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Colin Ireland

7 Nov 2014 · Coroner David Hinchliff · West Yorkshire (West)

The coroner's concerns

  1. 1. challenged clinical judgement of nurse and GP

    “That a Governor Grade Officer who had sole responsibility for the running of the Prison challenged the clinical judgement and decisions of both an experienced nurse and the on-call GP who believed that Mr [name redacted] had fractured his hip and that this was a potentially life-threatening condition and that he should be sent to hospital as an emergency.”
  2. 2. unresponsive operational manager

    “That the same Governor Grade Officer had difficulty in contacting by telephone the on-call Operational Manager for the High Security Prison Group to seek permission for Mr [name redacted] to be sent to hospital. Apparently, was not responding to her calls.”
  3. 3. lack of agreed protocol and training

    “consider that there should be an agreed protocol for this and that all on-duty Governors should receive appropriate training regarding responding to medical emergencies of all types to ensure a speedy release to hospital when necessary”

Responses

No published response was found on judiciary.uk.

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Source: Prevention of Future Deaths reports and responses published by the Courts and Tribunals Judiciary at judiciary.uk. Crown copyright, used under the Open Government Licence v3.0. Data updated 26 Oct 2026.

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Colin Ireland · Recurance