Bronson 3

by Charles Bronson

  Specify if:

  Acute: if duration of symptoms is less than 3 months

  Chronic: if duration of symptoms is 3 months or more Specify if:

  With delayed onset: if onset of symptoms is at least 6 months after the stressor.

  As indicated, Charles complies with the above criteria, as follows:

  A. He has been exposed to a traumatic event in which both of the following were present:

  1. he experienced an event that involved actual serious injury, or a threat to the physical integrity of himself.

  2. his response involved intense fear, helplessness.

  The terror from being threatened with arbitrary and instant removal from the relative comfort and sociable atmosphere of Hull Prison to a further sequence of Segregation Units, which he had long known and weathered in the past, put him quite explicitly in fear of his life.

  B. The traumatic event was persistently re-experienced in two of the following ways:

  1 to 4

  Charles shows symptoms in all these categories in B, except perhaps the physiological reactivity.

  C. He persistently avoids stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three of the following:

  1. efforts to avoid thoughts, feelings, or conversations associated with the trauma

  2. efforts to avoid activities, places or people that arouse recollections of the trauma

  3. inability to recall an important aspect of the trauma

  4. markedly diminished interest or participation in significant activities

  5. feeling of detachment or estrangement from others

  7. sense of foreshortened future

  Charles is less stressed by these now than immediately after the event – yet his sense of a foreshortened future, as a direct result of having the ‘magic roundabout’ inflicted upon him once again, especially after having been promised that it would not be – this caused him to doubt he had any future at all. Happily since then, the two events mentioned have assisted him in becoming more emotionally mature, and better able to cope.

  D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

  1. difficulty falling or staying asleep

  2. difficulty concentrating

  3. hypervigilance

  4. exaggerated startle response

  His sleep difficulties are, at times severe. His hypervigilance, that is to say his excessive alertness, afflicts him every time he is taken for exercise – he fears, even now, being ‘jumped upon’ and attacked, beaten and even killed. I hasten to add that there is no evidence that his current warders have given any concrete evidence to justify these fears – on the contrary, he has warm words for them, given the restraints under which they operate.

  E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

  F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  Criteria E and F speak for themselves.

  IN CONCLUSION

  Given these psychiatric findings, the diagnosis of PTSD becomes inescapable.

  COMMENTS ON THE DOCUMENTS AVAILABLE TO ME

  1. Record of PACE interview of Mr Charles Branson dated 27 April 1999.

  2. Handwritten verbatim notes of prison officers who witnessed the incident at HMP Hull.

  These are of interest but not of direct relevance from a strictly psychiatric point of view.

  3. Psychiatric reports: (detailed above)

  These are extensive, and in view of the length of this current report, I shall curtail my comments upon them. Dr Kennedy as mentioned, suggests the diagnosis of Post-Traumatic Stress Disorder (PTSD) – though it would seem that I place greater reliance upon this than he does. Dr Ghosh, who has known him longer than I have, concludes that he suffers, or did suffer when she examined him, from a Personality Disorder. As will be clear from my comments above, at the time of my examination, he was considerably more mature emotionally than previously, was in good control of his more powerful emotions, and showed excellent insight into where those emotions had come from – accordingly, I would no longer support the diagnosis of Personality Disorder in this case. Far more striking to me was the prevalence of PTSD symptoms, as described. The other psychiatric reports predate this incident, as also my first consultation with Charles Bronson – much has changed since they were written.

  4. Summing up and verdict dated 17 February 2000 at Luton Crown Court before his Honour Judge Moss. This has more direct legal interest than psychiatric.

  5. Witness statements – Schedule attached. This has more direct legal interest than psychiatric.

  6. Psychological Report by Hilary Laurie, Principal Psychologist, Durham Prison, dated January 2002.

  This is a decidedly unusual report. Frankly, I am surprised that it has been submitted at all. From the signal fact that Ms Laurie asked Charles Bronson not a single direct clinical question, it is hard to see how any of her current recommendations can be given any weight at all.

  In her para 1.2 she writes ‘when he stated the grounds for declining to see me’. She omits to mention what these grounds were. Charles Bronson tells me that he was acting under legal advice in so declining. The mere fact that a man is a prisoner surely does not remove his right of consent to psychological examination by the examiner of his choice.

  In para 2.2 she concedes she is unable to quantify any changes in attitude that ‘may have developed over time’. Given this fact, we are then invited to review a history of how he has been in the past – what is of pressing clinical, indeed legal significance, is how he is now, as I have alluded to in the body of my report.

  Her recommendations (page 4 of her report) para 6 do not merit significant weight in my view, for the reasons just given. My own conclusions, as noted above, are that considerable amelioration has occurred – and I base this on direct, pointed and robustly put questions, to which the replies given were clear, open and to the point, as described.

