A prison inmate found dead in his cell choked on his dinner, an inquest heard.
Prisoner Trevor Corr (41) was found dead in his cell by two inmate friends who raised the alarm.
Mr Corr, a convicted murderer, was serving a jail sentence in Mountjoy Prison for the fatal stabbing of a man he found sleeping on his bed.
He was found guilty by unanimous verdict at the Central Criminal Court on December 21 2015.
Mr Corr was found dead in Mountjoy on the morning of January 10 2018.
Former State Pathologist Dr Marie Cassidy said the presence of alprazolam (Xanax), which the prisoner was not prescribed, was a significant contributor to the choking.
Prof Cassidy said Mr Corr was dead in his cell for around 12 hours before he was discovered.
He was on the progression unit at Mountjoy, for prisoners who behave better, the inquest heard.
Trevor Corr’s brother Derek was due to visit him in the prison at 11am. Instead, he was met with the news that his brother had been found dead.
“Trevor Corr was a very pleasant man, held in high regard by both staff and prisoners,” Governor Edward Mullins told Dublin District Coroner’s Court.
Gov Mullins and the Prison Chaplain broke the news of Mr Corr’s passing to his brother.
“I met his brother Derek to inform him of the passing. After a short conversation he left the prison to inform his family,” Gov Mullins said.
Inmate and friend of the deceased Elliott Kidd had entered Mr Corr’s cell, on the C landing, just before 9.50am on January 10 2018 and raised the alarm.
“I pulled back the covers and shook him. I checked his eyes. He was cold and hard. I saw vomit around his mouth. I starting screaming for help,” Mr Kidd said.
Prison officers conducted multiple checks of Mr Corr’s cell during the night, but nothing untoward was noticed.
At the time, overnight checks were required hourly, but CCTV footage revealed these checks were not performed every hour that night.
Gov Mullins told the hearing that ‘disciplinary action was taken in a number of cases’ in relation to the unconducted checks.
The hourly requirement has since changed to allow for less intrusion on prisoners as they sleep, with checks every three hours instead.
A ‘more robust’ communication is now required when cells are unlocked in the morning and prison staff are asked to obtain a verbal response from inmates.
Mr Corr used a stick for walking due to Charcot-Marie-Tooth disease, which causes weakness in the muscles. He was on anti-depressant medication and pain medication but was otherwise healthy, the inquest heard.
At autopsy, Prof Cassidy found that Mr Corr had choked on piece of food and estimated that the inmate had been dead for 12 hours before he was discovered.
“He’d obviously eaten a large meal, there was a lot of food in his stomach and airways,” she said. The presence of Xanax was a significant contributory factor, Prof Cassidy said, because Mr Corr was more vulnerable to choking due to the suppression of the gag reflex due to the effects of the drug.
The jury returned a verdict of misadventure and in their recommendations, they endorsed the standard operating procedures adopted by the Irish Prison Service since Mr Corr’s death which included more robust checks. In addition, the jury also recommended that a panic and call button be located closer to the bed within prison cells.
Coroner Dr Myra Cullinane offered condolences to the family and acknowledged how difficult the two days of inquest evidence was for them.
“I know that in terms of death it may not have been immediate but it was very rapid,” the Coroner told the family.
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Was there a Garda investigation that was mentioned in the inquest Louise?