awaiting.
I will deal first with the violent incident in the stripped cell immediately before the first injection was given. As I have said, Mr. Mulcahy was charged with a disciplinary offence. The governor remitted the charge to the board of visitors. Mr. Mulcahy requested, and was granted, representation at the hearing, which took place on 25 June. 876 Mr. Mulcahy's defence was that he had been the victim of a concerted and unprovoked attack by staff; and he denied that he had assaulted the hospital officer first. The other four officers present during the incident gave evidence. All made statements confirming that Mr. Mulcahy had attacked the officer first and that no more force than necessary was used to subdue him. There was a very lengthy hearing and all the relevant evidence was considered by the board, which found Mr. Mulcahy guilty as charged and awarded him 60 days' forfeiture of remission.
The first of Mr. Mulcahy's petitions about this incident was received on 12 July. He complained both that he had been the victim of an unprovoked attack by the officers in the stripped cell and that he had been improperly medicated without his consent. In the following weeks we received letters about the case from my hon. Friend and from the hon. Members for City of Durham (Mr. Hughes) and for Newcastle upon Tyne, North (Mr. Brown) and also Lord Avebury. Mr. Mulcahy's solicitors also wrote about the case, asking for a copy of the transcript of the adjudication which we sent them on 25 September. Meanwhile, we had called for reports from the governor and medical officer on the issues raised by Mr. Mulcahy and the hon. Members concerned, including my hon. Friend.
During the course of these inquiries, we reached the conclusion that the adjudication on Mr. Mulcahy had been properly carried out, that Mr. Mulcahy's allegation that he had been the victim of an assault by staff was fully and correctly aired at the hearing and that all the relevant evidence had been put before the board. We therefore saw no reason to interfere with the award. However, we also reached the conclusion that, on the facts as they were known at that stage, a formal investigation into the allegation of forcible medication was required, and on 4 November the director of the prison medical service and regional director jointly ordered such an inquiry to be carried out by senior members of their staff — the regional principal medical officer and the deputy regional director. They then interviewed Mr. Mulcahy and the staff concerned at some length. My noble Friend wrote to my hon. Friend and other hon. Members on 19 February to explain that this inquiry was under way, that in the meantime he could not comment on the allegations. but that he took them very seriously and would write to them as soon as possible. The report and the accompanying statements were presented to the director of the prison medical service and the regional director in April this year. Of course, he would have preferred this report to have been completed earlier, both in the interest of Mr. Mulcahy and the staff concerned. However, it is only fair to say that the report is a substantial one and that the officers carrying out the investigation had to do so in addition to their normal duties. My hon. Friend very generously referred to that.
The director of the prison medical service and the regional director are now considering what action should be taken in the light of the report. In doing so, they will have regard to the advice issued by the director of the prison medical service to all medical officers on 27 January 1984 concerning the circumstances in which medication may be given without consent. That advice recognises that there is no statutory authority for medical treatment to be given in prison without the consent of the prisoner concerned. In this respect, prison medical officers 877 are in the same position as doctors in the community. In the absence of any statutory guidelines, the director of the prison medical service has commended to medical officers guidelines derived from the report of the Butler committee on mentally abnormal offenders, which subsequently formed the basis for section 62 of the Mental Health Act 1983, which of course applies to the treatment of patients detained in hospital under that Act. These guidelines advise that treatment should be given without the prisoner's consent only where, without that treatment, the prisoner's life would be endangered or there would be a likelihood of serious harm to the prisoner or others, or there would be an irreversible deterioration in the prisoner's condition.
My hon. Friend has asked pertinent questions tonight about the medication carried out in this case. The inquiry has been set up to elicit those facts and will seek to answer those questions fully.
I know that my hon. Friend, and indeed other hon. Members who are interested in the case, will be anxious to know the decision as soon as possible. I am not in a position to announce the outcome of the inquiry tonight. I can say, however, to my hon. Friend that we expect to 878 reach conclusions within the next two weeks, or sooner. My noble Friend will then write fully to him and to the other hon. Members concerned. I know that my noble Friend will also be willing to meet my hon. Friend the Member for Halifax to discuss the case fully. I imagine that my hon. Friend will wish that to happen.
However, I cannot conclude without expressing both personally and on behalf of my noble Friend, our apologies to my hon. Friend the Member for Halifax for the inordinate time that it has taken to resolve this most serious, but complicated, matter. I wish to place on record the admiration that I have for the great patience as well as pertinacity of my hon. Friend the Member for Halifax in maintaining his commitment and interest in the case.
I have to tell my hon. Friend—and I know that he will understand—that the allegations are very serious, and they are being treated very seriously indeed. I must sympathise with my hon. Friend that I am not able to provide him with the answers that he seeks tonight, but I have given him the assurance that in a very short time he will be in possession of the answers to his questions.
§ Question put and agreed to.
§ Adjourned accordingly at twenty-eight minutes to Two o' clock.