  7. Probation Report by Rosemary Kirkby, Probation officer, Luton, dated 11 February 2002.

  Mrs Kirkby comments, para 7, on the dearth of therapeutic input, though he informed her that he was willing to participate in any such programme. She comments too on the improvement that appears to have taken place in his behaviour since the relationship with his wife ‘has given him the stability and determination to work for his Parole’. If Mrs Kirkby can make this observation, one wonders why Ms Laurie cannot.

  MY RESPONSE TO QUESTIONS I AM ASKED TO ADDRESS IN THIS REPORT

  1. Does he suffer from Post-Traumatic Stress Disorder (PTSD)?

  The evidence that he does indeed suffer from PTSD is overwhelming, as I have described above.

  2. Would his condition have led him to take the hostage? The evidence, in my view, is stark and clearly in the affirmative. In order for him to avoid a desperate situation, namely a return to the insecurities and dangers as he saw it of being repeatedly and arbitrarily moved from Segregation Block to Segregation Block, he undertook the equally desperate measure of kidnap. The two are clearly linked in his mind, and I see no possible medical reason to doubt that this was the sole reason he undertook this offence. He was more susceptible at the time of the offence, since he was already suffering from flashbacks, avoidance and over-reactivity (hypervigilance) which are entirely characteristic of this awesome disease.

  MY OPINION AND RECOMMENDATION

  These have been given above, at the end of the Psychiatric Overview.

  If I can assist in any other way, I should be more than happy to do so.

  Dr Bob Johnson

  Wednesday, 15 May 2002

  BRONSON VS. THE SYSTEM (III)

  What follows is a ‘medical report’ from Dr Johnson; I do not want to say anything other than all of his ‘urgent’ medical recommendations were ignored. This is
HM Prison Service at its finest!

  GENERAL MEDICAL REPORT

  on Charles Bronson BTI 314 (formerly Peterson, currently Ahmed) Durham Prison, Old Elvet, Durham DHI 3HU

  Born 6 December 1952, age 49

  by Dr Bob Johnson

  at HMP Full Sutton, York

  I examined the above on Thursday, 6 February 2003, in the prison stated and found as follows.

  I am sending a copy of this report directly to the above, as is my invariable custom, though at his special request, via his solicitors as noted.

  GENERAL MEDICAL OVERVIEW

  This is an unusual case in several respects. Firstly, this is the first occasion a High Court Order, or its equivalent, has been required for me to gain medical access to a patient.

  Secondly, there is clear medical evidence of damage arising from injury which has not been receiving the appropriate medical attention it so obviously urgently needs.

  Thirdly, there is disturbing evidence that these injuries were caused by a deliberate assault of prison staff upon this patient while he was under their care.

  And finally, and perhaps most troubling of all, there is the suggestion of an under-culture of physical brutality which may run something as follows – if a prisoner smashes prison property (as here, the shower room) then the prison staff ‘are expected to’ smash the prisoner. This latter, of course, is a most serious allegation which would require more time and resources to establish than are available to me at this time. However the very possibility of its existence would, in my view, warrant it being investigated by the highest authorities, so that they can determine whether or not such a climate of brutality did operate on this occasion, and just how widespread it might be if it did. The legal team instructing me might consider sending copies of this report to the Governor of the prison, the Director General of the Prison Service, the Home Secretary, the Chief Inspector of Prisons, the Prison’s Ombudsman and others whose statutory duty it is to uphold the highest standards of care in our prisons, which represent a rather obvious basis by which our very civilisation can and should be judged.

  1. LEGAL CONSIDERATIONS

  As I understand it, the fact that I was permitted to examine this patient, after earlier strenuous prohibitions, relies on the fact that the Human Rights Act entitles the individual to a doctor of his choice. The fact that in the absence of such extensive legal endeavours this report would simply not have been possible – the Prison Service almost glibly prohibiting my visit – this reflects poorly on the statutory duty of the Prison Service to care for those for whom it is responsible.

  1.1 CONSIDERATIONS OF TRUST

  The stand taken by my legal team receives immediate and ample justification from my medical findings. A patient needs first and foremost to trust their doctor – in the absence of trust, medical practice evaporates, as here. Charlie Bronson refused to have his lacerations stitched by the prison medical staff – what clearer indication could there be that a stable, trustworthy doctor–patient relationship is the sine qua non of medical practice. No trust between both parties leads inexorably to no treatment. Both parties are thereafter wasting their time.

  In a superficial sense, blame for refusal by a patient of treatment offered, in this case suturing of an obvious wound to the thumb and elsewhere, can readily be laid at the patient’s door. However, since all medical practice since the dawn of time has relied upon a robust doctor–patient relationship, then the medical staff of the prison must bear a measure of responsibility for the failure of that bond to materialise, as here.

