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North Wales Chronicle
20-05-2025
- North Wales Chronicle
Prison service ‘closed ranks' after young offender took his own life, FAI finds
Jack McKenzie, 20, died in his cell at Polmont YOI in September 2021, nine months after being remanded on rape and sexual assault charges, which he denied. Mr McKenzie was pronounced dead in his cell at 7.57am on September 3, after taking his own life which was deemed 'unpredictable' in a fatal accident inquiry (FAI) determination by Sheriff Simon Collins, after hearing evidence at Falkirk Sheriff Court. Mr McKenzie had been confined to his cell following an 'aggressive' outburst attributed to drugs on September 1. His death could have occurred between 3am and 7.36am, the inquiry found, however, two prison officers tasked with a 'hatch check' just after 6.30am did not do so sufficiently, and a total of seven recommendations were issued to Scottish Prison Service (SPS) regarding improvements. Sheriff Collins said in his determination 'poor practice must be investigated and sanctioned, not ignored and therefore – apparently – condoned'. It added: 'The purpose of imposing a sanction is not to criticise prison officers for the sake of it, but to seek to drive up standards in the hope – in the present context – of preventing the deaths of further young prisoners by suicide.' A six-month deadline was set for SPS to reduce 'abusive and bullying verbal behaviour, drug dealing, and to respond to physical disturbances' during the night, in the sheriff's determination. Mr McKenzie was described as a 'chronic drug user' who had been remanded four times in three years in Polmont YOI, however, his death was described as 'impulsive' and a report called for improvements to cell environments. Sheriff Collins, who presided over the Katie Allan and William Brown FAI, which also investigated Polmont, said 10 young prisoners died by suicide there between 2010 and 2023, while more than 120 prisoners died by suicide in Scottish prisons between 2011 and July 2024. A total of seven recommendations were made, and the report said: 'Jack's death was spontaneous, unpredicted and unpredictable. But it is well known that prisoner suicides can be so. 'Accordingly prisoners should, insofar as reasonably possible, be detained in environments which are safe, in the sense of minimising the risk of such suicides.' The report said an audit had been done of potential suicide risks in equivalent cells and using the Manchester Tool Kit (MTK), Mr McKenzie's cell would have 'indicated the highest level of risk'. It said: 'If a young, vulnerable prisoner was accommodated, without regular observation, the resulting overall MTK scoring for the cell would have indicated the highest level of risk, calling for remediation.' The sheriff wrote it 'would have been a reasonable precaution for the Scottish Prison Service prior to September 2021, to have removed and replaced the toilet cubicle door in Jack's cell, or to have modified it, such that it was not readily capable of being used… without significant ingenuity or adaptation'. Jack McKenzie took his own life at HMPYOI Polmont in September 2021 (Andrew Milligan/PA) Mr McKenzie was perceived by staff as 'jovial, funny, likeable and talkative' but on drugs could be 'aggressive, agitated and anti-authority' and traded substances. However, he had never been assessed as suicidal, the report September 1, Mr McKenzie smashed two phones and was restrained and confined to his cell due to becoming 'non-compliant' and intoxicated – using an order which would have expired on September 4 just after 3pm. The report said: 'There was simply nothing to indicate, prior to September 3 2021, that Jack had any thoughts or intention of dying by suicide'. Accounts from neighbouring cellmates suggested 'that Jack was still alive at around 3am to 4am' on September 3, the report said. At 6.37am on September 3, two prison officers failed to carry out a hatch check at Mr McKenzie's cell to ensure he was safe and failed to take steps to ascertain his whereabouts, and did not log concerns on a handover, it added. A recommendation said: 'A sanction should have been imposed on both officers and/or corrective training required of them.' Governor Gerry Michie did not issue any 'disciplinary action, reprimand, warning or sanction' and neither officer was 'offered, nor required, to undertake additional training '- which was branded 'unacceptable' in the report. The report said: 'The absence of any disciplinary action, given the seriousness of the breach, and the possible seriousness of the consequences of it, is incongruous and unacceptable. 'I do not accept, as SPS submitted, that this was within the range of reasonable responses open to governor Michie. 