Death case raises fears over police doctors

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THE CONVICTION of two doctors for killing a man in police custody by prescribing excessive quantities of drugs demonstrates the poor training and organisation of police surgeons, senior doctors say.

No special training for police work was given to the two doctors who were found guilty of manslaughter this week at Nottingham Crown Court. When a complaint was made by another doctor about their excessive prescribing of addictive drugs to prisoners nothing was done to investigate their methods or advise them on better practice.

Dr Dhirendra Saha and Dr Chulam Salim, both 56, recklessly prescribed a lethal cocktail of drugs to Graham Rawlinson, 23, an unemployed roofer and former heroin addict. According to court evidence, Mr Rawlinson turned into a 'zombie', unable to walk straight or speak clearly, while under the two doctors' care at Grimsby police station.

Mr Rawlinson had been on remand on burglary charges in Strangeways Prison, Manchester, but was transferred to a series of other prisons after the riots in May 1990. He arrived at Grimsby police station fit and healthy, the court was told, but was then prescribed five drugs in doses of up to five times the recommended maximum by the two police surgeons.

Mr Rawlinson, whose home is in Levenshulme, Manchester, was in police cells in Grimsby for a week and a half before he died of pulmonary oedema (swelling of the lungs) caused by the overdose of drugs, the court was told.

Hours before Mr Rawlinson died, he was examined by Dr Salim who recorded in a notes that he was worried about the level of drugs he was receiving. However, he did not change the prescription. A few hours later, Mr Rawlinson was rushed to hospital but was sent back to police cells where he died early the following morning.

Mr Rawlinson was receiving 160 mg of temazepam, while the recommended maximum daily dose was 60 mg. He was also receiving 60 mg of the drug diazepam (Valium) for which the maximum dose is 30 mg daily. The drugs have a cumulative effect which would be extreme because they are so closely related. After six days on this regime, a fourth drug methadone, a powerful narcotic used as a substitute for heroin, was added. These drugs continued to be administered until Mr Rawlinson died.

Diane McCarrick, the mother of Mr Rawlinson's five-year-old daughter, Jamie, said that when her boyfriend was taken into custody he was addicted to heroin and had been receiving prescriptions of methadone to help him overcome his dependency. 'When I went to see him after his arrest he was a bit better but still quite nervous,' she said. 'He was shaking from the withdrawal symptoms. The next time I saw him was some time later in Blackpool police station, and he was much better, but by the time I visited him at Grimsby in September I could tell he had taken medication - he was chatting, but he was drowsy. When I spoke to him on the Sunday before he died he was very drowsy and confused. He was slurring his speech and he was upset, but he did not say why. We had a conversation, but I could not understand all he was saying.' Afterwards Ms McCarrick rang the duty inspector at Grimsby to complain about his condition.

At the trial of the doctors this week, the court was told that a relief surgeon, Dr Derek Luck, who had been called in while both police doctors were on holiday, was shocked when he discovered the level of prescriptions being given to prisoners in the cells. Dr Luck reported the matter to Superintendent Robert Bishop, of Grimsby police, who took the matter up with Dr Roger Deacon, the senior police surgeon for the area. However, Dr Deacon, who has since retired, saw it as a question of protocol and advised that prescription of drugs was a matter of confidence between doctor and patient. He declined to intervene.

Dr Conrad Harris, professor of general practice at Leeds University, who gave evidence at the trial, told the Independent: 'The matter should have been discussed, at least informally. The doctors could have been counselled to adopt a better approach to prescribing of addictive drugs. There was a very strong case for not giving Mr Rawlinson any drugs at all - he had been off them for five weeks. It is a grave mistake to give a man with this history any drugs because he just has to be weaned off them again later. No normal GP would begin to consider these doses.'

Dr Hugh de la Haye Davies, secretary of the Association of Police Surgeons, said: 'The work of police surgeons requires a lot of expertise, but this is not always understood and in many areas police forces just employ local GPs. Some police forces insist on training but many don't.

'These two doctors have been thrown like lambs to the slaughter . . . These men (the prisoners) were being kept locked up, three to a cell, in emergency conditions. They were under stress and so may need medication but it has to be carefully adjusted to their symptoms. For example if a prisoner complains he is not sleeping then a sleep watch can be kept on him to see if he is receiving sufficient drugs. It is the responsibility of senior policemen to make sure that doctors they employ have undertaken the necessary training. It is also the responsibility of the police to ensure that there is some supervision and consultation between police surgeons in an area to ensure that standards are met.'

Dr Saha suffered a heart attack in court while listening to the judge's summing up and was still receiving intensive care in hospital yesterday. Dr Salim was released on bail but the judge, Mr Justice Curtis, warned him that he could expect to go to prison.

(Photographs omitted)