One of Britain's most notorious serial killers who murdered at least 12 young men spent the last days of his life as "a loner in prison," an inquest heard.
Dennis Nilsen, died from natural causes aged 72 after being found slumped over a toilet at HMP Full Sutton near York.
An inquest heard that Nilsen died after having a pulmonary embolism – a blocked artery in his lung – and bleeding in his abdominal cavity on May 12, 2018.
The former civil servant murdered and dismembered several of his victims, most of them homeless young gay men, at his home in Muswell Hill, north London.
He strangled his victims and would sit with their posed bodies for days afterwards.
Nilsen had been found slumped over the toilet in the prison where he was serving a whole life sentence for his heinous murders.
He was checked over by medics in his cell on the morning of May 10, 2018 and was told to provide a urine sample and visit the prison's clinic later that day.
The inquest heard Nilsen was left deteriorating in his own faeces as health care staff refused to review his condition throughout the day.
Hull Coroners' Court heard a post-mortem revealed Nilsen had suffered a ruptured abdominal aortic aneurysm, which was only detected when paramedics examined him after 6pm.
He was successfully operated on at York District Hospital and transferred to intensive care.
His condition worsened and he died in the early hours of May 12, 2018.
The inquest heard how the killer had refused to engage with healthcare providers in the prison since he was transferred there in 2003.
He refused to have a routine screening for abdominal aortic aneurysm, which is offered to all men when they reach 65.
The inquest heard that had the aneurysm been detected by a screening, it was "likely" it could have been treated before it ruptured.
Nilsen, who was jailed for his crimes in 1983, was said to have been "polite" with staff, but had no close friends or associates in the category A prison.
Kenneth Bottomer, supervising officer, said he "kept himself to himself".
The inquest heard how he rang the bell in his cell to call for help and told prison officers he was in "excruciating pain".
Staff at the prison said they did not issue a "code blue" call as Nilsen was not having difficulty breathing, but made numerous calls to healthcare through May 10 to ask for help.
A paramedic described Nilsen as looking "ashen" when they arrived at the prison.
The court heard how they were delayed in transporting Nilsen from his cell to the ambulance and leaving the prison by around 30 minutes due to security procedures in place.
A statement by Sue McAllister, the Prison and Probations Ombudsman for England and Wales, slammed an "unacceptable" delay in the ambulance leaving the prison.
Her statement, which was read out at the hearing, said: "The standard of care he (Nilsen) received in prison was of the same standard he would have received in the community.
"However, I am concerned that when Nilsen's health deteriorated that day, health care staff did not review his health when asked.
"As a result, he lay in his own faeces as his condition worsened for around two hours.
"There was also an unacceptable delay of getting the ambulance out of the prison and the patient to hospital."
Senior coroner Paul Marks recorded a verdict of natural causes and said he would write informally to NHS England regarding delays in ambulances getting out of prisons.
Nilsen committed at least 12 murders between 1978 and 1983 and is thought to have killed 15 men in total, making him Britain's second worst serial killer behind disgraced doctor Harold Shipman.
His victims between 1978 and 1981 were murdered at his home in Cricklewood, North London, and their remains were burned on a bonfire.
The final three victims were killed in 1982 and 1983 at his Muswell Hill home and the flesh and small bones were flushed down the toilet.
He was convicted of six counts of murder and two of attempted murder and jailed in 1983.
Nilsen admitted killing at least 15 people, but he was convicted of the murders of six men: Kenneth James Ockenden, Martyn Brandon Duffey, William David Sutherland, Malcolm Barlow, John Peter Howlett, Stephen Neil Sinclair.
The killer, who was born in Fraserburgh in Aberdeenshire, usually met his victims in pubs and bars and lured them to their deaths, strangling them and sometimes drowning them.
He washed and dressed the bodies, sat with them for days or weeks before dismembering them, and carried out sexual acts with the corpses.
After removing their internal organs that were dumped nearby, he got rid of the remains.
He was caught by accident when a drain outside his home became blocked by the remains he tried to flush away.
He and other tenants in his block of flats had complained to the landlord about the smell from the drains.
An inspection by a plumber found pipes packed with human flesh.
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