'Rather, it was a response which sends a message to prison officers that they will not be held to account for a failure to 'do the basics well', and a message to the public that the first response of SPS to poor staff practice in the context of the death of a prisoner is to close ranks and protect its own.' Procurator fiscal Andy Shanks said: 'The sheriff's determination, which makes significant recommendations in relation to reduction and prevention and the checking of cells, is extensive and detailed. 'The FAI followed a thorough and comprehensive investigation by the procurator fiscal who ensured that the full facts of Jack's death were presented in evidence. My thoughts remain with Jack's loved ones.' An SPS spokesperson said: 'We would like to offer our sincere condolences and apologies to the family of Jack McKenzie for his sad death and the failings identified in this report. 'We are grateful to Sheriff Collins for his recommendations, which we will fully consider as we continue to deliver systemic change, at pace, in a way which keeps young people in our care safe, during one of the most challenging and vulnerable periods of their lives.' Justice secretary Angela Constance said: 'I wish to express my deepest condolences to the family of Jack McKenzie, I am deeply sorry about his death. 'Deaths from suicide in custody are as tragic as they are preventable, and Jack's death should not have happened whilst he was in the care of the state. 'I have been clear that there needs to be systemic change and action at pace to ensure we prevent avoidable deaths in custody. Work is well underway to put in place the necessary reforms to make our prisons safe and rehabilitative. 'I thank Sheriff Collins for his detailed determination which has highlighted a number of reasonable precautions that should have been taken and systemic failures that must be addressed to help prevent other deaths in custody. 'His recommendations will be given very careful and detailed consideration and responded to formally by July 11. 'Delivering lasting change must be underpinned by accountability and transparency at every stage which is why I have established a ministerial accountability board to provide oversight and drive progress.'
Western Telegraph
20-05-2025
- Western Telegraph
Prison service ‘closed ranks' after young offender took his own life, FAI finds
Jack McKenzie, 20, died in his cell at Polmont YOI in September 2021, nine months after being remanded on rape and sexual assault charges, which he denied. Mr McKenzie was pronounced dead in his cell at 7.57am on September 3, after taking his own life which was deemed 'unpredictable' in a fatal accident inquiry (FAI) determination by Sheriff Simon Collins, after hearing evidence at Falkirk Sheriff Court. Mr McKenzie had been confined to his cell following an 'aggressive' outburst attributed to drugs on September 1. His death could have occurred between 3am and 7.36am, the inquiry found, however, two prison officers tasked with a 'hatch check' just after 6.30am did not do so sufficiently, and a total of seven recommendations were issued to Scottish Prison Service (SPS) regarding improvements. Sheriff Collins said in his determination 'poor practice must be investigated and sanctioned, not ignored and therefore – apparently – condoned'. It was a response which sends a message... to the public that the first response of SPS to poor staff practice in the context of the death of a prisoner is to close ranks and protect its own Sheriff Simon Collins It added: 'The purpose of imposing a sanction is not to criticise prison officers for the sake of it, but to seek to drive up standards in the hope – in the present context – of preventing the deaths of further young prisoners by suicide.' A six-month deadline was set for SPS to reduce 'abusive and bullying verbal behaviour, drug dealing, and to respond to physical disturbances' during the night, in the sheriff's determination. Mr McKenzie was described as a 'chronic drug user' who had been remanded four times in three years in Polmont YOI, however, his death was described as 'impulsive' and a report called for improvements to cell environments. Sheriff Collins, who presided over the Katie Allan and William Brown FAI, which also investigated Polmont, said 10 young prisoners died by suicide there between 2010 and 2023, while more than 120 prisoners died by suicide in Scottish prisons between 2011 and July 2024. A total of seven recommendations were made, and the report said: 'Jack's death was spontaneous, unpredicted and unpredictable. But it is well known that prisoner suicides can be so. 