Royal Marine inquest: 'It's my eternal regret I didn't act differently', doctor tells hearing
A doctor who treated a Royal Marine recruit shortly before he died, says it is an "eternal regret" that he "did not act differently".
Connor Clark, 18, from Norfolk, was just three weeks into his military career when his body was discovered on the railway line beside the Commando Training Centre in Lympstone, Devon, on the morning of 12 June 2021.
An inquest into his death began on Monday 17 June and has heard from senior naval officers and Connor's peers at Lympstone.
Giving evidence on Friday 21 June was Captain Matthew Turner who is also a surgeon and in charge of overseeing health services at naval bases across the South West.
Captain Turner said: "An immediate conference call should have been set-up after Connor Clark presented himself to the medical centre with a cut to his arm."
Connor had explained to the duty locum doctor, Dr Jonathan Bedford, that he had "fallen against a radiator" but had "made it worse" to justify going to the sickbay.
Dr Bedford told Connor what options were available to him.
In a statement submitted to the inquest, Dr Bedford said: "Seeking an urgent case conference would ultimately have resulted in RCT Clark being withdrawn from training.
"But also removal from the stressful situation on the course - therefore exceptionally frustrating for him.
"It would have allowed a wider assessment and management of his stressed state, and equally the chance to put him in a safer environment."
He said it was clear to him that Connor was determined to persevere and did not want to take a break or restart training.
Dr Bedford also said: "It is my eternal regret that I did not act differently."
'Inappropriate language' has been a 'key theme' of the inquest
A senior officer also told the inquest that there was no expectation that Royal Marine instructors should shout and swear at recruits during their training.
Colonel Innes Catton, the commandant of the Commando Training Centre in Lympstone, Devon, said the non-commissioned officers selected to train new Royal Marine recruits were “handpicked for their empathy and emotional intelligence”.
An inquest into the death of 18-year-old Connor Clark has heard he received more “thrashings” – a physical punishment from instructors – than others because he made more mistakes.
Recruits described the instructors being “in their face” shouting and swearing calling them a “f****** twat, prick or punk” and “c***”.
Senior Coroner Philip Spinney asked the witness: “It is not lost on me that the Royal Marines are some of the most elite troops in the world, but I would like to get a sense for the reason for that method of training and that approach to training.”
Col Catton replied: “Those methods are not the methods we would choose to use to train some of the best infantry in Nato.
“As I understand it inappropriate language has been one of the key themes that has come out.
“There is no requirement for that. It is certainly not expected, and we don’t want that.”
Col Catton said Royal Marine training had undergone a “fundamental shift” in the last two decades.
“We want people to join, and we need these bright young people, and we are very fortunate to attract some of the very best of society,” he said.
“There is a responsibility there to give them the very best instruction.
“If I was to think more broadly about what we do at the Commando Training Centre with that initial entry, what we are really doing is helping them realise their potential.
“Some of that training is very hard and some of the psychologically around it is very hard and very uncomfortable.”
Col Catton was asked where the balance lay between producing resilient Marines and exercising a duty of care.
“On specifically language and shouting, there is a need to get them ready for the environment they are going to go into,” he said.
“In certain instances, I would categorically tell our instructors they don’t need to swear, you don’t need to shout, there are sometimes and down to their judgment, I can see where that would add a certain bit of drive and atmosphere to the training they are delivering.
“Let me be really clear. The ROP was specifically designed to be physically and psychologically progressive.”
The inquest has heard that two days before Mr Clark died he went to the medical centre with an arm injury and admitting he had made worse with a knife to avoid duties.
Mr Spinney asked why none of the instructors seemed to notice Mr Clark was struggling that week.
“No matter how much we pour into the front end to ease the introduction to the Commando Training Centre and the Royal Marines they all come their own expectations,” Col Catton replied.
“Elite is not a word we would use but it is word often connected to us. People have all sorts of expectations of themselves and the institution.
“The ROP instructors are handpicked for their empathy and emotional intelligence.
“Our instructors know the value of a good shake of the shoulder and ‘good effort’ and what that means to a recruit and picking them up.
“If you speak with the senior instructors, if you want to gain the recruits’ attention you don’t give them 50 press-ups in 15 minutes – they have been conditioned to do that – what you do is give them an extra locker inspection.
“That actually is incredibly inconvenient. You deny them shore leave or delay shore leave. Those are the sanctions that really bite.
“If a troop had done something that was seen as a real offence those are the sorts of punishments used, rather than 45 minutes of running up a hill.”
At the inquest, Captain Turner confirmed that where self harm cases are presented: "There should always be an immediate call to set-up a case conference on the same day."
The principal medical officer, also giving evidence, said at the time it may not have been easy for a visiting doctor to find the policies around self-harm in their induction documents.
A number of revisions have taken place since Connor's death three years ago.
These include improvements to the induction of doctors, to make them fully aware of all the policies developed within their initial weeks of employment.