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A Coroner’s jury sitting in Exeter has concluded that failings by Devon and Cornwall Police, Devon County Council, Devon Partnership NHS Trust and G4S probably contributed to the deaths of Anthony Payne and twin brothers Dick and Roger Carter, Deighton Pierce Glynn said in an announcement on its website on 27 October 2026.
The firm said the three men, all in their 80s, were killed on 10 February 2019 by Alex Lewis-Ranwell, who had been released from police custody a few hours earlier while experiencing a psychotic episode. According to the firm’s account, the inquest hearing lasted five weeks before the jury returned its conclusions.
Key points
- The firm said the jury found shortcomings by Devon and Cornwall Police in information gathering, sharing and recording, including a failure to communicate with Lewis-Ranwell’s mother and reliance on oral handovers.
- The jury found systemic failures by Devon County Council and Devon Partnership NHS Trust in misunderstanding when a face-to-face mental health assessment would be required, the firm said.
- According to the firm, the jury identified a fundamental misunderstanding by the G4S doctor of how to carry out a mental state examination, with signs of delusion and disordered thinking said to have been ignored.
- The firm said the jury found poor management and mixed understanding among police of section 136 of the Mental Health Act 1983, which it concluded should have been used given Lewis-Ranwell’s behaviour on the morning of the killings.
- The firm said the jury found evidence of a disregard by G4S for its tender and recruitment practices, which it said meant the doctor was engaged despite not meeting the requirements for the role.
Background to the inquest
The firm said the doctor’s lack of qualification for his role as a forensic medical examiner, and his limited mental health experience, only emerged on the final day of evidence at the inquest. It said police officers, including a custody sergeant, had also misunderstood their own powers to challenge the doctor’s assessment at the time.
Reaction
Bharine Kalsi, acting for the Payne and Carter families, said: “The scale of the failures in this case are breathtaking.” Amanda Taylor, niece of the Carter twins, said the families “believe the evidence heard during the inquests demonstrate the need for a national review of guidance and training on mental health in police custody.” The firm said the Payne and Carter families are represented by Bharine Kalsi and Rachel Tribble of DPG, together with Nick Armstrong KC and Danielle Manson of Matrix.