Drug dealer missed nurse appointments in months before hospital death

A drug dealer battling an opioid addiction and a hepatitis C infection lost four stone in prison before dying in hospital. Raymond Cartwright, who had a diagnosis of hepatitis C and liver damage dating back nearly 20 years, died in hospital on August 6 last year after being admitted from HMP Risley in Warrington.

A report into his death by the Prisons and Probation Ombudsman said Cartwright was sentenced to five-and-a-half-years' imprisonment for possession and supply of class A drugs in October 2019. He was released from prison in February 2022 on licence - before being returned in December of the same year following the theft of alcohol.

The report, written by ombudsman Adrian Usher, said Cartwright had a long history of prison sentences associated with both his use and supply of drugs. On his return to prison, he said he had been using heroin and crack cocaine. He tested positive for opioids and was placed on a methadone treatment programme. After initially being admitted to HMP Altcourse, he was transferred to Risley.

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The report said the prison had recently begun a routine testing programme for hepatitis C. Cartwright tested positive for the virus. He had a diagnosis of hepatitis C and liver damage, dating back nearly 20 years. Cartwright also had a history of intravenous drug use, which has a strong association with the spread of hepatitis C through shared needles.

Mr Cartwright did not attend an appointment with a specialist nurse to discuss his hepatitis C infection in January 2023. This was the first of several similar appointments he missed. Healthcare staff did not record the reasons for his non-attendances, the report said.

The report said Cartwright continued with his non-attendance into April and, as he had an active hepatitis C infection, the following month consulted a hospital team about treatment. He completed his methadone treatment on June 8 - but two weeks later became "seriously ill with breathlessness, chest pain, and a fast heart rate".

He was taken to hospital, restrained by handcuffs, where he remained for a month. On July 28 Cartwright returned to Risley with a diagnosis of a pulmonary embolism - when a blood clot blocks a blood vessel in the lungs - and liver cancer. He had lost around four stone in weight since April.

On August 5, Cartwright was unwell again and a nurse assessed him shortly after 6am. He was vomiting, had chest pains, an elevated heart rate and a low blood oxygen level. The nurse requested an ambulance, but Cartwright refused to go to hospital as he was expecting a visit from his partner that day. However, by 7.45am his pain was so bad he agreed to go to hospital.

Once again, he was restrained by handcuffs escorted by two prison officers. At the hospital, a doctor spoke to Cartwright and confirmed he was very unwell and that if he got any more unwell, they would not have any further treatment options. Cartwright declined any treatment. He continued to deteriorate and died the next day.

The post-mortem report concluded Cartwright died from complications of the hepatitis C virus associated with liver cirrhosis - scarring of the liver caused by long-term liver damage - with disseminated hepatocellular carcinoma, cancer has spread throughout the liver.

Mr Usher wrote: "The clinical reviewer concluded that the care Mr Cartwright received was of a standard equivalent to that which he would have been received in the wider community. However, she was concerned about the lack of information regarding his missed healthcare appointments."

The ombudsman made recommendations including that the governor and head of healthcare at Risley should agree protocols for recording the reasons for missed clinical appointments and ensure medical sections of risk assessments are fully completed.

A Prison Service spokesperson said: "Our thoughts remain with Raymond Cartwright’s friends and family. HMP Risley has since issued guidance reminding staff of the need to complete prisoners’ medical risk assessments."