Investigation reveals prisoner health-care failures in Ontario prisons that staff and advocates say are widespread

recently completed coroner’s inquest The death of a Wikwemkong First Nation man in a Sudbury prison has drawn attention to what advocates and corrections officials say are longstanding Ontario-wide failures in correctional health care.

Sarah-Jane Berghammer, CEO of the John Howard Society of Sudbury, said she was not surprised by the nurses’ testimony about the prison’s understaffing and lack of overnight medical coverage.

Berghammer said, “My initial thoughts are, no, I’m not surprised. This is something that’s been happening for a long time, as far as I remember.” “A prisoner’s health is not governed by the Ministry of Health. It is governed by corrections and corrections (and) their mandate is care and control. This is not health.”

Berghammer said his organization regularly hears from inmates and families about people not getting prescribed medications before entering custody.

“We sometimes get calls from the inmates themselves or from family members saying, ‘Can you please help me? My son is not getting the medication that he needs to be in.'”

Jury recommendations aim for better medical care

investigated in inquiry The 2021 case involved Justin Alexander Trudeau, 44, who died five days after arriving at a Sudbury prison to serve a 30-day sentence. An autopsy revealed that he died of pneumonia and blood poisoning caused by an antibiotic-resistant bacterial infection.

After hearing testimony from medical experts, correctional staff, and health care workers, the jury issued 13 recommendations aimed at preventing similar deaths.

Jurors urged the Ministry of the Solicitor General and Sudbury Prison to improve health care staffing, including adding night nursing coverage and reviewing doctor and nurse practitioner availability.

They also called for better communication between guards and nurses during shift changes, clearer observation standards for prisoners in isolation and upgrades to cell doors and windows to allow officers to better monitor people in crisis.

Other recommendations focused on improving infection control and medical surveillance.

The jury said prisoners showing signs of bacterial or viral infection should be monitored more closely and staff should receive training to recognize the symptoms of septic shock. Other recommendations include moving forward with electronic medical records, hiring pharmacists or pharmacy technicians to free up nurses’ time, and offering cultural awareness and trauma-informed training for staff working with Indigenous prisoners and those with substance use disorders.

Berghammer said that after each investigation the same recommendations resurface, albeit with slight variations.

She said, “For many years, I have been following the inquiries and it is incredibly heartbreaking because the recommendations of the inquiries are often the same.” “The results are the same, but there’s really no pressure to improve conditions for the people inside or to implement some of these recommendations.”

The government is not legally bound to implement the inquiry recommendations.

CBC News has contacted the Ontario Ministry of the Solicitor General to request an interview, but instead received an emailed statement Friday.

It said the government has made “record investments” in the corrections system, including more than $500 million to update and build new facilities and hire more staff, said Oleksandr Shvets, a spokesman for the Solicitor General.

“We have also established a new health services division to ensure that detainees receive the care they need, including support with mental health and addiction issues provided by social workers, nurse practitioners, mental health nurses and addiction counselors.”

Continued staff shortage ‘nothing unusual’

Berghammer believes Ontario should hand over responsibility for the health of prisoners to the Ministry of Health and take the coroner’s findings seriously.

“We have an obligation to treat people and try to prevent their punishment from resulting in their demise.”

At Monteith Correctional Complex, just outside the city of Iroquois Falls, corrections officer Ken Steinbrenner said the same problems described in the inquiry persist.

“Our facility has been generally understaffed for a long time – nothing unusual. It’s clear that there are understaffing at various levels across the province and it’s consistent everywhere,” said Steinbrenner, who is also president of Local 642 of the Ontario Public Service Employees Union (OPSEU) and sits on the union’s executive board.

He said Ontario’s reliance on private-agency nurses is making the situation worse.

Agency nurses “make more money, but they’re not invested in that place, they’re not part of the workplace.”

Steinbrenner said staff nurses must continually train agency nurses assigned to work at the facility. Agency nurses are not able to meet all requirements, such as access to digital medical records, because they are not permanent staff members.

“The solution is not agency nurses. We really need the government to invest in recruiting and retaining all of them.”

Steinbrenner said overcrowding has also reached its peak.

“I’ve been doing this for about 25 years and it’s never been this bad in the province,” he said. “You fill the place, you have people sleeping on the floor, you have people sleeping near the toilets. Is that right? I don’t think so.”

He said that violence has also increased.

“Criminals have never been more violent, and there has never been more violence in my time,” Steinbrenner said.

“Three correctional officers are being assaulted in Ontario today. That’s the number we’re seeing.”

Steinbrenner said the province’s own staffing assessments are often not shared with unions.

“We just went through one. We participated, provided feedback, and the government won’t share the report. I just suspect they won’t share it with us because it recommends more staff.”

More than 3,000 prisoners along with the same number of nurses.

Adam Siegler, a social worker at the Ontario Correctional Institution in Brampton and one of the elected representatives on the ministry’s employee relations committee representing non-correctional staff across the system, echoed those problems.

“Our inmate population is increasing… We are housing anywhere between — I want to say — probably 3,000 more inmates than we normally housed pre-COVID, and our staffing levels and especially health care have remained relatively stable or stable compared to before.”

He said small and medium-sized jails like Sudbury don’t have pharmacists, leaving nurses to sort and dispense medications themselves.

“Medications come in large quantities, and then nurses have to pour them, dispense and kind of prepare all the medications,” Siegler said. “That’s where the room for error (appears because) you’re rushing and trying to compete with all those other duties.”

Siegler believes compensation packages need to increase to attract more employees.

“Our nurses show up in those challenging environments every day and do an incredible job that many people come in contact with for a short time and say, ‘No, thank you.’-Adam Siegler, social worker

According to Siegler, other health care professionals, including social workers and psychologists, also earn less than their counterparts in the community.

“It’s very hard to recruit people and then keep people for long periods of time in this already challenging environment when we’re not paying them a fair rate.”

Despite this, he said, most health care workers continue to show commitment to their patients.

“Our nurses show up in those challenging environments every day and do an incredible job making many people come in contact with them for a short period of time and say, ‘No, thank you.'”

‘They have the same rights as us’

Berghammer said the public often overlooks the human cost of neglecting health care behind bars.

“There’s a lot of stigma that comes with people who commit crimes, but we have to remember that just because someone is put in jail, it doesn’t mean they’re guilty,” he said.

“Technically, they are innocent until proven guilty and they are entitled to the same rights that we are given on the outside.”

Berghammer attributes the significant investment required from the Ministry of the Solicitor General and inaction to the widespread stigma attached to criminals. But, he said, providing basic health care to prisoners is essential to their reintegration into society.

“They have the same rights as we do. And if we want them to have a chance to get out and be productive, they have to be good,” he said.

“We can’t just close the doors and pretend like they don’t exist.”