Police contact with a man before his death - Wiltshire Police, February 2017

On 14 February 2017 Wiltshire Police officers attended a block of flats in Salisbury after report that a man had gained access to the stairwell. The man was said to be very intoxicated and talking to himself.

The officers spent some time interacting with the man. They established that he had been travelling on a train and hadn’t intended to get off at Salisbury. (It later transpired that the man had been removed from the train because he was intoxicated.) Police officers arranged for ambulance service staff to assess the man. The paramedics, who had difficulty communicating with the man because of his limited command of English, concluded that the man had no immediate medical issues and did not require hospital admission.

The officers then took the decision not to arrest and detain the man, despite him being found with items that appeared to be stolen. Instead they took him to a public toilet at approximately 3.20am, with the expectation that he would remain there until he could resume his onward journey later in the morning.

The man was found dead in the toilets at approximately 7.45am the same morning. The medical cause of death was later established to be acute alcohol intoxication and hypothermia.

This was initially investigated by Wiltshire Police as a death or serious injury matter. The force then referred this to us in August 2017 as a conduct matter. Our investigation considered the circumstances in which the officers interacted with the man, and analysed their actions and decision-making.

During the investigation, investigators interviewed the officers and control room staff. They also examined the evidence obtained in the earlier internal police investigation and considered relevant policies and procedures.

In their accounts, the officers stated that they were focused on attempting to find the best way of dealing with the man. Neither felt that processing him through the criminal justice system at that point would be in his best interest given that the stolen items in his possession appeared to be of relatively low value. Officers believed that the man’s level of intoxication was decreasing and he did not require any medical treatment. He could walk and communicate, albeit in a limited fashion.

Based on the evidence available, we were of the opinion that the officers had attempted to act in what they perceived to be the man’s best interest. In interviews, both officers acknowledged that their performances had fallen below the standards normally expected of them and that they had learned from the experience. We recommended management action as the most suitable course of action.

After reviewing our report, the force agreed that both officers would receive management action.