'Accordingly prisoners should, insofar as reasonably possible, be detained in environments which are safe, in the sense of minimising the risk of such suicides.' The report said an audit had been done of potential suicide risks in equivalent cells and using the Manchester Tool Kit (MTK), Mr McKenzie's cell would have 'indicated the highest level of risk'. It said: 'If a young, vulnerable prisoner was accommodated, without regular observation, the resulting overall MTK scoring for the cell would have indicated the highest level of risk, calling for remediation.' The sheriff wrote it 'would have been a reasonable precaution for the Scottish Prison Service prior to September 2021, to have removed and replaced the toilet cubicle door in Jack's cell, or to have modified it, such that it was not readily capable of being used… without significant ingenuity or adaptation'. Jack McKenzie took his own life at HMPYOI Polmont in September 2021 (Andrew Milligan/PA) Mr McKenzie was perceived by staff as 'jovial, funny, likeable and talkative' but on drugs could be 'aggressive, agitated and anti-authority' and traded substances. However, he had never been assessed as suicidal, the report September 1, Mr McKenzie smashed two phones and was restrained and confined to his cell due to becoming 'non-compliant' and intoxicated – using an order which would have expired on September 4 just after 3pm. The report said: 'There was simply nothing to indicate, prior to September 3 2021, that Jack had any thoughts or intention of dying by suicide'. Accounts from neighbouring cellmates suggested 'that Jack was still alive at around 3am to 4am' on September 3, the report said. At 6.37am on September 3, two prison officers failed to carry out a hatch check at Mr McKenzie's cell to ensure he was safe and failed to take steps to ascertain his whereabouts, and did not log concerns on a handover, it added. A recommendation said: 'A sanction should have been imposed on both officers and/or corrective training required of them.' Governor Gerry Michie did not issue any 'disciplinary action, reprimand, warning or sanction' and neither officer was 'offered, nor required, to undertake additional training '- which was branded 'unacceptable' in the report. The report said: 'The absence of any disciplinary action, given the seriousness of the breach, and the possible seriousness of the consequences of it, is incongruous and unacceptable. 'I do not accept, as SPS submitted, that this was within the range of reasonable responses open to governor Michie. 'Rather, it was a response which sends a message to prison officers that they will not be held to account for a failure to 'do the basics well', and a message to the public that the first response of SPS to poor staff practice in the context of the death of a prisoner is to close ranks and protect its own.' Procurator fiscal Andy Shanks said: 'The sheriff's determination, which makes significant recommendations in relation to reduction and prevention and the checking of cells, is extensive and detailed. 'The FAI followed a thorough and comprehensive investigation by the procurator fiscal who ensured that the full facts of Jack's death were presented in evidence. My thoughts remain with Jack's loved ones.' An SPS spokesperson said: 'We would like to offer our sincere condolences and apologies to the family of Jack McKenzie for his sad death and the failings identified in this report. 'We are grateful to Sheriff Collins for his recommendations, which we will fully consider as we continue to deliver systemic change, at pace, in a way which keeps young people in our care safe, during one of the most challenging and vulnerable periods of their lives.' Justice secretary Angela Constance said: 'I wish to express my deepest condolences to the family of Jack McKenzie, I am deeply sorry about his death. 'Deaths from suicide in custody are as tragic as they are preventable, and Jack's death should not have happened whilst he was in the care of the state. 'I have been clear that there needs to be systemic change and action at pace to ensure we prevent avoidable deaths in custody. Work is well underway to put in place the necessary reforms to make our prisons safe and rehabilitative. 'I thank Sheriff Collins for his detailed determination which has highlighted a number of reasonable precautions that should have been taken and systemic failures that must be addressed to help prevent other deaths in custody. 'His recommendations will be given very careful and detailed consideration and responded to formally by July 11. 'Delivering lasting change must be underpinned by accountability and transparency at every stage which is why I have established a ministerial accountability board to provide oversight and drive progress.'
