Jail inquest exposes overcrowding, limited monitoring and little access to methadone

Snoring, low pressure and a low pulse.

Those are the symptoms that should be flagged as a possible opioid overdose, says Angela DiMarco, health care services manager at Hamilton-Wentworth Detention Centre. And those are the symptoms no one appeared to notice when inmate Marty Tykoliz died of a powdered methadone overdose in 2014.

The symptoms "would probably be a reason to send them back to hospital, because those are signs of an overdose that we can't treat," DiMarco said at an inquest Tuesday. The inquest examines the deaths of eight men who suffered drug overdoses in the Barton Street jail between 2012 and 2016. DiMarco was the second to testify this week. 

When Marty Tykoliz's sister April heard DiMarco say that, her mouth hung open in shock and she started crying.

Her brother wasn't seen by any medical staff until hours later back in 2014, said her lawyer Kevin Egan. Marty later died in hospital.

DiMarco is the second to testify at the inquest into the deaths of Tykoliz, Louis Angelo Unelli, William Acheson, Stephen Conrad Neeson, David Michael Gillan, Trevor Ronald Burke, Julien Chavaun Walton, and Peter Michael McNelis.

The inquest was first announced in 2015 and was repeatedly pushed back until it began Monday, April 9.

Limitations in monitoring inmates

The issue of monitoring inmates and the limitations surfaced on Monday, when the first witness Michael DuCheneau, staff sergeant for operations, testified that correctional officers do not have access to CCTV and camera footage of the living quarters.

There are also some blind spots that are not covered by the existing cameras.

DuCheneau agreed while on the stand that "it would definitely benefit" the monitoring of inmates if there is more camera coverage and a dedicated person watching the live feeds at all times.

And when inmates return from a hospital after a medical emergency, how they're monitored is highly dependent on the information provided by hospital staff and availability of a nurse at the jail.

Currently, the jail is supposed to be staffed around the clock with a nurse, but that doesn't always happen. And if someone is admitted into the facility when no medical professional is available, they are stuck waiting.

"If they come in overnight, if there is no night nurse, they will wait until morning to see someone," said DiMarco.

Limited access to methadone program

There is also no policy in place to start inmates who are opioid-dependent on a methadone program when they are in custody.

The only way for them to be on a methadone program in jail is if they were already on one prior to being admitted to jail, if the inmate is pregnant and opioid-dependent, or if the inmate is roughly a month away from release.

"My concern is somebody who is interested in methadone, who's an addict, and can't because of this policy, can't get onto a methadone program, is going to look for drugs somewhere else," Egan said while he questioned DiMarco on the stand.

DiMarco argued that while there isn't a policy for those people, they may still be able to be initiated on the program upon consultations with the doctor inside the jail.

But she stressed that continuity of care is important, and they are primarily concerned about inmates who may be released without any connection to a community methadone provider.

Environment for rehabilitation

Access to methadone wasn't the only thing on Egan's mind.

The jail cells in the Barton Street jail are roughly eight-by-ten feet with two bunk beds. When the jail gets too full, a third person will have to sleep on a mattress on the floor.

When the jail was first built in the 1970s, it was meant for just under 300 inmates, with one bed in each cell. Since then, the number of inmates has increased to about 400 to 500 people at any given time, said DuCheneau. 

And as many as 72 inmates are under the watch of only two officers.

Egan argued that the conditions of overcrowding, having regular exposure to violence in the living quarters and lack of recreational programming, may foster drug use among inmates.

DuCheneau did not agree, saying inmates were tempted to do drugs even before the problem of overcrowding existed.

And when Egan questioned DiMarco on whether the effects of being confined may lead to mental health problems, causing inmates to turn to drug use, she said "it's really hard to specify" why inmates use drugs.

However, she said segregation may cause sensory deprivation, among other negative impacts on a person.

"There is a lot of evidence to support that people who are in segregation will have a negative impact on their mental health and mental wellness," said DiMarco.

And for Mariea McNelis, a self-representing family member of Peter McNelis, the high number of inmates compared to the low number of correctional officers assigned to oversee them was shocking to hear.

With a shaking voice, she pressed DuCheneau about the level of accountability from the corrections facility and also the Ministry of Community Safety and Correctional Services.

"I think the ministry needs to restructure the whole facility," she said, "because obviously there's something not working."