  Again, the prison medical staff do not operate in a cultural vacuum – I have worked for five years in Parkhurst Prison so I am well aware of the pressures on professionals working in prison, endeavouring to maintain the highest standards of their profession. Thus the responsibility for the manifest failure of medical care is shared among all three parties here – the patient, the doctors, and the prison ethos for which the prison Governor, the prison staff and indeed the Prison Service as a whole is clearly responsible. I see little value in allocating percentages of blame in this respect to each of these three parties – suffice it to say that the failure of a therapeutic medical context should be entirely unacceptable in this age, and steps should be actively taken to remedy this medical disaster area.

  1.2 THE MEDICAL RECORD AS EVIDENCE OF LACK OF TRUST

  Evidence that there is some justification on Charlie’s part not to trust the prison medical staff comes from a review of his medical record. Here we see clear entries dated as follows:

  4.1.03 ‘smashed up shower block this a.m. multiple lacerations to both hands. Inmate refused examination and treatment.’

  5.1.03 ‘injuries abrasions / contusions to Left front-temporal area, less to Right, ditto. Hands Right?? bony injury, needs X-ray. Left 2.5cms and 1.5cms laceration to thumb. Refuses suture.’

  The second entry, dated 05.01.03, records extensive injuries to his head. There is no record of where these came from. Obviously, they are unlikely to have arisen from the patient’s own actions, unlike the injuries to his right hand which he used to smash the window and the basin.

  No full medical history is recorded here, no suggestion that these head wounds were inflicted by others and not by the patient. The medical record is incomplete, and seriously so. The reason why it is incomplete is readily deduced – were the prison doctors to document actions entailing staff violence, then the doctor’s working life would become decidedly difficult. Siding with the prisoner against the prison staff is not a comfortable position – there is thus clear evidence in the deficiency of this medical record of a conflict of interest operating inside the medical profession. This in itself is readily registered by the patient, who here withdraws his trust.

  Thus Charlie’s refusal to trust the medical staff has some justification since they show themselves in these medical records to be less than 100 per cent on the patient’s side – perhaps inhouse medical staff would find this difficult or impossible to achieve. Where medical personnel cannot, for whatever reason, put their patients’ interests first, then medical practice fails, as here. If prisons concentrate heavily on punishment, then treatment, which is its antithesis, takes a back seat, as here.

  I have a relationship of trust with this man, built up since I first examined him on 5 July 1991. As evidence of this, I had no trouble in obtaining a urine sample – and entering the result for the first time in his medical record. It occurs to me that this is the first occasion when the entry of a normal urine test result is of such medical significance.

  Confirmation of this breakdown in medical care comes from the following. The patient and the patient’s wife both assured me that he had been passing blood in his urine following his injuries. If I knew of this most ominous symptom, why is there no record of it in his medical notes? Again, the answer reflects on the parlous quality of the doctor–patient relationship. No doctor can practice medicine in the absence of a clear history from the patient – indeed, medical skill and expertise consists largely in successfully eliciting significant clinical items from troubled individuals.

  Here a combination of the three factors mentioned eliminates entirely the medical consideration of this dire symptom. Since the doctors do not know about it, have no access to it, cannot raise enough of a trustworthy relationship to acquire it – they cannot offer treatment, nor, inexorably, can Charlie receive any possible medical assistance with it. Here then is clear evidence of a breakdown in medical care, arising from three sources mentioned, but nevertheless resulting in a complete vacuum of care for this individual at this time.

  1.3 CONSIDERATIONS OF CONFLICT OF INTEREST

  I would wish to emphasise that I have some measure of sympathy for the doctors in this matter. I know what attempting to provide medical services in a prison can entail. However, there is clearly a conflict of interest here – preserving amicable relations with colleagues among the prison officers, while endeavouring to conduct an ethical medical practice requires su
pport and diplomatic skills which are not generally included in the medical curriculum.

  Where these two powerful factors conflict, as here, then one or other must suffer. Thus, where the prison staff appear to be the cause of the medical problem, then only by confronting this thorny issue can the doctor hope to gain the patient’s trust, and thereby access to the vital symptoms on which alone medical practice can progress.

  Here, as the medical records clearly show, this particular nettle was not grasped, the whole issue of possible staff violence is simply ducked, placing this particular patient in a dire condition, with an untreated kidney injury of major clinical significance. Again, timely intervention of legal procedures may well have circumvented a dire outcome that no one could possibly wish for.

  2 INJURY DAMAGE STILL UNTREATED

  In examining this patient, it was clear that damage still remained from his injuries. He told me he was deaf in his left ear. This again has not been recorded in the medical record. There is a clear possibility that this deafness arose from injuries received. He needs urgent examination of his eardrum, something that was quite inappropriate for me in a confined cell, with six officers standing at one end. He needs a full ENT evaluation, with inspection of his eardrum. He also needs a full set of hearing tests.