“Now he is gone and life is nothing without him. I cannot see a future without him and I worry about my children and their future.”
Today we continued to hear from the paramedic at the scene, we heard family statements and evidence from the anaesthetist at the hospital and finally the pathologist who went through the post mortem reports.
In the morning following on from the issue that came up at yesterday the family lawyer Tony Metzer QC raised the concerns about submission of previous notes of the inquest regarding the evidence given by the paramedic Kevin Thompson. Thompson was asked by Patrick Gibbs the TVP Counsel about the audio transcript that he heard from Dec 2010 and the evidence that he gave. Confirmed that an ‘attempt’ to put him in a recovery position and was asked to explain any shortcomings that existed.
There was no reference in paperwork that Thompson completed to blueness or change to skin colour H e did confirm that the length of chest compressions and ball valve face mask ventilations were for 20 minutes duration. Habib was then transferred to hospital bed where he was moved and handed over to hospital staff.
Jurors asked about when he detected that Habib was in cardiac arrest and whether he could see him breathing. Thompson suggested that you needed to be closer to the body to see and check the breathing He was also was asked about the difference between Category A and Category B in terms of the response. Had he arrived earlier would have made a difference? No. But the ambulance arriving earlier may have. It was confirmed that paramedic had not been told that any package was in his throat until much later. He could not see anything in his mouth when he inspected it but was not able to see all the way down
Nasrit, Habib’s sister read out a family impact assessment status, this was difficult for her and she was in tears reading this. Her testimony gave an account of what kind of man he was and how dedicated he was to his family. A statement was also read out from his mother Hamida Begum and a statement from his widow Mussarat Habib which again was harrowing and showed what he meant to the family. Both of them were unaware of his drug habit, his other life or relationships. Photos of Habib were then handed out to the jury.
Dr Diane Tran, an anaesthetist at the local hospital proceeded to give evidence and read her statement and was asked questions about this by the Coroner and she explained to him about the processes involved and that they continued to do the breathing for him mechanically. There was an issue issue of when he was declared dead and how this was reached and CPR was stopped. Family lawyer then proceeded to ask Dr Tran questions. Clarified about the breathing and whether the bag was ruptured. She did not see this.
Tran was then cross examined by TVP Counsel Gibbs and was asked about the item that she pulled out of Habib’s mouth and where this may have come from – windpipe or food pipe. She couldn’t comment on where or whether had caused obstruction. Gibbs asked Tran about Habib’s mouth being closed and whether he was conscious. Again she could not comment about this about being open. Witness is not here as an expert and this was challenged by the family lawyer successfully. Jurors asked about the bag and whether there was stomach acid from going down the oesophagus
Nicholas Hunt the pathologist was questioned by the Coroner regarding the 2008 post mortem report and the subsequent one based on new findings. Talked through the various injuries that were found on different parts of Habib’s body from the post mortem report. Tony Metzer asked for a focus on the neck and heart in particular. Bruising in the jaw and bruising on the spit gland and in neck muscles going to the shoulder blade and breast bone and around the Adams apple. Bruising was also present at the back of the throat
Number of rib fractures present in his chest – these were associated with the chest compressions that were administered Heart showed evidence of hardening of the arteries and tissue samples showed some scarring and damage. Muscle tearing on upper arms on both sides on deltoids and triceps, bruising of each elbow. Internal bruising on the middle and lower back and on the back of the neck
Hunt used statements from the officers and read out this evidence. He stated that Habib had taken cocaine and heroin that day and he felt that cocaine toxicity played a part in his death. Toxicology report suggested previous cocaine and opiate use and that the state of his heart may have been a factor in his cardiac arrest. Hunt does not believe that positional asphyxia applies despite the periods of neck compression and the injuries. He does however dismiss ‘excited delirium’ as being present in this case. Still believes that this is not a death solely attributable to restraint but is multifactorial
After lunch Coroner asked Hunt about the report from 2012 where he had additional information and fresh evidence including transcripts of the previous inquest held in 2010. He is asked about the opinion that Hunt shared in this report. His evidence is that Habib did not die from strangulation as the injuries do not point to this but there is some bruising on his throat that suggests gripping of the throat. He is asked about the kidneys being damaged and there being trauma but he associated this with blood loss rather than a blow in this area. Family lawyer made Hunt aware again of the redacted statements but clarified that he was not provided with other evidence from the witnesses such as Emma & Morris.
