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Relevant expert evidence

  1. The Inquiry’s use of force expert, Mr Jonathan Collier, originally considered that force was only used after all reasonable efforts to persuade D149 to walk compliantly to E Wing had failed.1 However, in his oral evidence and having watched the footage afresh, Mr Collier said that he would have expected Mr Loughton to have engaged more with D149 before using force, for example by providing an answer to D149’s question as to why he was being moved.2
  2. Mr Collier’s overall impression of this incident was that the staff were inexperienced and lacked an understanding of how to manage the situation.3 He commented that “once it became evidence [sic] that this was a complex and difficult removal, consideration could have been given to summoning additional experienced staff”.4 In his view, this incident involved a number of failings.

34.1 D149 was kept in the prone position for an unnecessary amount of time, which risked interfering with his ability to breathe normally.5

34.2 The handcuffs were applied to D149 while one of his hands was turned in, rather than with his hands ‘back to back’. This, Mr Collier explained, causes pressure through the wrist even without staff taking hold of the detained person’s arms.6 The incorrect application of the handcuffs to D149 meant that the carry technique could not be performed and the application of pain to D149 could not be controlled.7 Mr Collier told the Inquiry that, when it became apparent that the handcuffs had not been applied correctly to D149, they should have been removed and reapplied.8

34.3 Mr Collier initially considered that the use of a wrist flexion – a pain- inducing technique (PIT) – was reasonable.9 He later concluded in his oral evidence that it was unnecessary due to the fact that D149 was already being controlled by handcuffs.10 He also considered that the PIT was applied to D149 without following the correct procedure: (i) give an instruction; (ii) give a clear warning; and (iii) apply pressure. 11

34.4 The officers who restrained D149 did not follow the correct procedure when moving him down the first flight of stairs to E Wing, in that they went down “square on”. Mr Collier described the way the movement was conducted as “particularly risky for staff and D149”, and said that the technique was a potentially dangerous approach when restraining someone who was resisting.12 In his second report, Mr Collier explained:

“Staff should have set up the stairway negotiation formation prior to moving. This would require additional staff to act as ‘anchors’ at the lower side of the three-officer team.”13

34.5 That notwithstanding, Mr Collier noted that, after the first flight of stairs, the staff had corrected their position.12

34.6 Staff appeared unsure of how to release the restraint of D149 and exit the cell safely. When attempting to apply the figure of four leg restraint, Mr Tait was incorrectly positioned and tried to compensate by pulling on one of D149’s legs. There was also a misapplication of the technique used to restrain D149’s legs, which caused his feet to be twisted and resulted in pressure being put through his hips and his knee joint.14 This risked physical injury and caused him pain, although this was noticed and corrected.15


  1. INQ000111_028 para 92[]
  2. Jonathan Collier 30 March 2022 34/24-35/14[]
  3. INQ000111_026 para 83[]
  4. INQ000111_026 para 84[]
  5. Jonathan Collier 30 March 2022 41/21-42/4[]
  6. Jonathan Collier 30 March 2022 36/4-11[]
  7. INQ000158_060 para 26.9[]
  8. INQ000111_027 para 85[]
  9. INQ000111_027 para 89[]
  10. Jonathan Collier 30 March 2022 39/14-17[]
  11. INQ000111_027 para 89; Jonathan Collier 30 March 2022 38/17-25[]
  12. INQ000111_023 para 64[][]
  13. INQ000158_098 para 2[]
  14. Jonathan Collier 30 March 2022 43/12-44/1; INQ000111_027 para 87[]
  15. Jonathan Collier 30 March 2022 43/12-44/1; INQ000111_027 para 87[]