Antonie Dixon said he feared being killed by prison officers shortly before his death, but a psychiatrist decided against trying to move him, expecting he would be safe in an at-risk prison unit.
Dixon, who became notorious after a 2003 drug-fuelled rampage when he attacked two women with a samurai sword and then fatally shot a man, was found dead with a blood-stained piece of fabric around his neck in a prison cell at Auckland Prison at Paremoremo in February 2009.
At an inquest into his death in Auckland Coroners Court on Monday, it was revealed Dixon had methamphetamine in his system.
Dixon had also taken methamphetamine during the 2003 rampage when he killed James Te Aute in Auckland a few hours after attacking Simonne Butler and Renee Gumbie with a samurai sword in Pipiroa, near Thames.
Psychiatrist Krishna Pillai saw Dixon several times after his arrest and had seen him in the two days prior to his death as he was awaiting sentence.
"He seemed to believe his own life was at risk from prison officers and others," Dr Pillai said Dixon told him on one of those days.
He said Dixon could be difficult to interpret as he sometimes appeared to feign symptoms of mental illness but he had felt it prudent to discuss plans with the admitting team and the clinical director at the Mason Clinic, a psychiatric hospital.
He was subsequently called by Dixon's lawyer expressing concern for his health, but Dr Pillai felt he would be safe in the at-risk unit.
The inquest was told video from the sole security camera in Dixon's cell couldn't be seen from 4pm on February 4, five hours before he died, after it was obscured by wet paper.
A prison officer, whose name is suppressed, said he checked on Dixon at least every 15 minutes and was given a "thumbs up" not long before his death.
The officer saw Dixon was injured when he returned to Dixon's cell and called other staff to assist.
When Coroner Garry Evans told the officer there was an exception to the policy which meant four officers were needed to enter a high-risk offender's cell, the officer said he wouldn't have gone in anyway due to the risk Dixon posed to safety.
The inquest is set down for three days.