A YOUNG man who was found hanging in his prison cell by a shoelace had a history of self-harm and had been assessed by a prison doctor as being "vulnerable".
Prison officers discovered Seán Guerrine (26), Cloonmore Park, Tallaght, Dublin, hanging in his Cloverhill Prison cell on November 16th, 2006, an hour after returning from Tallaght District Court.
Mr Guerrine was assessed by a prison doctor upon committal on November 13th as being "vulnerable" and was placed in the security section, where he was checked every 15 minutes, an inquest at Dublin County Coroner's Court heard yesterday.
When he returned to Cloverhill Prison on the afternoon of November 16th, he was placed in a security cell in the reception area of the prison at about 1.35pm.
At 4pm on November 15th, Mr Guerrine sought methadone from nurse officer Ann Halpin, but Ms Halpin was unable to dispense the heroin substitute, which can only be prescribed by a doctor.
She assured the prisoner that she "would try to sort out his methadone" the following day if he returned from court.
The next day, upon returning from court, Mr Guerrine spoke with nurse Gráinne Costello and requested methadone, but she advised him to put his name down to see the doctor the following morning as she could not dispense methadone.
She instead gave him other medication "to stop the shakes". A half an hour to 40 minutes later, prison officer Paul Duggan found Mr Guerrine hanging in his cell and raised the alarm. He was unresponsive and had no pulse.
A post-mortem by Deputy State Pathologist Dr Michael Curtis found that he died of hanging and that there were no suspicious circumstances, but he said multiple old scars on his forearms suggested a history of self-harm.
A jury of nine men and three women returned a verdict of death by suicide under the direction of the coroner and called for a review of the procedures governing the transfer of prisoners from the courts to holding cells.
The jury also called for prison officers to be aware of the names of all prisoners on their landing whose names had been placed in the book of vulnerable people.
Many of the prison staff questioned at the inquest did not know of the existence of the book, including a doctor and nurse.