Martin Green

A family was left devastated after the death of Martin Green, a prisoner who became dehydrated during treatment for heroin addiction. Martin, aged 25, of Burton-upon-Trent, Staffordshire, was 11 days into his sentence at Blakenhurst Prison, Worcestershire, when he died in 2002. He had been detoxing after being jailed 11 days earlier for dangerous driving.

At his induction he advised staff he was a methadone user and confirmed that he would like to be placed on a detoxification programme. It soon became apparent that Martin, who had a history

of stomach problems, was not coping with the detoxification programme. On 8th July 2002 he was seen three times by healthcare staff to whom he complained of stomach pains and stated he had not eaten for six days.

Over the following days Martin's condition continued to deteriorate and he was seen repeatedly by prison and health care staff who noted his severe and continuous vomiting, dramatic weight loss and lack of energy. On more than one occasion Martin requested to be taken to hospital. On 14th July a doctor was sufficiently concerned that he arranged for Martin to be taken to an outside hospital for intravenous fluid treatment. This proposed transfer did not happen and Martin was found dead in his cell on the morning of 15th July 2002.

The cause of death was dehydration and electrolyte imbalance, as a consequence of repeated vomiting. He was also found to have two duodenal ulcers. Martin, who was 6ft 2in (188cm), weighed just 6st 10lbs (43kg) at the time of his death.

Commenting on pictures taken of Martin just before his death, his father, Alex Moore said the pictures reminded him of those taken of victims of the Nazi concentration camps. He said: "The only time I've ever seen photographs like that are pictures taken of Belsen, Dachau and all those places.”To actually see that type of photograph or picture taken and it's your own nephew - it really hits home."

Following an investigation into the circumstances of Martin's death the case was referred to the Crown Prosecution Service in January 2003 and in December 2005 decided not to bring a manslaughter charge against the prison. The Prison Service said it would give an explanation into the death when an inquest is held.

Martin’s family believe his death was unnecessary and avoidable and hoped that the inquest would look carefully at the standard of care provided to him whilst in prison, how his illness was managed and treated and in particular why he was not given intravenous fluids. They also hoped the inquest would examine whether the staff at the prison should have transferred him to hospital for appropriate treatment and why the proposed transfer to hospital on 14th July was blocked.

The inquest into Martin’s death began on Tuesday 9th October 2007, nearly five and a half years after his death, and was scheduled to last four weeks. The jury finally returned a highly critical narrative verdict. They found that the medical care given to Martin was inadequate and serious failures in his treatment contributed to his death.