Failings of prison staff and 'missed opportunities' have been found over the 'preventable' death of an inmate at HMP Nottingham who was murdered by his cellmate. Brett Lowe, 43, was strangled by shoe laces and stabbed with a piece of plastic cutlery while on remand at the Category B prison in Perry Road, Sherwood.
Nottingham Crown Court was told in 2020 that Mr Lowe, who was originally from Stapleford, had asked to be moved from his cell and told a prison officer that Ferencz-Rudolf Pusok had tried to strangle him as he slept. There were plans to move Mr Lowe from the cell later that day but he was killed shortly after being locked away with Pusok.
Mr Lowe was murdered on July 18, 2018, and two years later Pusok was ordered to serve a minimum term of 20 years before he can apply for parole after pleading guilty to his cellmate's murder. An inquest into the death of Mr Lowe, who was on remand on suspicion of burglary and robbery, found his death to be 'preventable'.
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Laurinda Bower, deputy coroner for Nottinghamshire, found prison staff "consistently failed to execute their responsibilities". Miss Bower said: "Brett's death was preventable had reasonable action been taken in relation to a series of missed opportunities which linked to failures in communication, insufficient and inadequate reporting, lack of staff accountability and failure to provide a safe environment."
The inquest was told that overnight on July 16/17 threats to Mr Lowe were reported to a prison officer but this was not shared with other officers, logged formally or further investigated. On July 17, as a result of failings to review the 'cell sharing risk assessment' (CSRA), Mr Lowe was placed in a cell with Pusok. In the early hours of July 18, the cell bell was illuminated twice but on both occasions an untrained employee was allowed to respond to the calls.
When Mr Lowe activated the cell bell at 3.31am, he reported that his cell mate had tried to throttle him. The inquest was told all of the subsequent opportunities to report this, other than verbally, were not taken by any prison staff. No immediate action was taken, including separating the prisoners for their own safety. No record was formally made of the incident, and no reference to the incident was included in the handover to the prison's early shift staff, the inquest also found.
Later at around 8.25am on July 18, Brett was released from his cell and sent to receive his medication. There, he informed an officer of his cell mate’s “bizarre behaviour” and requested a move. This was agreed, but Mr Lowe was then inappropriately directed to the D Wing office to facilitate the move by himself.
At the prison office, Mr Lowe again alerted staff to the incident and requested a cell move. No further investigation of the incident took place and nothing was recorded to acknowledge what happened, its severity and the associated heightened risk.
In an inquest report, Miss Bower wrote in conclusion that: "Brett [Lowe] took every opportunity available to him to alert staff to his situation an the risk to his own life. Within this chain of events, prison staff consistently failed to execute their responsibilities in relation to Brett’s safety. The failure of any member of prison staff to intervene at any stage of the chain of events reflected systemic issues linked to leadership, staffing, training, communication, documentation and records management, risk assessment and culture."
A Prison Service spokesperson said: “Our thoughts remain with Brett Lowe’s family and friends. We will carefully consider the inquest’s findings and respond in due course.”
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