Coroner's Finding: Holding, Matthew Benjamin

44y · Male·unascertained

Matthew Benjamin Holding, aged 44, died suddenly in prison on 2 January 2023. He had schizophrenia managed with antipsychotics and severe obesity (BMI 41.6). In December 2022, he showed signs of significant deterioration including extreme daytime sleepiness, low oxygen saturation (90-91%), and facial swelling from a dental issue. Medical staff recommended hospital assessment and CPAP therapy for suspected sleep apnoea; he refused both despite being informed of death risk. He fell in his cell on 1 January and was found unresponsive at 6:40 am. CPR commenced within 3 minutes but was unsuccessful. Post-mortem examination found no definitive cause; electrocution was investigated and excluded. The coroner found the cause unascertained but likely related to functional breathing abnormality or cardiac conduction disorder. Medical care was deemed adequate despite refusal of recommended interventions.