The "physical and mental torture" of a disabled man in prison

Daniel Roque Hall was sentenced to three years in jail after drugs were found in his wheelchair. Since being sent to Wormwood Scrubs, his condition has deteriorated dramatically, say his mother and friend. Alan White investigates.

Last month, Private Eye magazine alerted its readers to the story of Daniel Roque Hall. He is a disabled man who was sentenced to three years’ imprisonment after being arrested at Heathrow airport with cocaine hidden in his wheelchair.

The sentence was passed despite the fact he confessed to his crime and probation reports found that he had been “groomed and manipulated”.  I have in my possession a letter written to Crispin Blunt, the prisons minister, by Roque Hall’s GP, on 14 August 2012. Among many other things, she says: “I feel that the disease from which he suffers has affected his judgment and also I feel he would be unable himself to hide the cocaine in his wheelchair.”

Roque Hall suffers from Friedreich’s ataxia, an inherited disease that causes damage to the nervous system. It limits the movement in his limbs, affects his heart and makes it hard for him to swallow. The full run-down of his health issues includes Type 1 diabetes, cardiomyopathy, hypotension, paroxysmal atrial fibrillation, leg and back spasms resulting in insomnia, a spastic bladder, and previous depression leading to two suicide attempts.

Daniel needs 24-hour care, including two carers to transfer him from chair to chair with a mobile hoist; insulin injections; five tests of blood glucose a day; toileting; turning in bed to avoid pressure sores; someone present when drinking to stop him choking; an exercise regime to prevent the development of contractions; the drug Warfarin; help with dressing himself; and manipulation and exercise to maintain muscle activity. He will die from his disease, but the exercises, in particular, help lessen his suffering. He is 29 years old and at best, he has 10 years to live.

Wormwood Scrubs, where Roque Hall is being held, promised that he would be adequately cared for once incarcerated. You might wonder, since that Private Eye story, how he’s getting on after a few more weeks in prison.

The answer is that he’s in the critical care unit at University College Hospital.

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Yesterday I went to meet his mother in the hospital’s relatives’ room – I’m not sure she was happy to leave his side, but there are two prison officers currently standing guard at his ward, and they won’t let me visit a prisoner. 

Personally I’m not sure I want to see my taxes deployed this way: it’s unlikely Roque Hall will suddenly recover from the serious condition he’s in, and then magically learn to walk, but I suppose you can’t be too careful. At the time of writing an application for interim relief is being considered – if successful these staff will be sent away.

Anne Hall, Daniel’s mother, is depressed, shattered, and a little ball of nervous energy. She tells me his story from the start, when Daniel had been found guilty, and was put under home curfew while awaiting sentence.

Daniel was sentenced on 24 June. The judge at Isleworth Crown Court said they couldn’t send him to prison unless the prison could meet his needs. Wormwood Scrubs received the relevant information from Daniel’s consultants: both his neurologist and endocrinologist said he’d deteriorate without constant, particular care.

The judge gave the prison two weeks to see if it could meet these requirements. Daniel’s barrister repeatedly asked the CPS if they’d had any word from Wormwood Scrubs, and they said not. Anne says: “We went into court on 6 July, and there were guards from Wormwood Scrubs sitting behind the CPS. Two minutes later the judge emerged and said he’d just been given an email confirming the governor of Wormwood Scrubs is ready to receive the defendant, and he therefore had no choice but to send him there. What he said after that shocked me: ‘I can’t say any more because the press are here.’”

Anne jumped up in court and said he couldn’t be taken to prison. Daniel was with his occupational therapist, who told the escorting nurse that he was having more spasms than normal. He had only been in the Scrubs’ health wing for two hours when, left alone on a medical examination couch, a muscle spasm caused Daniel to fall off and hit his head on the floor.

Consultant reports said the staff would need a hoist and two people to move him. Anne says: “A prison warder had to lift him up there, which is against all legislation. They weren’t prepared. When Daniel called, a doctor said he threw himself off the trolley deliberately and refused to call an ambulance.” Daniel said he said he needed to go to hospital: standard procedure for someone with his health issues. Anne spoke to Daniel, and then a prison officer, who assured her he’d be taken.

Private Eye described what happened next in its story:

“Instead of taking him to hospital, Scrubs staff for some reason decided to send him to a care home for the elderly and those with dementia. No one told the staff there that he had hit his head, or that he was taking blood-thinning medication. Instead security staff sat chained to him (how they thought he might escape is a mystery) until the care home later arranged a transfer to hospital.”

Anne’s friend called the care home, and told them the prison had to call an ambulance. He eventually went to Charing Cross Hospital, whereupon he was scanned and put on the acute medical assessment unit. On the Saturday he went back to the care home. There, Anne spoke to a duty governor from the prison and a senior nurse manager, both of whom accepted her point that he simply couldn’t be cared for in Wormwood Scrubs. 

On 7 July, Daniel was taken to Hammersmith Hospital, almost unconscious with hypoglycaemia. His consultant endocrinologist said he had a high level of thyroid toxicity; a result of the heart medication he takes. When Anne saw him, he was still cuffed to a guard with a security officer standing over him. She describes Daniel as looking ill and agitated.