Hunt confirmed key details that Habib was 5ft 9 inches and of medium to heavy build and that he had no history of heart problems and was a reasonably healthy person. He agreed that the restraint by the police was a factor in his death and identified 25 injuries that he had suffered due to this He was asked whether he was given any evidence about the police prior to the post mortem and he was given background information that officer(s) had gripped Habib’s throat. The two areas that were grabbed were identified by Hunt. He was asked about whether he was aware of the use of the pressure point techniques on him in the neck area.. He was aware but not of the frequency and confirmed that this could have caused the bruising found in those areas.
There was nothing to suggest of heart attack but was there any evidence of scarring from the cardiac arrest? Acute damage in his view was due to cocaine toxicity. The arrest itself does not leave any marks. He was asked about the muscle tears in his arms and it was confirmed that this could be caused by grabbing of the arms. The bruises on elbows are consistent with knee strikes and the bruising on the back is consistent with blows to the back. Bruising at the back of the neck could be caused from a punch, kick or some impact.
He was asked about if he was informed about the packages and that these had not leaked prior to the second report. He was asked about his conclusions about the cause of death. TM asked about him about the toxicity report and the levels of cocaine in his bloodstream. Asked about the scarring on his heart muscle and that on balance this is and the narrowing of the arteries contributed to his death. He was questioned about the lack of oxygen and positional asphyxia in Habib’s case. Understands about stress during arrest and the additional stress that restraint causes as well as commands such as ‘break his arm’.
Questioned about bruising on the neck and confirmed that this is most likely to have been caused by the gripping of the throat by an officer. Agreed that it would have looked like strangling from afar. Hunt confirmed that he dismissed ‘excited delirium’ in this case and that there was no temperature change, extreme violence, paranoia and does not see any signs of this in Habib’s case. Asked about bruising to back and neck were consistent with one or a number of blows and knee strikes.
Hunt was questioned about agonal breathing and agreed that it could be interpreted as someone is still breathing but nearing death. Checked about ABC and CPR and hunt advised that CPR should be given if they have such shallow breathing and have no pulse. Hunt said that Habib being face down could have impeded his airway. It was put to him about the effect of the actions/restraints and the part that they paid in Habib’s death. From the evidence from the officers and the injuries that Habib’s breathing could have been obstructed by the actions of the officers. Hypoxic cardiac arrest may have played a part overall cause of death is cardiac dysrhythmia caused by restraint. Can’t be 100% sure that there was airway obstruction from the foreign body and the package could have moved when the body was moved.
Hunt was taken through the guidance on the risks of positional asphyxia and asked to comment on this given the risks that he was aware of and this was heightened by a subject being intoxicated as well as body position. Some evidence indicates positional asphyxia (haemorrhages under the eye lids) and Hunt said that depending on the length of restraint he would not exclude this as a cause of death. If he was restrained for more than a number of minutes and there were other constraints and drug use this would increase the risk of positional asphyxia
Questioned by TVP Counsel and he stated that injuries were all recent and suggested that the abrasions and bruising could have been caused by the rough floor in the car park. The tears he suggested could have been caused by Habib lifting himself on the floor. The bruises on the sides of the neck could have been caused by pressure point techniques used and these are not always in the right place. The rest of marks and bruises consistent with knee strikes and blows to the head. The direction of questioning predictably was about downplaying the officer’s role in Habib’s death and the role of restraint that played. If a death is multifactorial what weighting is applied to each factor in this circumstances? Excited delirium was again dismissed. There was no way of knowing where the bag was lodged – windpipe or food pipe. Queried positional asphyxia assessment predictably and examined the periods of restraint that Habib was subject to.
Even though this is an inquest and not a criminal court plea bargaining has started to begun and looks like TVP are beginning to adopt a damage limitation approach so watch this unfold over the next few days and weeks as we get closer to the final day and the verdict.