The family of a mum who died after suffering a fatal reaction to a sudden absorption of cocaine have called for changes in communication between police and medics.
Mum of three Anastasia Theofilou, 36, who was born in Birkenhead, died at Derriford Hospital on July 4, 2020 after suffering a fatal reaction to a sudden absorption of cocaine believed to have come from a bag hidden inside her before she was arrested.
She had been arrested by police the previous day on suspicion of blackmail and taken to Charles Cross police station, where she was placed in a cell after being strip searched, Plymouth Live reports.
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Annie was arrested shortly before 2pm and taken to Charles Cross police station custody suite where she was checked on by staff over the next two and a half hours, but at around 4.40pm she was seen fitting. She was treated at the scene and en-route to Derriford Hospital, where she later died.
It was not until 12.10am on July 4 that nursing staff found a small opened plastic bag - which contained traces of a white powder - secreted inside Annie.
At an inquest at Plymouth Coroner's court this week, evidence was heard from detention officers, paramedics from South Western Ambulance Service and medical staff from Derriford Hospital Emergency Department.
Police station CCTV footage showed Anastasia repeatedly going back and forth between the bed area and the toilet, placing a blanket over her legs and lap and occasional moving her hands underneath the blanket, out of sight from the camera.
After several hours she moved to a blue mattress onto the floor, and became agitated before rolling onto her back and suffering a fits A detention officer spotted her on the monitor and she was quickly treated by a healthcare professional at the station, while paramedics were called.
A later toxicological examination found Anastasia had a large quantity of cocaine and benzoylecgonine in her blood which "fell into the range where death was attributed". Toxicologist Dr Stephen Morley said the amount of benzoylecgonine - what cocaine turns into in the body - in her blood was recorded at a "very high level", usually only seen in "body packers or mules".
Dr Morley said it was "difficult to say if she would have ever been saved" due to the large quantity of cocaine which she had rapidly absorbed.
The cause of Anastasia's condition was discovered by nurse Matilda Crowther, who noticed something "white and blue" inside the 36-year-old while trying to change her catheter. She found a blue zip-lock bag, which was removed with forceps.
Ms Crowther said the bag had a "white substance" inside, that the bag was "also open and not sealed - this might explain why she was in the critical condition if this is drugs". Some rolled up tissue was also removed.
An examination of Anastasia's detention cell following the incident found a "white powder residue" on the blue mattress and a "small white substance" on the floor.
The court heard that custody officers would need "significant grounds" to go further than a strip search. It also heard that officers were instructed not pull out packages, as it could cause damage to the package as well as the person, and that medical staff would not carry out a "forced intimate search".
However, a recorded phone call from South Western Ambulance Service paramedic Paul Norman to a ED consultant mentioned potential 'intel' from the police about drugs being concealed inside Anastatia's body. He said he could not account for why this information was not acted upon in the ED. The police said Anastasia had "markers" for concealment of drugs, but a senior officer said that this would not necessarily result in an intimate body search, as the context of the arrest was for the alleged blackmail.
Chief Insp Melanie Simmonds, Devon and Cornwall Police's head of custody, said a number of measures had been introduced since July 2020 to safeguard detainees in the force's custody suites.
A statement from Anastasia's sister Thalia described the mum-of-three as a "good girl who got led down the wrong track", who had been "in and out of foster care from about eight" and suffered from mental health problems. Thalia added that she had fallen in with "the wrong people " while in foster care, leading to her taking drugs and being placed in a mental health hospital after she suffered from drug-induced schizophrenia.
She said Anastasia suffered a downward spiral after her son and daughter were removed by social services, which "just destroyed her".
She said: “She was a kind, loving girl once, she had a great sense of humour. Sadly things just fell apart for her earlier in her later life. Annie blamed society and everyone else for the state of her life. She was troubled from such a young age."