Two days later he was taken back to Wormwood Scrubs. The intention was for him to continue serving his sentence.

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The staff at Wormwood Scrubs had been given a clear description of Daniel’s required care, in detailed consultant reports, which I’ve seen.

Anne claims that none of these needs were met. Daniel has to exercise in order to maintain his muscle mass, because his diaphragm muscles are compromised by his neurological disease. However, she says that staff were either unwilling or unable to carry out these extensive exercises. Anne also says he reported being in pain due to the lack of exercise – the evidence borne out by his now much-reduced muscle mass.

Daniel’s routine has to be flexible, but his medication – Warfarin - has to be given at the same time, every day. Anne claims they’d give it at differing intervals of eight or nine hours. He told her he was kept in a cell that was overwhelmingly hot, with no air conditioning.

Anne even says even his basic rights were denied: “There was no adaptive toilet for him – they had to bring a commode in and everyone passing by could see him because they weren’t allowed to shut the door.” She says no one helped him use a phone – which he’s unable to use himself – until his solicitor insisted.

Daniel was spasming so much that, when sat on a shower chair, he cut his feet – a risk described in the endocrinologist’s report, with ulcers being a particular risk. He also suffered abrasions on his foot due to his prison slippers. When Anne phoned a member of the prison staff, she was told “it would be a protracted process to get alternative footwear”. It would be a different story if Anne could bring some slippers to the gate – or, in the staff member’s words, “facilitate a solution”. “The language,” she says, “is often amazing.”

Three weeks ago, she visited Daniel in prison and was horrified by the state in which she found him: “They brought him out with his wheelchair wrongly configured. It was completely in the wrong position. He was sliding out of the chair in terrible pain. When I saw him he was struggling to breathe and I told the governors he was in tachycardia. I said the symptoms had to be investigated and managed. For two weeks he asked to see the doctor, rather than the visiting GP.”

Anne made a fuss in the prisoners’ hall, but the warnings weren’t just coming from her. In the aforementioned letter from Roque Hall’s GP on 14  August she describes Daniel’s condition in great detail, and concludes there is “a risk he will have hypoglycaemia resulting in a coma” and that his incarceration “will result in his demise”.

A week after Anne’s visit, he told the staff he had atrial fibrillation and needed to see a cardiologist. She says: “The nurses would take his heart rate and say it was high but wouldn’t say how high.”

On Monday 20 August, Daniel Roque Hall fainted during a meeting with his solicitor.

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Kaleem Naeem is a young, bearded man, who has been one of Daniel’s carers for several years. He has quiet manner, and is well spoken. He was with him at Queen’s Park school, and went on to become a full-time carer for his friend: “As a carer, you probably won’t get any sleep because you constantly have to move his legs. The prison staff told me I couldn’t do it when I saw him – but they weren’t doing it.”

When he visited Daniel, he was shocked. “I’m someone who believes if you do the crime you do the punishment – and Daniel’s the same because he doesn’t want people to think he’s using the wheelchair to get away with it. But when I saw him it was appalling. His face looked different. He was thin, he was sweating - you could tell he was going through an ordeal.”

Daniel had now been saying he was in tachycardia for two weeks, and needed to go to the hospital. Kaleem told Anne about his concerns. She rang a member of the prison’s staff, and said they’d have a dead body on their hands. He told her he’d only been joking and laughing with Daniel a minute ago. “The depravity of their lies is amazing,” she says.

On Wednesday 22 August, staff from the prison took Daniel to University College Hospital in London, queued up at A&E - not as an emergency - and said he’d been generally unwell. According to Naeem, he came handcuffed, screaming to the nurses to get him away from the prison staff: “That two-week wait will possibly have caused irreversible damage. They played Russian Roulette with his life,” he says.

He had an ECG, and the doctors found he had vast, unstable, atrial fibrillation.

The next day, lawyers were fighting for him to be released from prison while his medical needs were assessed. Wormwood Scrubs submitted to a judicial review that an outside doctor was not needed. At the time, Roque Hall was lying in UCH, in intensive care. His family and lawyers had not been told.

Anne says: “I only found out that Daniel was in the hospital on 4.30am on the Friday morning because he deteriorated when he was in intensive care. When somebody’s dying the family have to be informed. The governor told me that.”

She went to see him: “He was in an appalling state. He’d lost all of his speech by that point. I asked the doctor if the confusion would go, and he didn’t know. Daniel had heart failure. I cried when I saw him. The nurse asked me to kiss him, and they took me out again. There was a good chance he wouldn’t survive.”

Daniel was critical but stable. He was on a ventilator and came off it yesterday afternoon. He has two warders now. “I asked the nurse to put him out of their sight because when he woke up and saw them he was very upset,” says Anne.

She claims a member of the prison staff once told Daniel no one cared about his plight. “It’s physical and mental torture. I want them – from the governor to the so-called prisoner health team – never to do this to anyone again.”

Naeem says: “Yes he did wrong, but what he’s received is torture. Funny thing is they had a solution - they had him under curfew at home and that would have been an adequate punishment. He’s an outgoing guy and being held there would hardly have been a bed of roses.”

