A jury at Ipswich Coroner’s Court has concluded that a prisoner died from natural causes, having refused to take medication prescribed to manage his serious heart conditions.

On Christmas morning 2020, Stephen Holden (54) was found dead in his cell. He had suffered from acute cardiac failure.

Healthcare at HMP Highpoint was provided by a private contractor, Practice Plus Group (PPG). Following Mr Holden’s transfer to the prison in March 2020, a GP employed by PPG decided to reduce and ultimately withdraw Mr Holden’s prescription of pregabalin, a drug typically used for epilepsy and pain relief. The Court was told that pregabalin was among those drugs typically ‘traded’ within the prison estate.

Mr Holden suffered from back pain, but the doctor noted that he was already taking other forms of analgesia, in the form of opiates. The GP considered that the pregabalin was not medically indicated. There was also evidence that Mr Holden had previously ‘diverted’ his pregabalin, pretending to have taken it during observed administration, but in fact holding it within his mouth until he had left the healthcare unit.

The Court heard that Mr Holden was unhappy about the GP’s decision to reduce and withdraw his pregabalin. He made a pact with another prisoner that, due to Healthcare’s actions, they would  refuse to take their other medication. In Mr Holden’s case, this included life-preserving heart medication.

Questions were raised as to whether there ought to have been an attempt by PPG to contact and involve Mr Holden’s family in his healthcare, in this case to help persuade him to restart his medication regime. The family also asserted that specialist mental health input ought to have been sought in relation to Mr Holden’s refusal of medication.  They had been entirely unaware of his medication refusal, and indicated that had they known they would have tried everything to persuade him to re-start his medications.

On the fifth day of this ‘Article 2’ inquest, the jury returned its narrative conclusion. Mr Holden had died of heart failure, having declined life-saving medication as a protest to the withdrawal of pregabalin.

There was no criticism of the prison itself; indeed, the Coroner agreed that the jury ought to be directed that neither the prison nor its staff could be referred to in the conclusion. The Assistant Coroner, Tim Deeming, made no report with respect to the prevention of future deaths.

Jim was instructed by the Government Legal Department on behalf of the Treasury Solicitor.