Daily Record
20-05-2025
- Daily Record
Prison officers 'failed to check in' on inmate who took own life at Polmont YOI
Prison officers failed to properly check up on an inmate who had taken his own life in prison, a probe has found. Jack McKenzie was pronounced dead in his cell at Polmont Young Offenders Institute (YOI) just before 8am on September 1, 2021, 90 minutes after guards were meant to conduct a thorough 'hatch check' on his wellbeing. A Fatal Accident Inquiry (FAI) also found the Scottish Prison Service (SPS) 'condoned' the incident by not disciplining staff involved. McKenzie had been at the institution for nine months on rape and sexual assault charges, which he denied. Sheriff Simon Collins ruled his death as 'unpredictable' but criticised the prison service for 'poor practice'. The 20-year-old from Shettleston, Glasgow, had been confined to his cell following an 'aggressive' outburst attributed to drugs on September 1 and his death could have occurred between 3am and 7.36am that night, the inquiry found. The SPS has since apologised to Jack's family for the failings found in the report and his sad death. The young man, who lost both parents to drugs, was described as a 'chronic drug user' who had been remanded four times in three years in Polmont. However his death was described as 'impulsive' and a report called for improvements to cell environments. Sheriff Collins - who presided over the Katie Allan and William Brown FAI, which also probed the prison - said 10 young prisoners died by suicide there between 2010 and 2023, while more than 120 prisoners died by suicide in Scottish prisons between 2011 and July 2024. A total of seven recommendations were made, with the report saying: 'Jack's death was spontaneous, unpredicted and unpredictable. But it is well known that prisoner suicides can be so. 'Accordingly prisoners should, insofar as reasonably possible, be detained in environments which are safe, in the sense of minimising the risk of such suicides.' The report said an audit had been done of potential suicide risks in equivalent cells and using the Manchester Tool Kit (MTK), Mr McKenzie's cell would have 'indicated the highest level of risk'. It said: 'If a young, vulnerable prisoner was accommodated, without regular observation, the resulting overall MTK scoring for the cell would have indicated the highest level of risk, calling for remediation.' The sheriff wrote it 'would have been a reasonable precaution for the Scottish Prison Service prior to September 2021, to have removed and replaced the toilet cubicle door in Jack's cell, or to have modified it, such that it was not readily capable of being used… without significant ingenuity or adaptation'. A six-month deadline was set for SPS to reduce 'abusive and bullying verbal behaviour, drug dealing, and to respond to physical disturbances' during the night, in the sheriff's determination. Mr McKenzie was perceived by staff as 'jovial, funny, likeable and talkative' but on drugs could be 'aggressive, agitated and anti-authority' and traded substances. However, he had never been assessed as suicidal, the report added. On September 1, Mr McKenzie smashed two phones and was restrained and confined to his cell due to becoming 'non-compliant' and intoxicated – using an order which would have expired on September 4 just after 3pm. The report said: 'There was simply nothing to indicate, prior to September 3 2021, that Jack had any thoughts or intention of dying by suicide'. Accounts from neighbouring cellmates suggested 'Jack was still alive at around 3am to 4am' on September 3, the report said. Then at 6.37am on September 3, two prison officers failed to carry out a hatch check at Mr McKenzie's cell to ensure he was safe and failed to take steps to ascertain his whereabouts, and did not log concerns on a handover, it added. A recommendation said: 'A sanction should have been imposed on both officers and/or corrective training required of them.' Governor Gerry Michie did not issue any 'disciplinary action, reprimand, warning or sanction' and neither officer was 'offered, nor required, to undertake additional training '- which was branded 'unacceptable' in the report. It said: 'The absence of any disciplinary action, given the seriousness of the breach, and the possible seriousness of the consequences of it, is incongruous and unacceptable. 'I do not accept, as SPS submitted, that this was within the range of reasonable responses open to governor Michie. 