Guards laugh and joke before inmate dies - inquest

Azroy Dawes-Clarke, 28, died from a lack of oxygen and/or blood flow to the brain

Prison officers were caught on body cam footage laughing and joking while restraining an inmate who later died, an inquest has heard.

Azroy Dawes-Clarke, 28, was serving time at HMP Elmley on the Isle of Sheppey in Kent when he suffered multiple cardiac arrests, both during and after the incident on 10 November 2021.

The father-of-four had tied a ligature around his neck before officers intervened and began an "inappropriate and disproportionate" restraint which "escalated unnecessarily", the court was told.

Jurors at Kent and Medway Coroners Court in Maidstone concluded that officers had showed a "deeply concerning lack of care and compassion" throughout.

Staff were captured on video joking about the size of the handcuffs they needed for Dawes-Clarke as he writhed and screamed on the floor.

"Animalistic" language was also used, with the inmate being described by officers as being "like a bucking bronco".

The inquest also revealed handcuffs were wrongly applied, with jurors finding it "inappropriate for paramedics to have approved the handcuffing" given their lack of training to administer such advice.

They added there were "significant shortcomings" from all present in response to Dawes-Clarke's medical emergency and him subsequently going limp.

He went on to suffer two more cardiac arrests in the ambulance to the hospital, followed by a fourth and final one upon arrival.

The inquest found that "throughout the restraint, the proximity of one prison officer's knee to Dawes-Clarke's chest was bad practice".

"On top of this, leadership was lacking and control of (the prisoner's) head was not prioritised".

Along with the initial self-ligature, this "combination of factors" was cited as having led to Dawes-Clarke's death - the medical cause of which was a lack of oxygen and/or blood flow to the brain.

After the inquest, his sister Shay Inico said he had died "in the most shocking circumstances - restrained, neglected, and dehumanised while prison staff and paramedics who were trained to save lives stood by and did nothing".

Assistant coroner for Kent Ian Brownhill has commissioned three separate prevention of future deaths reports as a result of this case.

A HM Prison Service spokesperson said: "Our thoughts remain with the family and friends of Azroy Dawes-Clarke.

"Since this incident we have taken action to improve staff training around use of force, and we will now carefully consider the inquest's findings in full."