Habib Inquest Day Thirteen 19th February 2015

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‘Restraint is a ‘sweaty business’ and they should be aware of the physical exertion on themselves and therefore on Habib. Officers were out of breath so they should have been assessing Habib’s breathing in this context.’

 TVP Counsel for the Officers Patrick Gibbs QC continued his cross examination of Pybus the police trainer/expert and asked him about the planning of the stop and search operation. He was clear that there needs to be leadership and coordination. Pybus maintained his support for searching occupants of the vehicle one by one rather than taking everyone out as they did in this instance. More controlled and clinical way of managing the search.

He asked him about his criticisms of the officers around their communication at the scene. Officers need to be clear about what they are doing and their roles. Pybus referred to the Conflict Management model and One plus One theory – the action needs to be proportionate to the threat being posed. He stuck to his opinion that the first backslap was too soon and he also felt that the other backslaps were unlikely to have ejected the item in his throat

Pybus was again critical of the lack of communication with Habib when the pressure points were being used up and beyond the instruction to ‘spit it out’.  Pain over rides communication so he may have not been heard these commands.  He was asked about the prone position and the timing of this and about the use of restraint in Habib’s case. Again he raised why a rear takedown was not used in this instance and questioned use of the nose pinch

When Habib went ‘limp’ the police needed to look at their options. Restraint is a ‘sweaty business’ and they should be aware of the physical exertion on themselves and therefore on Habib. Officers were out of breath so they should have been assessing Habib’s breathing in this context. Pybus confirmed that there was nothing in the training manual about subjects feigning injury but they could have handcuffed him if necessary.

TVP Counsel for the force Sarah Simcox took Pybus through  ACPO manual/guidance around mouth searches. Asked him about use of LS technique and risks associated with this

Juror asked about the ‘something being odd’ expression. Would officers be aware of the slow breathing and if so why did they not act on this? If they were out of breath and he wasn’t this should have been addressed. Question was raised about the stress on the officers and about stepping back. Stress has link to decision making and the training of skills is kept simple and he talked about increased heart rates. Question asked about command hierarchy – current way of dealing with this is that Officers are encouraged to speak out and whistle blow whatever their rank. However in reality younger officers may not do this and he was asked about the consequences of being a whistle blowing. Officers are bound by law as well as their duty as police to do this.

There was another question about verbal and non verbal communication under stress and that communication is also important for the wider public for reassurance purposes.  There was a question about subject feigning being covered in training – this is covered through developing scenarios and discussions and may include handcuffing. A juror asked about drink and drugs in context of Habib’s initial state and advice was for an officer to stand back and observe if possible and for someone to take charge. There was a final Question about drugs searches and training and Pybus referred to the different techniques that are taught

Tony Metzer QC acting on behalf of the family followed up by raising Kent police policy around mouth searches from 2009 advice was allow subject to swallow item. Pybus was interested in how this has been taken up by ACPO and seeing how injuries could be prevented in the future.

We heard evidence from David Skinner, a medical expert with a background in accident and emergency and trauma background and working with GMC and criminal negligence and has written books about CPR, trauma and accident & emergency medicine. He had no prior knowledge or involvement in this case before December 2014.

He was questioned about the cardiac arrest by the Coroner and the potential to be resuscitated.  Habib was least likely to be revived as there was ‘asystole’ and no electrical activity in the heart.  Skinner went through the actions that took place and the consequences of these and dismissed cocaine use and level of drugs as causing a cardiac problem.

He challenged the Post Mortem findings and that stated there was no cardiac dysrhythmia as Habib had flat lined. Airways obstruction could have not only have been caused by the foreign body in his throat but by the hands on his throat. In particular he noted the Hunt’s reference to PC Pomery’s comment about grabbing Habib’s throat ‘too hard’ in terms of pinpoint bleeding being present.