'Rather, it was a response which sends a message to prison officers that they will not be held to account for a failure to 'do the basics well', and a message to the public that the first response of SPS to poor staff practice in the context of the death of a prisoner is to close ranks and protect its own.' Join the Daily Record WhatsApp community! Get the latest news sent straight to your messages by joining our WhatsApp community today. You'll receive daily updates on breaking news as well as the top headlines across Scotland. No one will be able to see who is signed up and no one can send messages except the Daily Record team. All you have to do is click here if you're on mobile, select 'Join Community' and you're in! If you're on a desktop, simply scan the QR code above with your phone and click 'Join Community'. We also treat our community members to special offers, promotions, and adverts from us and our partners. If you don't like our community, you can check out any time you like. To leave our community click on the name at the top of your screen and choose 'exit group'. If you're curious, you can read our Privacy Notice. Procurator fiscal Andy Shanks said: 'The sheriff's determination, which makes significant recommendations in relation to reduction and prevention and the checking of cells, is extensive and detailed. 'The FAI followed a thorough and comprehensive investigation by the procurator fiscal who ensured that the full facts of Jack's death were presented in evidence. My thoughts remain with Jack's loved ones.' An SPS spokesperson said: 'We would like to offer our sincere condolences and apologies to the family of Jack McKenzie for his sad death and the failings identified in this report. 'We are grateful to Sheriff Collins for his recommendations, which we will fully consider as we continue to deliver systemic change, at pace, in a way which keeps young people in our care safe, during one of the most challenging and vulnerable periods of their lives.'
The Herald Scotland
20-05-2025
- The Herald Scotland
Prison service ‘closed ranks' after young offender took his own life, FAI finds
Mr McKenzie was pronounced dead in his cell at 7.57am on September 3, after taking his own life which was deemed 'unpredictable' in a fatal accident inquiry (FAI) determination by Sheriff Simon Collins, after hearing evidence at Falkirk Sheriff Court. Mr McKenzie had been confined to his cell following an 'aggressive' outburst attributed to drugs on September 1. His death could have occurred between 3am and 7.36am, the inquiry found, however, two prison officers tasked with a 'hatch check' just after 6.30am did not do so sufficiently, and a total of seven recommendations were issued to Scottish Prison Service (SPS) regarding improvements. Sheriff Collins said in his determination 'poor practice must be investigated and sanctioned, not ignored and therefore – apparently – condoned'. It added: 'The purpose of imposing a sanction is not to criticise prison officers for the sake of it, but to seek to drive up standards in the hope – in the present context – of preventing the deaths of further young prisoners by suicide.' A six-month deadline was set for SPS to reduce 'abusive and bullying verbal behaviour, drug dealing, and to respond to physical disturbances' during the night, in the sheriff's determination. Mr McKenzie was described as a 'chronic drug user' who had been remanded four times in three years in Polmont YOI, however, his death was described as 'impulsive' and a report called for improvements to cell environments. Sheriff Collins, who presided over the Katie Allan and William Brown FAI, which also investigated Polmont, said 10 young prisoners died by suicide there between 2010 and 2023, while more than 120 prisoners died by suicide in Scottish prisons between 2011 and July 2024. A total of seven recommendations were made, and the report said: 'Jack's death was spontaneous, unpredicted and unpredictable. But it is well known that prisoner suicides can be so. 