The jury's narrative conclusion, read out by senior coroner Ian Arrow, noted the medical cause of Annie's death was cardiovascular instability with resultant hypoxic ischaemic brain injury and secondary bronchopneumonia by cocaine intoxication.
Mr Arrow noted that additional action could be taken by police to improve information sharing with medics. He said: "I think we've learned things from this. The Chief Inspector [Melanie Simmonds, head of Devon and Cornwall Police's custody teams] will be taking action which may prevent some unfortunate occurrence in future. The Chief Inspector will write to me within three months [about] what is happening."
Following the inquest, Anastasia's family told PlymouthLive: "We hope that there are changes in relation to future incidents of a similar nature and what is fundamentally important is that there is immediate sharing of information between the different departments to try and see if it will make material difference."
A Devon and Cornwall Police spokesman said: "We acknowledge the findings of the coroner and jury following the inquest into the death of Anastasia Theofilou. Our thoughts remain with Ms Theofilou’s family and friends.
"The inquest heard how Ms Theofilou fell ill while in police custody at Charles Cross Police Station, Plymouth, on July 3 2020 and later died in hospital. The jury returned a narrative conclusion in which they found that all policies and procedures had been followed by all parties involved in Ms Theofilou’s care and that no defects were found within the care given at all stages. The proceedings heard evidence from a number of police witnesses.
"Devon and Cornwall Police made a mandatory referral to the Independent Officer for Police Conduct (IOPC) following this tragic incident. The subsequent independent investigation concluded that officers treated Ms Theofilou in line with policies and procedures. This included the level of care provided to Ms Theofilou and the thoroughness of searches and checks carried out.
"The Force has committed to investigating the implementation of a direct line of communication between custody and emergency departments and will update HM Coroner on the progress of this within the coming months."
An IOPC spokesman said: "We began our investigation following a mandatory referral from Devon and Cornwall Police. We looked at the level of care provided to Ms Theofilou during the period of detention, including the thoroughness of searches and checks carried out. Investigators reviewed CCTV and body-worn video footage of Ms Theofilou’s arrest and time in police custody as well as relevant police documentation. We also obtained witness statements from officers and staff who interacted with Ms Theofilou and the paramedics who treated her.
"Our investigation found no evidence that Ms Theofilou was either under the influence of drugs or that she had concealed any item internally at the booking in stage. This was supported by our review of CCTV footage. Ms Theofilou was strip-searched on her arrival in custody with a negative result. The evidence indicates that officers conducted an appropriate and thorough visual inspection during the strip-search. Police personnel stated they had asked Ms Theofilou whether she had any weapons or drugs on her and she had replied not.
"We found it reasonable for custody staff to place Ms Theofilou under Level 1 observations requiring a cell visit every 30 minutes. The evidence shows that staff checked on her at regular intervals. A detention officer noticed that Ms Theofilou appeared to be experiencing a seizure when reviewing the CCTV feeds around four minutes after their previous visit to the cell. An ambulance was called promptly, and a healthcare professional attended swiftly to assist in providing treatment. Following the arrival of the Ambulance Service, police officers and staff helped carry out CPR. A detention officer further assisted by performing chest compressions on Ms Theofilou on the journey to hospital."
IOPC regional director David Ford added: "This was a tragic case and I send my condolences to Ms Theofilou’s family and everyone affected by her death.
"Intimate searches are extremely intrusive and a very significant step when balancing the risk to a detained person versus the need to respect their human rights and dignity. Police officers have to make case-by-case decisions concerning individuals with a history of drug use and whether an intimate search is justified on each occasion. The relevant PACE Code of Practice does not allow or envisage intimate searches be conducted as a matter of course purely based on a history of drug use. Additionally, they should only be conducted with the informed consent of the detained person. We did not find any evidence in the manner of Ms Theofilou’s presentation which justified an intimate search, taking into account police decision-making was based on what was known to officers at the time.
"The evidence demonstrates that the medical interventions by police officers and staff were timely and appropriate but were unfortunately unable to prevent the sad outcome."
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