A string of failures have been found after a serial killer who stabbed six people to death, including his wife and children, took his own life behind bars.
Damian Rzeszowski, killed his wife Izabela Rzeszowska, 30, and their two children Kinga, five, and Kacper, two as well as his father-in-law, his wife’s friend and her daughter in August 2011.
After the crime, Polish-born Rzeszowski stabbed himself in the chest and collapsed, later receiving life-saving surgery and was later jailed for 30 years for manslaughter.
An inquest last month heard he was moved to the maximum security Full Sutton prison in 2013 and he was found dead in his cell in March 2018.
After nine days, a jury concluded that he took his own life on March 31, 2018, Hull Live reported.
The Prisons Ombudsman, which investigates deaths in custody, has now raised concerns about Rzeszowski's treatment for serious mental health conditions.
His family have said he should have been in a psychiatric hospital and he died two weeks after medical staff decided to refer him to Broadmoor special hospital.
A statement was read to the inquest by PC Kalina Tyszeca, a British police officer tasked with talking to Rzeszowski’s parents in Poland.
In the statement, the officer said the killer’s father complained to her about his son’s treatment in prison.
Ombudsman Sue McAllister identified a number of findings which needed to be addressed by the prison governor and the healthcare team.
Rzeszowski received a care package in prison to deal with his complex mental health needs and saw a psychiatrist regularly but in January 2018, his mental health began to deteriorate and he took an overdose of pills.
He was successfully treated and placed on suicide monitoring (ACCT).
He was later diagnosed with paranoid schizophrenia and moved to a segregation unit after trashing his cell.
He was considered psychotic and was due to be referred to a psychiatric hospital. After 45 days he was sent back to the normal prison wing and took his own life four days later.
In her report Ms McAllister said: “I have a number of serious concerns about the way Mr Rzeszowski was managed at Full Sutton.
“There were several failings in the management of Mr Rzeszowski’s time in the segregation unit.
“Managers failed to record that Mr Rzeszowski was in the ACCT post-closure phase and should therefore only have been segregated if there were exceptional reasons for doing so.
“Healthcare staff failed to take account of the fact that he was awaiting an assessment for a transfer to a secure psychiatric hospital and wrongly concluded that there were no healthcare reasons to advise against segregation.
“In addition, staff did not create a mental health care plan for Mr Rzeszowski, as required for anyone held in segregation for over 30 days."
“I also consider there were deficiencies in staff’s management of the ACCT procedures. Staff did not hold ACCT case reviews in response to apparent increases in Mr Rzeszowski’s risk and there were discrepancies between prison and healthcare staff’s assessment of his level of risk.
“Mr Rzeszowski’s family lived in Poland and had very limited English. We are concerned that staff who contacted the family did not use an interpreter, which meant there were delays and difficulties in communicating his death. We do not consider that this was appropriate or sensitive.”
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