A senior official at the Niagara Detention Centre (NDC) told the inquest into the deaths of five men that there can be tension between managing inmate health care and securing the jail.

"First, we're caring for these guys," Patrick Sproat, deputy superintendent of the facility in Thorold, Ont., said Tuesday. "They're here as punishment, not for punishment."

But in answering questions at the inquest that began Oct. 21, Sproat suggested several proposed changes might not be ideal or feasible for the NDC, even if they could benefit inmates' health.

For example, Sproat said, constantly monitoring intoxicated inmates would be beneficial, but significantly drain staff resources. Call buttons in cells might allow overdosing inmates to get help more quickly, but could also result in frequent false alarms. And while giving inmates direct access to naloxone — which can reverse the effects of an overdose — might help, Sproat said it may also lead inmates to attempt to treat overdoses without informing jail staff.

"We need to take everything into account to ensure the jail is operating as optimally as possible," Sproat said.

Timothy Anderson, Murray Balogh, David Cowe, Michael Croft and Jahrell Lungs all died of drug toxicity between 2018 and 2022. Since they were incarcerated, inquests into their deaths are mandatory. None were more than 10 days into their time at the facility when they died.

For over a week, the inquest, which the Office of the Chief Coroner of Ontario is holding virtually, has been hearing from workers at the jail and medical experts. Each witness answers questions from lawyers who work for the coroner, then from those representing the Ministry of the Solicitor General, which oversees NDC, the Prison Harm Reduction Coalition, and two doctors who served as witnesses.

Members of Anderson's and Balogh's families are party to the inquest and can ask questions through its lawyers.

Jurors will be responsible for answering a series of factual questions about how the men died. They may also issue non-binding recommendations intended to prevent future, similar deaths.

Sproat was the first NDC leader to be questioned. He said he was previously a worker at the jail, and according to an agreed statement of facts presented earlier in the inquest, he was present when Lungs overdosed and he attempted to revive him.

Over two days, inquest lawyers asked Sproat to describe procedures at NDC, including how inmates are scanned for drugs when admitted and what happens when an inmate is found to have ingested drugs.

Jurors heard that with an inmate's consent, upon arrival at the NDC, staff use a body scanner to detect whether they have ingested any contraband, such as drugs. Sproat said this is not a foolproof method, since the scanner highlights density and it can be hard to discern loosely packed drugs from natural phenomena like gas.

Sproat also shared how some inmates distribute drugs within the prison. At one point, he said, it was common for inmates to tie objects to strings and try to pass them between cells, either through barred windows or in the space under cell doors. Security cameras captured Anderson appearing to take an item from another inmate by reaching into that inmate's cell from within the hallway. He overdosed the next day.

Cells no longer have open bars, Sproat said, and dams block the space under doorways, but inmates still find ways to share contraband. Inquest lawyers played security video appearing to show Croft asking a guard for help in disposing garbage, then putting an object into a garbage bin via a slot in his cell door. Immediately after, another inmate asked for the garbage, only to reach through the cell door and into the bin to take something out. Sproat described this as a likely drug deal. Croft, who appeared intoxicated in the video, died of an overdose soon after.

Although there are about 400 cameras in the NDC, Sproat said, most security footage is only observed if there is an incident.

In discussing Lungs's overdose death, which Sproat responded to in 2021, lawyers asked Sproat why the inmate was not watched more closely after going to the hospital for an overdose and refusing treatment. Sproat defended his decision to put Lungs on a standard intoxication watch, which included checks every 20 minutes, saying he felt that was sufficient at the time.

He also defended his decision not to have a nurse look over Lungs when he returned to the hospital, saying he figured the inmate would refuse that treatment too and "saw no benefit." Lungs became unresponsive between checks and died.

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Sproat also offered a behind-the-scenes look at how NDC operates and how it's changed over the last six years.

The NDC is a medium-sized institution, Sproat said, with a plus-shaped layout featuring different kinds of living areas, from dorm-style cells with common areas to segregated cells designed to house one or two people. It has 272 beds, but routinely operates above capacity with around 320 inmates most days this year, Sproat said.

"Overcrowding is an issue sometimes," he said, "If we're even at capacity, we feel the pressure."

The inmate population was lower in the first couple years of the pandemic, Sproat said, but there were other operational challenges, including having to isolate inmates when they arrived to prevent the spread of COVID-19.

About 90 per cent of NDC inmates have not been sentenced for committing a crime, Sproat said. Rather, they are awaiting court dates after being arrested and stay about a month. Those sentenced for crimes are typically moved to other institutions.

Sproat also said most inmates require some kind of medical care.

Another theme of Sproat's testimony was how information is shared within NDC.

Sproat said sharing news about inmates between the health and security teams has been a focus in recent years. He said he'd like to see federal police and security officials exchange more information with the NDC so staff can know if inmates have gang affiliations or connections to crimes that local police are unaware of.

Sproat said he also wants security staff to have more access to inmates' health information, much of which is currently limited to the health-care team. He said that since health-care workers aren't at NDC all day, but security workers are, that could make it easier to respond to patients' needs.

When it comes to preventing overdoses, Sproat said, NDC is "light-years" ahead of where it was in 2018 when Cowe died. He said six years later, staff have a much better understanding of the opioid crisis and have better training and equipment to deal with overdoses.

Sproat was cool to one lawyer's suggestion that a safe supply program in the jail could prevent overdoses, saying that would be hard to do in a jail. He said he believes harm reduction is "very effective" in the community and he directs inmates who want to get clean to supports, including addictions counselling.

Lawyers questioned Sproat on Monday and most of Tuesday, when he finished testifying around 4 p.m.

Inquest counsel then began to question the NDC's current health-care manager, Priscilla Ankamah-Lachaud, who said she's been in that role since May.

At Wednesday's proceedings, Ankamah-Lachaud faced more questions, followed by testimony from corrections projects adviser Shelly Robins and Michael Pernal, who works on projects dealing with drug contraband.

Scheduled witnesses include another health-care manager and an expert on health inequities.

The jury is expected to hear closing arguments on Nov. 4 before beginning deliberations.