Health-care gaps exposed at jail inquest

Nursing shortages and problems accessing inmates’ medical records glaring examples

In principle, inmates at the Hamilton Wentworth Detention Centre should have access to the same health care as non-incarcerated people; but in reality there are often barriers, an inquest into eight drug-related deaths at the Barton jail has revealed.

Some of those barriers are logistical, including security constraints, nurses being restricted to four rounds a day, and delays because of court appearances, the jail’s health care services manager Angela DiMarco said during day three of the inquest Wednesday.

But some are also because of a lack of resources or restrictive policies.

DiMarco pointed specifically to the fact that only one doctor in the jail is allowed to prescribe methadone — an opioid medication used to treat addiction. Inmates not already on methadone before being arrested are not given a prescription in custody, unless they’re pregnant or until about a month before their release.

There has not been a clear explanation for this policy, nor why there is only one doctor available for methadone prescriptions.

The large-scale inquest is examining the drug-related deaths of Louis Unelli, William Acheson, Trevor Burke, Stephen Neeson, David Gillan, Julien Walton, Marty Tykoliz and Peter McNelis.

At the time of these deaths, between 2012 and 2016, there was not 24-hour nursing available at the jail — that was implemented last October. But even now, sometimes management can’t fill the night shift, the inquest previously heard.

Wednesday, DiMarco explained that when inmates are released from hospital and sent back to jail there is a sealed envelope that includes medical care recommendations. But correctional officers are not allowed to access inmates’ medical information, so if there is no nurse on duty, that envelope remains sealed until morning.

Tykoliz died after being returned to the jail from hospital where he had been treated for an overdose.

Coroner’s counsel Crown Karen Shea questioned how correctional staff are supposed to know how to supervise an inmate returning from hospital without being told what to do. For instance, if that inmate should be checked on more frequently than the standard hourly.

She suggested the inquest’s jury could consider a recommendation to mandate “enhanced supervision” for all inmates returning to jail from hospital when there is no medical staff available.

“I agree with that,” DiMarco replied.

Lawyers for the family of Walton — the youngest of the men to die at just 20 — and for the Prisoners with HIV/AIDS Support Action Network (PASAN), which has standing at the inquest, both pressed DiMarco about greater access to the opioid overdose antidote naloxone.

Nurses have long had access to injectable naloxone used in the event of a medical emergency where an inmate has symptoms of an overdose, such as shallow breathing.

The jail’s sergeants have recently been given access to the nasal spray version of the antidote and front-line correctional officers are going through training.

“Anyone with a health card can walk into a pharmacy and get naloxone,” PASAN lawyer Vilko Zbogar said.

The the spray is easy to use, added Zbogar, so why not allow inmates to have direct access?

DiMarco also noted that the medical staff at the jail, including doctors and nurses, are managed by the Ministry of Community Safety and Correctional Services, unlike other health-care providers who answer to the Ministry of Health and Long-Term Care. This sometimes leads to challenges with accessing medical information.

The inquest, being held at the Hamilton Plaza Hotel and Convention Centre, resumes at 1 p.m. Monday with pathology and toxicology experts.