Andrew Carey
A YOUNG Limerick woman who had served eight months of a three year jail term, was two weeks away from being granted temporary release was she overdosed on heroin and anti depressants in her prison cell.
Described as a model prisoner, Pamela Graham was 25 when she was jailed in early 2008. She died six days after being taken from her prison cell in an unresponsive state on the morning of September 12, 2008.
The mother-of-one, originally from Davin Gardens in Caherdavin, was serving a three year sentence after being extradited from the US for importing €15,000 worth of cocaine into Ireland.
At her inquest in Limerick last week, Limerick City Coroner Dr Tony Casey was told that she shared a cell with two other female prisoners in E Wing of Limerick Prison which was described as overcrowded with almost double its 25 female prisoner capacity.
The evening before she died, Ms Graham, one of 40 prisoners in the female wing, had been administered her normal dose of prescription medicine for depression and pain relief from Prison Surgery Officer Jeremiah O’Riordan.
A few minutes later, he found her on the floor of the cell shaking.
Mr O’Riordan said that when he returned from the prison kitchen with milk for her cellmate, he found Pamela Graham on the floor “trembling” and appearing to be having “generalised type seizures”. She only responded to painful stimuli while in that “semi unconscious state” and was placed in the recovery position.
Although known to have a dependancy on heroin, she had been drug-free while in prison.
Mr O’Riordan said she was given medication before 8:25pm for a toothache as well as her normal night sedation medicine, but due to her state, he monitored her for an hour while she lay on the mattress on the cell floor.
Ms Graham’s condition stabilised and, after monitoring her for an hour, Mr O’Riordan checked on her a number of time during the rest of the night. The night guard was notified that Ms Graham “may have taken something” and should be checked and scheduled to see the prison doctor.
In 2007, prison rules changed to “allow people take responsibility for their own health and welfare” and Mr O’Riordan said they no longer force anyone to go to the doctor or seek medical treatment.
He refuted a claim from counsel for the Graham family that Ms Graham was not treated with “dignity or respect”.
Asked if leaving a semi-comatose patient on a mattress on the cell floor was treating them with dignity and respect, he said the wing was overcrowded and he couldn’t get a single room for Ms Graham. He didn’t accept there were no fixed guidelines for semi-comatose patients.
At 6:30am the following morning, Pamela Graham was sitting upright on her mattress “aware but drowsy and looking pale and tired”. She was still sick and was scheduled to see the doctor at 8am.
However she refused to see the doctor and also refused breakfast shortly after 8:20am when her cell door was unlocked.
At 9:20am on September 18, 2008, an emergency call was activated and Pamela Graham was lying on the floor, unconscious and unresponsive.
She had a faint pulse but her breathing stopped and she went into cardiac arrest. She died shortly before midnight on September 18 when brain stem tests returned negative.
A postmortem carried out by Assistant State Pathologist Dr Michael Curtis revealed that she died from massive internal organ failure as a result of brain damage due to drug intoxication. A toxicology report showed toxic levels of heroin, mirtazapine and citalopram (both anti depressants).
The brain damage was due to the effects of heroin.
Limerick Prison Assistant Governor Mark Kennedy said that Pamela Graham was a model prisoner only two weeks away from being granted temporary release.
Since Ms Graham’s death, prisoners were subject to vigorous search procedures. Prison was a reflection of society and prescription drugs were a scourge within the prison population.
Mr Kennedy said there was an 100 per cent addiction rate among female prisoners at the time.
The policy was to leave decisions about the medical treatment of prisoners to the clinician on duty, but staff would have done everything in their power to help Ms Graham.
Two women who shared a cell with Ms Graham failed to respond to witness summonses to give evidence to the court.
Laurence Goucher, counsel for the Graham family, said that it was not the role of the inquest to find fault .
“We just want to find out what happened”.
He said that the Assistant Governor admitted there was no linkage between medical and operational staff and it was clear there were severe gaps in the system.
There were no clinical notes to indicate that medical concerns were followed through and nobody thought to remove Ms Graham from the cell the previous evening and take her to hospital.
Coroner Dr Tony Casey said that people who don’t respond to pain need greater observation.
Diane Duggan, counsel for Irish Prison Service said prison staff had, at all times, acted appropriately and everything was done in accordance with best practice and reflective of the prison rules.
She added that Ms Graham refused to come to the doctor on the morning in question.
After almost two hours, the jury returned a verdict of death in accordance with the medical evidence.
However, the jury foreman said that there were concerns over the treatment of people with altered levels of consciousness and the management of people in such states should be more active.
