Inquest Jury conclude unlawful killing by a police officer of a vulnerable young man, and that his death was contributed to by neglect on the part of healthcare staff and three other police officers at the scene.
Following an inquest lasting nearly six weeks, the jury reached a conclusion that Brian Ringrose, 24, was unlawfully killed by unlawful act manslaughter. Brian’s death resulted from a prolonged period of prone restraint with his arms elevated in an abnormal position by a Thames Valley Police officer on the floor of the Emergency Department of Milton Keynes University Hospital in January 2021.
The jury also concluded that Brian’s death was contributed to by neglect on the part of three other police officers at the scene, as well as failings by healthcare staff who observed the restraint but failed to intervene.
In a careful and detailed narrative which (unusually) extended to 7 pages, the Jury found that:
- Hospital staff prematurely discharged Brian, even though he was still suffering the effects of an overdose of his prescription medication. His treatment plan was “vague” and “inadequate” and the process of confirming discharge into police custody was “unsafe and inappropriate”
- The officer who conducted the restraint at Brian’s head end elevated his arms behind his back “in an extreme and unnecessary position”, at times between 90 and 180 degrees, which caused “severe injury to Brian’s shoulders, including torn ligaments and muscles, and deep internal bruising”. The same officer “dragged Brian by his arms across the floor…causing him severe pain” and “inappropriately….return[ed] him to the prone position [on his front, where he was at heightened risk of asphyxia] when there was no indication it was reasonable nor necessary to do so”.
- The officer who conducted the restraint at Brian’s feet “used a baton pin on Brian’s legs, severely restricting his ability to move and this…made it practically infeasible to place Brian safely on to his side”.
- Although trained on the risks of positional asphyxia and to “speak up, speak out”, neither officer raised any concerns or questions regarding the position of Brian’s arms nor the length of the prone restraint. Both officers “failed to react to Brian’s abnormal breathing” and “ignored” his “obvious sounds of pain”. Their “severe failure … in respect of the period of prolonged restraint and struggle in a prone position with his arms in an abnormal position” – which they concluded was for a total of a 24 ½ minutes – “probably caused Brian’s death”.
- Two further police officers arrived later at the scene and “should have realised Brian’s arms would be causing him pain but neither raised this, in contravention of the police training requiring officers to ‘Speak up and Speak out’. Neither “made any attempts to monitor Brian’s welfare” and “failed to recognise his abnormal breathing which was continuing to deteriorate”.
- The restraint was also observed by hospital staff but “no single member of hospital staff adequately monitored Brian’s welfare during the entire restraint”. The ED doctor “should have attempted to end the prone restraint, and checked Brian’s vital signs….Instead, they just walked past”. Nursing staff and health care assistants “made inappropriate gestures and comments regarding Brian, when they should have been monitoring his welfare”.
- “No officers and no hospital staff checked on Brian’s welfare before he was lifted and carried out of the ED. There was no further monitoring until he was placed in the van with the doors closed and the internal light switched off”. At that point, it was too late to save Brian’s life.
The coroner has indicated that he will issue a report directed at preventing future deaths.
Lorna Skinner KC and Zoe McCallum acted for Brian’s family, instructed by Carolynn Gallwey of Bhatt Murphy.
Media coverage: Channel 4 news (link), Bucks free press (link)