HMP Highpoint: Inadequacies may have contributed to murderer Ahsan Hassan's suicide
There were "unacceptable delays" in checking on a prisoner on the night he died, an ombudsman found.
Ahsan Hassan, 33, was jailed in 2017 for murdering his partner Zofia Sadowska in Buckinghamshire in 2016.
He was an inmate at HMP Highpoint in Suffolk when he died on 20 February 2022.
An inquest jury also found "procedural inadequacies" for mental health referrals may have contributed to his death.
Hassan was jailed after suffocating his girlfriend in a disused kebab shop in High Wycombe, before taking her body home in a taxi. He was transferred to HMP Highpoint, near Haverhill, in November 2021.
The Prison and Probation Ombudsman (PPO) found there was a delay of over five minutes between a prison officer noting Hassan's cell observation panel was covered and attempting to enter the cell.
The officer got no answer to a call through the cell door, but checked another 30 cells before alerting other staff, the ombudsman found.
"We cannot say whether the delay affected the outcome for Mr Hassan, but we know that, in a medical emergency, a delay of a few minutes may be critical," the report said.
Hassan had a history of suicidal thoughts and self harm, having previously told mental health professionals at another prison that he wanted to be reunited with his girlfriend "in the afterlife", an inquest last week was told.
'Inadequacies and inefficiencies'
He had been subject to suicide and self-harm procedures - known as assessment, care in custody and teamwork (ACCT) - in the past, but they were not deemed necessary at Highpoint after a mental health assessment upon his arrival.
A narrative conclusion by the jury at Suffolk Coroner's Court determined Mr Hassan died as a result of suicide.
Jurors said: "Opportunities were missed in acting upon the contents of some complaints received from Mr Hassan.
"With consideration of placing him on an ACCT and/or referring him to mental health care. This highlights potential procedural inadequacies and inefficiencies. This possibly contributed to Mr Hassan's death."
In contrast to the jury's findings, the PPO's report stated it was "satisfied" prison staff could not have prevented his death.
On the morning he died, he told his new partner about dying, and that it would be the last time he spoke to her.
However the prison was not made aware of the conversation by Hassan or his partner.
The ombudsman recommended that all staff be made aware of and follow instructions for security at night and report on covered panels immediately.
Assistant coroner for Suffolk, Peter Taheri, asked for a further report from the Ministry Of Justice before deciding if a Prevention of Future Deaths Report was necessary in this case.
An MOJ spokesman said: "We do all we can to prevent prisoner suicide which is why HMP Highpoint has accepted and implemented the single recommendation from the Prison and Probation Ombudsman."
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