Olivia Checa-Dover and Mahdev Singh Sachdev represent police force during 3-week inquest into the death of a man in custody

On 22 April 2020, Matthew Terrill was arrested following an allegation that he has assaulted his partner. He had taken a combination of drugs including heroin, cocaine and “spice” (synthetic cannabinoids). He presented in an agitated state, leading to restraint being required. Sadly, he died that afternoon despite best efforts to resuscitate following him being found unresponsive in his cell. Mr. Terrill had serious heart disease, which was not known about at the time. Further, the post-mortem findings included the identification of hypoxic brain injury.

The inquest touching upon Mr. Terrill’s death was heard over the course of three weeks before HMAC Pountney sitting with a jury. Evidence was heard from experts in pathology and survivability. The cause of death was described by Dr Robinson, Consultant Forensic Pathologist, as difficult and complex.

At the conclusion of the evidence, and following submissions, the Court was persuaded to remove Unlawful Killing and Neglect from the conclusions open to the jury, as well as Acute Behavioural Disturbance (“ABD”) and upper airway obstruction from the causes of death. Further, the jury was directed that the actions of the police neither probably nor possibly caused or contributed towards Mr. Terrill’s death, there being insufficient evidence to make a finding of causation on the evidence heard.

Following deliberations, the jury returned a narrative conclusion and recorded the cause of death as follows:

1(a) Cardiorespiratory arrest;
1(b) Hypoxic ischaemic brain injury; and
1(c) Cocaine, synthetic cannabinoids, heroin, pregabalin, gabapentin, and dihydrocodeine toxicity (with associated acute agitation), and ischemic heart disease.


Post script: a word on ABD

An important strand of the case involved the extent to which ABD was apparent in Mr. Terrill’s behaviour and whether it was appropriate to include the same in the cause of death. ABD is not a diagnosis, rather it is used as an ‘umbrella’ label to describe a person’s presentation. In Mr. Terrill’s case, it was ultimately concluded that there was insufficient evidence to establish the existence of ABD but, in any event, inclusion in the cause of death would have been inappropriate given that it made no medical contribution.

More widely, restraint is sometimes required in a case of suspected ABD when de-escalation is not possible or has proved unsuccessful. The need might arise, for example, to prevent self-harm or in self-defence. In such cases, it is often the person’s exertion against restraint, as opposed to the agitation per se, that has the medical impact.