Overdosed inmate should have gone to hospital, inquest told

Marty Tykoliz, who died four years ago while an inmate at the Hamilton Wentworth Detention Centre, ought to have been taken back to hospital when symptoms of an overdose returned, an inquest into eight inmate drug deaths at the jail heard Tuesday.

The revelation came as lawyer Kevin Egan, who represents Marty’s sister April Tykoliz, was cross-examining Angela DiMarco, health care services manager at the jail, about comments she’d made about the opioid antidote naloxone.

She had explained naloxone lasts for about six hours and there is a risk of relapse if there are still opioids in a person’s system when the antidote wears off.

Marty had been taken to hospital the night before his May 7, 2014, death suffering from an overdose and was saved by naloxone.

But he was soon returned to jail, where the next morning he was observed snoring and with a low pulse — symptoms of overdose.

When Egan suggested this scenario to DiMarco she said those symptoms, “would probably be a reason to send them back to hospital, because those are signs of an overdose that we can't treat.”

But this is not what happened to Marty.

Instead, he was left in his cell and found unresponsive hours later, Egan said.

Looking on, April’s mouth hung open and then she began to cry.

She later said DiMarco’s response was finally validation for what she has long believed — that her brother could have been saved.

DiMarco didn’t work at the jail when Marty or any of the other seven died. Louis Unelli, William Acheson, Trevor Burke, Stephen Neeson, David Gillan, Julien Walton and Peter McNelis all died between 2012 and 2016.

At that time, the jail did not have 24-hour nursing.

DiMarco testified that was only introduced in October 2017, and even now there are times when a nurse is sick that they can’t fill the shift.

Nurses administer medication during rounds that happen four times a day and inform correctional officers if a sick or injured inmate needs more frequent checks.

Egan also questioned DiMarco about a policy she said limits who has access to methadone — a medication used for opioid cessation.

Inmates who are already on a methadone program before being arrested are able to continue, but the doctor in charge of that program will not write prescriptions for inmates to start methadone unless they’re pregnant or unless they are a month away from being released, she said.

Egan peppered DiMarco with questions for a “reasonable explanation” about why new inmates waiting for trial or who do not know when they’re being released could not access methadone.

Eventually DiMarco agreed there is no reason the policy couldn’t be changed.

Egan argued that with overcrowding, a lack of programming and lack of access to methadone, nothing is done to discourage inmates from using drugs.

Earlier Tuesday, Hamilton Wentworth Detention Centre Staff Sgt. Michael DuCheneau agreed that changes — including having staff continuously monitor security cameras, be trained to detect addiction, have access to a dedicated canine unit and random urine tests — would all be “beneficial” and would “improve the system.”

Mariea McNelis, mother of Peter McNelis, who died in 2016, questioned whether there were adequate training and resources to identify and help inmates who are mentally ill.

“I was really shocked to hear the number of inmates within the institution — that's terrible,” she said.

DuCheneau previously testified that there was no maximum and as a remand centre they cannot refuse to take anyone. There are typically between 400 and 500 inmates.

In a general population living unit, this means a maximum of 72 inmates, with one inmate sleeping on a mattress on the floor of each cell. They are supervised by two correctional officers.

DuCheneau said the opioid crisis has impacted the jail, with the narcotics starting to become prevalent in the institution in 2010.

Before 2012 there had not been an overdose death of an inmate for a decade.

At the time of all the deaths being examined in the inquest, naloxone was only available for use by nurses and by injection.

The inquest heard that sergeants now have access to naloxone and front-line staff are being trained to administer a nasal spray version of the overdose antidote.

“We're waiting for the green light from the ministry,” DuCheneau said.

The inquest is expected to last six weeks and hear from more than 100 witnesses.

It continues Wednesday morning at the Hamilton Plaza Hotel and Conference Centre.