In the final paragraph of the letter from Hall’s GP to Crispin Blunt she says: “I am not trying to contradict the law but I do feel that we are a humane and democratic society and that the health service is there to provide care for those in need and danger.” More fool her. Perhaps the cruellest twist is that, by a strange quirk of fate, the opening ceremony for the Paralympics is taking place as I type this.

UPDATE 30/08/2012 13:30:

A Prison Service spokesperson said:

"We don't comment on individuals. We have a duty of care to those sentenced to custody by the courts. As part of that duty of care, we ensure that prisoners have access to the same level of NHS services as those in the community."

Wormwood Scrubs, where Daniel Roque Hall is being held. Photograph: Getty Images

Alan White's work has appeared in the Observer, Times, Private Eye, The National and the TLS. As John Heale, he is the author of One Blood: Inside Britain's Gang Culture.

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Air pollution: 5 steps to vanquishing an invisible killer

A new report looks at the economics of air pollution. 

110, 150, 520... These chilling statistics are the number of deaths attributable to particulate air pollution for the cities of Southampton, Nottingham and Birmingham in 2010 respectively. Or how about 40,000 - that is the total number of UK deaths per year that are attributable the combined effects of particulate matter (PM2.5) and Nitrogen Oxides (NOx).

This situation sucks, to say the very least. But while there are no dramatic images to stir up action, these deaths are preventable and we know their cause. Road traffic is the worst culprit. Traffic is responsible for 80 per cent of NOx on high pollution roads, with diesel engines contributing the bulk of the problem.

Now a new report by ResPublica has compiled a list of ways that city councils around the UK can help. The report argues that: “The onus is on cities to create plans that can meet the health and economic challenge within a short time-frame, and identify what they need from national government to do so.”

This is a diplomatic way of saying that current government action on the subject does not go far enough – and that cities must help prod them into gear. That includes poking holes in the government’s proposed plans for new “Clean Air Zones”.

Here are just five of the ways the report suggests letting the light in and the pollution out:

1. Clean up the draft Clean Air Zones framework

Last October, the government set out its draft plans for new Clean Air Zones in the UK’s five most polluted cities, Birmingham, Derby, Leeds, Nottingham and Southampton (excluding London - where other plans are afoot). These zones will charge “polluting” vehicles to enter and can be implemented with varying levels of intensity, with three options that include cars and one that does not.

But the report argues that there is still too much potential for polluters to play dirty with the rules. Car-charging zones must be mandatory for all cities that breach the current EU standards, the report argues (not just the suggested five). Otherwise national operators who own fleets of vehicles could simply relocate outdated buses or taxis to places where they don’t have to pay.  

Different vehicles should fall under the same rules, the report added. Otherwise, taking your car rather than the bus could suddenly seem like the cost-saving option.

2. Vouchers to vouch-safe the project’s success

The government is exploring a scrappage scheme for diesel cars, to help get the worst and oldest polluting vehicles off the road. But as the report points out, blanket scrappage could simply put a whole load of new fossil-fuel cars on the road.

Instead, ResPublica suggests using the revenue from the Clean Air Zone charges, plus hiked vehicle registration fees, to create “Pollution Reduction Vouchers”.

Low-income households with older cars, that would be liable to charging, could then use the vouchers to help secure alternative transport, buy a new and compliant car, or retrofit their existing vehicle with new technology.

3. Extend Vehicle Excise Duty

Vehicle Excise Duty is currently only tiered by how much CO2 pollution a car creates for the first year. After that it becomes a flat rate for all cars under £40,000. The report suggests changing this so that the most polluting vehicles for CO2, NOx and PM2.5 continue to pay higher rates throughout their life span.

For ClientEarth CEO James Thornton, changes to vehicle excise duty are key to moving people onto cleaner modes of transport: “We need a network of clean air zones to keep the most polluting diesel vehicles from the most polluted parts of our towns and cities and incentives such as a targeted scrappage scheme and changes to vehicle excise duty to move people onto cleaner modes of transport.”

4. Repurposed car parks

You would think city bosses would want less cars in the centre of town. But while less cars is good news for oxygen-breathers, it is bad news for city budgets reliant on parking charges. But using car parks to tap into new revenue from property development and joint ventures could help cities reverse this thinking.

5. Prioritise public awareness

Charge zones can be understandably unpopular. In 2008, a referendum in Manchester defeated the idea of congestion charging. So a big effort is needed to raise public awareness of the health crisis our roads have caused. Metro mayors should outline pollution plans in their manifestos, the report suggests. And cities can take advantage of their existing assets. For example in London there are plans to use electronics in the Underground to update travellers on the air pollution levels.

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Change is already in the air. Southampton has used money from the Local Sustainable Travel Fund to run a successful messaging campaign. And in 2011 Nottingham City Council became the first city to implement a Workplace Parking levy – a scheme which has raised £35.3m to help extend its tram system, upgrade the station and purchase electric buses.

But many more “air necessities” are needed before we can forget about pollution’s worry and its strife.  

 

India Bourke is an environment writer and editorial assistant at the New Statesman.