'Accordingly prisoners should, insofar as reasonably possible, be detained in environments which are safe, in the sense of minimising the risk of such suicides.' The report said an audit had been done of potential suicide risks in equivalent cells and using the Manchester Tool Kit (MTK), Mr McKenzie's cell would have 'indicated the highest level of risk'. It said: 'If a young, vulnerable prisoner was accommodated, without regular observation, the resulting overall MTK scoring for the cell would have indicated the highest level of risk, calling for remediation.' The sheriff wrote it 'would have been a reasonable precaution for the Scottish Prison Service prior to September 2021, to have removed and replaced the toilet cubicle door in Jack's cell, or to have modified it, such that it was not readily capable of being used… without significant ingenuity or adaptation'. Jack McKenzie took his own life at HMPYOI Polmont in September 2021 (Andrew Milligan/PA) Mr McKenzie was perceived by staff as 'jovial, funny, likeable and talkative' but on drugs could be 'aggressive, agitated and anti-authority' and traded substances. However, he had never been assessed as suicidal, the report September 1, Mr McKenzie smashed two phones and was restrained and confined to his cell due to becoming 'non-compliant' and intoxicated – using an order which would have expired on September 4 just after 3pm. The report said: 'There was simply nothing to indicate, prior to September 3 2021, that Jack had any thoughts or intention of dying by suicide'. Accounts from neighbouring cellmates suggested 'that Jack was still alive at around 3am to 4am' on September 3, the report said. At 6.37am on September 3, two prison officers failed to carry out a hatch check at Mr McKenzie's cell to ensure he was safe and failed to take steps to ascertain his whereabouts, and did not log concerns on a handover, it added. A recommendation said: 'A sanction should have been imposed on both officers and/or corrective training required of them.' Governor Gerry Michie did not issue any 'disciplinary action, reprimand, warning or sanction' and neither officer was 'offered, nor required, to undertake additional training '- which was branded 'unacceptable' in the report. The report said: 'The absence of any disciplinary action, given the seriousness of the breach, and the possible seriousness of the consequences of it, is incongruous and unacceptable. 'I do not accept, as SPS submitted, that this was within the range of reasonable responses open to governor Michie. 'Rather, it was a response which sends a message to prison officers that they will not be held to account for a failure to 'do the basics well', and a message to the public that the first response of SPS to poor staff practice in the context of the death of a prisoner is to close ranks and protect its own.' Procurator fiscal Andy Shanks said: 'The sheriff's determination, which makes significant recommendations in relation to reduction and prevention and the checking of cells, is extensive and detailed. 'The FAI followed a thorough and comprehensive investigation by the procurator fiscal who ensured that the full facts of Jack's death were presented in evidence. My thoughts remain with Jack's loved ones.' An SPS spokesperson said: 'We would like to offer our sincere condolences and apologies to the family of Jack McKenzie for his sad death and the failings identified in this report. 'We are grateful to Sheriff Collins for his recommendations, which we will fully consider as we continue to deliver systemic change, at pace, in a way which keeps young people in our care safe, during one of the most challenging and vulnerable periods of their lives.' Justice secretary Angela Constance said: 'I wish to express my deepest condolences to the family of Jack McKenzie, I am deeply sorry about his death. 'Deaths from suicide in custody are as tragic as they are preventable, and Jack's death should not have happened whilst he was in the care of the state. 'I have been clear that there needs to be systemic change and action at pace to ensure we prevent avoidable deaths in custody. Work is well underway to put in place the necessary reforms to make our prisons safe and rehabilitative. 'I thank Sheriff Collins for his detailed determination which has highlighted a number of reasonable precautions that should have been taken and systemic failures that must be addressed to help prevent other deaths in custody. 'His recommendations will be given very careful and detailed consideration and responded to formally by July 11. 'Delivering lasting change must be underpinned by accountability and transparency at every stage which is why I have established a ministerial accountability board to provide oversight and drive progress.'
