Judge calls for sobering centre after cell death

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This article was published 08/11/2024 (392 days ago), so information in it may no longer be current.

WINNIPEG — A provincial judge is urging the Manitoba government to establish a safe sobering centre in The Pas, after ruling the death of a man found unresponsive inside an RCMP jail cell was preventable.

The recommendation was included in the inquest report into the death of John George Ettawakapow, issued by Senior Judge Brian Colli this week.

Ettawakapow, 54, was arrested Oct. 5, 2019, after police received reports he was intoxicated and causing a disturbance.

Police placed him inside a holding cell alongside two other men, where he likely died as a result of a sleeping cellmate accidentally placing his leg over his neck for 40 minutes, Colli ruled.

The five-day inquest, held in June, found officers did not come to Ettawakapow’s aid until more than five hours later, when he was already “cold to the touch,” the report said.

“In this case, I am mindful that in all probability Mr. Ettawakapow lay dead in the cell for several hours before being discovered. Knowledge of this fact cannot be comforting to the family,” Colli said in the 50-page document, released Thursday.

“His death was a tragedy that might have been prevented.”

Ettawakapow, a First Nations man from Moose Lake, was a longtime member of the homeless community in The Pas. He suffered from mobility issues and was known to police at the detachment, Colli said.

Video footage showed Ettawakapow being “partly carried, partly dragged” into the cell around 7:10 p.m.

“He was semi-upright at first, but slowly his body relaxed so that he was resting on his left side on the floor. Soon after he shifted his body to lay on his back,” Colli said.

Around one hour later, one of the men sleeping nearby rolled over and his leg fell on Ettawakapow, who raised his arms in an apparent effort to remove it.

He tried to free himself for 13 minutes, after which he did not move again, the report said.

Despite a policy requiring guards to check on prisoners every 15 minutes, nobody noticed Ettawakapow needed help until 1:30 a.m.

Police and emergency medical personnel tried to revive him, but he was pronounced dead around a half-hour later, it said.

Colli said guards checked on Ettawakapow by “glancing” at a video monitor instead of physically opening a slot in the cell’s door and looking in, as the policy dictates.

According to the report, officers only physically checked the cell once throughout the night and were seemingly confused by the supervision policy.

Colli recommended the Justice Department consider establishing a safe shelter for intoxicated people in The Pas as an alternative to placing them in jail.

He pointed to the protective care facility operated by Main Street Project in Winnipeg as an example.

The Winnipeg Police Service has a partnership with the facility, where intoxicated people can be monitored around-the-clock with a paramedic on site.

“Such a program would, in my estimate, if well designed, eliminate the type of death that Mr. Ettawakapow suffered and would also free up police resources to deal with other threats to community safety,” Colli said.

Justice Minister Matt Wiebe said the province will work with community partners to develop a safety well-being plan in The Pas.

“While the inquest report was just released, it will help … inform future steps, specifically regarding detention and supports that are available to people struggling with mental health and addictions issues,” he said in a statement.

Chief medical examiner Dr. John Younes, who performed an autopsy on Ettawakapow and recommended an inquest, found alcohol toxicity and a pre-existing heart condition also contributed to his death.

Younes said he likely would not have died if he had been medically assessed before entering custody because medical staff would have flagged his high blood alcohol level — which was nearly five times the legal limit — and placed him under strict supervision.

The inquest found arresting officers are tasked with determining whether an intoxicated person requires medical intervention.

Multiple people testified that obtaining a professional medical assessment for a person in custody can take several hours, with police stuck waiting in hospital emergency departments.

The judge recommended the RCMP also partner with the health department to develop a program allowing them to quickly connect with nurses, paramedics or other medical professionals who can access medical records and provide such assessments on a priority basis.

“The recommendation would, where the resources exist, eliminate the need for police, who often have no medical background, to make the decision without knowledge of underlying health conditions,” he said.

“This program should be available in all communities where there are qualified medical personnel to perform this service.”

Officers who testified at the inquest described Ettawakapow as “joyful” and “a very friendly person who was always laughing and joking.”

“He was a good man; he was more than just his addiction. He was loved by his family,” Colli said in the report, paraphrasing the words of Ettawakapow’s son, Jeremy Ettawakapow, who also testified.

» Winnipeg Free Press, with files from Carol Sanders