Inquest hears jail staff had no reason to think inmate at medical risk
Saskatoon Correctional Centre staff had no reason to think Kevin Ryan Umpherville was at medical risk when he returned from the hospital on Dec. 30, 2015, a coroner’s jury heard Tuesday.
An inmate who brought breakfast the next morning raised the alarm when he told a correctional officer that Umpherville, 22, hadn’t taken his breakfast tray by 8:45 a.m.
Umpherville was unresponsive and was taken back to Royal University Hospital on Dec. 31, 2015, where he remained until his death on January 15, 2016.
Umpherville had suffered an overdose after taking another inmate’s methadone between 8 a.m. and 9 a.m. on Dec. 30, 2015. He was revived at about 11:30 a.m. by MD Ambulance paramedics, who used the opioid antidote naloxone before taking him to RUH, where he was given another dose of naloxone.
During the nine hours he was at the hospital he became drowsy and his breathing was suppressed, for which he was given oxygen sometime after the last naloxone dose.
As the day progressed, Umpherville seemed alert and didn’t show signs of narcotic use.
Dr. Nicholas Bouchard checked with Alberta-based Poison and Drug Information Services (PADIS) on treating methadone overdose and was told the patient would be safe to discharge six hours after the last naloxone dose. That was incorrect information, the jury heard.
Overdose patients should be monitored until 24 hours after they took the methadone and six hours after the last naloxone dose, Bouchard said Monday.
Methadone can remain active in the body for up to 24 hours and naloxone can stay active about 30 minutes.
Based on the PADIS consultation, Bouchard set the end of monitoring time at 6:30 p.m.
Before leaving at 5 p.m. Bouchard told Dr. John Pesenti PADIS had recommended Umpherville be monitored until 6:30 p.m. Pesenti discharged him at 9:15 p.m.
Correctional Centre nurse Christine Barh said Umpherville didn’t show signs of impairment when he returned to the jail. He spoke with her and ate a sandwich. His vital signs were stable. He said he regretted taking the drug, she said.
Barh spoke with the charge nurse at the hospital, telling her the jail has no ability to do medical supervision. Umpherville was cleared to return to general population.
Barh said staff assumed he’d obtained the methadone from the one inmate in the dorm who was on methadone. Umpherville was not returned to the dorm but was sent instead to a single cell in the remand unit, where staff make hourly rounds to ensure people are present and alive.
At night, correctional officers shine a flashlight on sleeping inmates and watch for body movement.
The inquest continues Wednesday at the Sandman Inn.