In terms of the blows to the back he clarified that a blow to the back is part of first aid but questioned the appropriateness of this. Attempts to open his mouth – asked about techniques used and pain compliance. The squeezing of the neck raised and was aware of the bruising that was found and could have constricted his breathing. He was not aware of the duration of this. The finger in the eye socket was painful and would have caused vagal stimulation.   He raised issue of airway obstruction – Paramedic may have pushed the item further back in his throat unintentionally.  Low blood oxygen was present

In the afternoon the Coroner picked up further sections of Skinner’s report. He confirmed that the application of pressure to Habib’s back by someone kneeling on their, together with him being face down and an officer putting pressure on his neck would have made breathing difficult.

Skinner went through graded scale of consciousness (Glasgow Coma scale) and he assessed this with being scale 3 – patient is deeply unconscious or dead. However Habib was conscious when screeched with pain when he was poked in the eye. He stated that he could not have been feigning/faking it if his arm was picked up and it flopped to the ground and was ‘limp’.

Skinner confirmed that the breathing that was heard was agonal breathing otherwise known as a ‘death rattle’ and these were signs of a life threatening situation. He raised issue of the aftercare and assessment of Habib and what was communicated to the paramedics and the ambulance service. Call was important as well as the actions

He does not lay any blame on the paramedic and the actions carried out  but he pointed inadequate communication to ambulance service – ‘male gone limp’ not good enough and they should have passed on better information and advised on officers giving CPR. Due to the lack of oxygen present at this stage CPR would have increased survival chances

He has no criticism of hospital staff when Habib was taken there. In his opinion positional asphyxia and neck holding & other techniques used around the arrest made a major contribution to Habib’s death. Skinner confirmed that there was no evidence of excited delirium exists in this case and that it is not widely accepted as an accepted medical condition.

Tony Metzer asked questions about his experience and previous work with the police he asked Skinner about Habib’s previous medical history and being in ‘reasonable health’  It was his view that by the time the paramedic arrived that he was dead already and confirmed that it was the actions of the officers and restraint that led to his death. Skinner doesn’t rule out completely that historic cocaine use as a factor in his death but does not believe that cocaine toxicity was to blame

He believes that the package became lodged as he became unconscious and would not have been able to spit it out. He could not do anything about it himself.   Paramedic says that there was partial airway obstruction when he arrived. He confirmed that seeing evidence of the bruising that this occurred whilst he was still alive. Skinner had little doubt that positional asphyxia  contributed to Habib’s death in his opinion and Tony picked up issue of breathing and constraints on this and the poor monitoring of his breathing.

Skinner c onfirmed that no effort was made to check his pulse and effective CPR. Assessment of breathing is part of first aid training.  Chest compressions and mouth to mouth suggested using ABC techniques. Whilst he was unconscious there would have been no problem opening his mouth and checking his airway and they should have done this in accordance to their training. First aid ABC training was not done adequately by the officers. Whole range of techniques could have been done and it is clear that early CPR enhances survival.

TVP Counsel for the officers raised questions about the evidence that he was party to. In particular he asked about his knowledge of the neck hold that was deployed

He was asked about the length of time of the period of restraint – he was not sure about this and the length of time of the neck hold. Referred to the blueness of Habib and was asked about this and related it to partial or full obstruction of the airway.

Skinner was asked about the actions of the paramedic and the techniques he deployed  He was also asked about heart disease and cocaine use in Habib and abnormality of heart rhythm.  Gibbs tried to ask Skinner a number of questions that were outside of his expertise around drug use and history Cocaine and heroin in particular.

TVP Counsel tried to undermine Skinner on his reading of the evidence and his understanding of the techniques used.  He was then asked to talk through the restraint in a face down position and barriers to breathing. He was asked about the item being found by the anaesthetist at the back of his mouth. Not possible to say where it was before then.

Gibbs asked about agonal breathing and how could this be interpreted and he was taken through the communication by an officer to ambulance which gave slightly more detail.

As ever a long and hard day for the family to listen to the evidence being given and tomorrow is the last day that we will hear from the experts.

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