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‘Missed opportunities’ contributed to migrant's death in detention centre, jury finds

A MAN held in immigration detention died from misadventure after taking an overdose of painkillers, an inquest jury has found.

Amir Siman-Tov, a 41-year-old migrant from Morocco, swallowed a toxic amount of tablets while held at the privately run Colnbrook immigration removal centre near Heathrow on the morning of February 16 2016.

He was taken to the local Hillingdon Hospital but was discharged hours later and returned to Colnbrook.

He vomited repeatedly on the journey back and appeared to fall asleep at the detention centre before being found unresponsive early the following morning.

In a narrative verdict jurors at West London coroner’s court said: “Although Mr Siman-Tov spoke of his intention to self-harm and expressed suicidal ideation this is judged to be a cry for help rather than a desire to deliberately end his life.”

The three-week inquest, which concluded on Thursday, identified a series of failures that contributed to his death.

“Inadequate information-sharing [resulted] in several missed opportunities to prevent the hoarding and ingestion of prescribed medication, despite Mr Siman-Tov repeatedly stating his intention to do so,” the jury noted.

Mr Siman-Tov had been on constant suicide watch by guards from Home Office contractor Mitie.

The inquest was also critical of healthcare staff at Hillingdon Hospital and Colnbrook. It cited their “failure to provide a discharge summary, inadequate communication at handover and failure to establish an adequate care plan on return.”

Dr Miriam Harris, an expert in accident and emergency medicine, had told the jury that Mr Siman-Tov should have been kept in hospital or regularly monitored at Colnbrook. She believes this would have led to the deterioration in his condition being identified and successfully treated.

A statement was issued on behalf of Mr Siman-Tov’s family saying: “Amir was loved by his family and his death has been devastating for them.

“The jury’s conclusions show that he did not wish to die and that if those with responsibility for his care had not failed him, he would be alive today. The family were shocked to learn that, more than three years on, lessons said to have been learned have still not been implemented, and [they] now call on those involved  — the NHS trusts and Mitie  — to do so without further delay.

“They also call on the Home Office to end its inhumane policy of indefinite immigration detention which, as Amir’s case shows, ruins lives and has no place in a civilised society.”

The verdict marks the end of a three-year search for answers after the inquest was repeatedly postponed.

It is also the latest indictment of Colnbrook detention centre which has seen a series of deaths in custody, many of them due to poor information-sharing between agencies.

In March, another jury at West London coroner’s court found that a 64-year-old Bangladeshi detainee, Tarek Chowdhury, was unlawfully killed at Colnbrook.

Mr Chowdhury was bludgeoned to death in December 2016 by fellow detainee Zana Ahmad despite multiple warnings about the latter’s violent tendencies.

These warnings were never relayed to the right authorities because of failures with Home Office IT systems. These problems were supposed to have been fixed after the death of detainee Brian Dalrymple at Colnbrook in 2011. Witnesses said they still persist to this day.

Samaritans can be contacted for free from any telephone in Britain on 116 123.

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