Glasgow Times
20-05-2025
- Glasgow Times
Prison ‘closed ranks' after young inmate died, FAI finds
Jack McKenzie, 20, died in his cell at Polmont YOI in September 2021, nine months after being remanded on rape and sexual assault charges, which he denied. Jack was pronounced dead in his cell at 7.57am on September 3, after taking his own life, which was deemed 'unpredictable' in a Fatal Accident Inquiry (FAI) determination by Sheriff Simon Collins, after hearing evidence at Falkirk Sheriff Court. READ MORE: Heartbroken school pays tribute to 'kind and caring' teen after Irvine beach tragedy Jack had been confined to his cell following an 'aggressive' outburst attributed to drugs on September 1. His death could have occurred between 3am and 7.36am, the inquiry found; however, two prison officers tasked with a 'hatch check' just after 6.30am did not do so sufficiently, and a total of seven recommendations were issued to the Scottish Prison Service (SPS) regarding improvements. Sheriff Collins said in his determination: 'Poor practice must be investigated and sanctioned, not ignored and therefore – apparently – condoned." It added: 'The purpose of imposing a sanction is not to criticise prison officers for the sake of it, but to seek to drive up standards in the hope, in the present context, of preventing the deaths of further young prisoners by suicide.' A six-month deadline was set for SPS to reduce 'abusive and bullying verbal behaviour, drug dealing, and to respond to physical disturbances' during the night, in the sheriff's determination. Jack was described as a 'chronic drug user' who had been remanded four times in three years in Polmont YOI, however, his death was described as 'impulsive," and a report called for improvements to cell environments. Sheriff Collins, who presided over the Katie Allan and William Brown FAI, which also investigated Polmont, said 10 young prisoners died by suicide there between 2010 and 2023, while more than 120 prisoners died by suicide in Scottish prisons between 2011 and July 2024. A total of seven recommendations were made, and the report said: 'Jack's death was spontaneous and unpredictable. But it is well known that prisoner suicides can be so. 'Accordingly, prisoners should, insofar as reasonably possible, be detained in environments which are safe, in the sense of minimising the risk of such suicides.' READ MORE: Owners banned after dogs endured 'unnecessary and avoidable suffering' The report said an audit had been done of potential suicide risks in equivalent cells and using the Manchester Tool Kit (MTK), Jack's cell would have 'indicated the highest level of risk." It said: 'If a young, vulnerable prisoner was accommodated, without regular observation, the resulting overall MTK scoring for the cell would have indicated the highest level of risk, calling for remediation.' The sheriff wrote it 'would have been a reasonable precaution for the Scottish Prison Service prior to September 2021, to have removed and replaced the toilet cubicle door in Jack's cell, or to have modified it, such that it was not readily capable of being used… without significant ingenuity or adaptation." Jack was perceived by staff as 'jovial, funny, likeable and talkative' but on drugs could be 'aggressive, agitated and anti-authority' and traded substances. However, he had never been assessed as suicidal, the report added. On September 1, Jack smashed two phones and was restrained and confined to his cell due to becoming 'non-compliant' and intoxicated, using an order which would have expired on September 4 just after 3pm. The report said: 'There was simply nothing to indicate, prior to September 3 2021, that Jack had any thoughts or intention of dying by suicide." Accounts from neighbouring cellmates suggested 'that Jack was still alive at around 3am to 4am' on September 3, the report said. At 6.37am on September 3, two prison officers failed to carry out a hatch check at Mr McKenzie's cell to ensure he was safe and failed to take steps to ascertain his whereabouts, and did not log concerns on a handover, it added. A recommendation said: 'A sanction should have been imposed on both officers and/or corrective training required of them.' Governor Gerry Michie did not issue any 'disciplinary action, reprimand, warning or sanction' and neither officer was 'offered, nor required, to undertake additional training," which was branded 'unacceptable' in the report. The report said: 'The absence of any disciplinary action, given the seriousness of the breach, and the possible seriousness of the consequences of it, is incongruous and unacceptable. 'I do not accept, as SPS submitted, that this was within the range of reasonable responses open to Governor Michie. 'Rather, it was a response which sends a message to prison officers that they will not be held to account for a failure to 'do the basics well', and a message to the public that the first response of SPS to poor staff practice in the context of the death of a prisoner is to close ranks and protect its own.' READ MORE: Glasgow dad 'feels robbed' after losing wife and son to same heart condition Procurator fiscal Andy Shanks said: 'The sheriff's determination, which makes significant recommendations in relation to reduction and prevention and the checking of cells, is extensive and detailed. 'The FAI followed a thorough and comprehensive investigation by the procurator fiscal, who ensured that the full facts of Jack's death were presented in evidence. My thoughts remain with Jack's loved ones.' A Scottish Prison Service spokesperson said: 'We would like to offer our sincere condolences and apologies to the family of Jack McKenzie for his sad death and the failings identified in this report. 'We are grateful to Sheriff Collins for his recommendations, which we will fully consider as we continue to deliver systemic change, at pace, in a way which keeps young people in our care safe, during one of the most challenging and vulnerable periods of their lives."
