Coroner evaluating inquest request on cold-related homeless deaths in Toronto

Ontario's chief coroner is investigating several cold-related deaths among Toronto's homeless population and evaluating whether to hold an inquest on the issue.

An advocacy group has requested an inquest, Dr. Dirk Huyer said. At least two homeless people have died as a direct result of the cold in Toronto this winter, but advocates believe there are more.

"The inquest request is being evaluated by our regional supervising coroner," Huyer said in an interview.

Health experts and advocates say there's a lack of centralized data on homeless cold-related deaths and injuries, which they say makes it harder to push for changes to support those who live outside.

Last month, Health Providers Against Poverty, a group of health-care workers who provide medical care to the homeless, wrote the coroner requesting an inquest.

"We believe that it is crucial for the people of Toronto to have an open and full hearing of the circumstances surrounding these deaths so we can take steps to ensure that no other members of our community freeze to death on the streets or in the ravines," the group wrote.

Dr. Richard Wells, the regional supervising coroner, said he was grateful for the group's interest in the deaths.

"I shall plan, when the investigative work in these cases has been completed, to bring them forward for inquest," he wrote.

Suspected hypothermic deaths of anyone — homeless or not — must be reported to the coroner under a provincial legislative mandate, Huyer said.

The most recent coroner data on hypothermic deaths comes from 2020 when seven people died from the cold in Toronto. Seven others died in 2019 and seven more in 2018, 12 in 2017 and six in 2016.

Those aren't necessarily deaths among the homeless, explained the spokeswoman for the Office of the Chief Coroner, saying coroners don't always know the circumstances of individuals who died.

Timely information needed

Huyer said his office has a new case management system that should allow for timely data collection and analysis, rather than having to pore through each case file. But it's not operational yet.

"The goal is to be able to get timely information," he said.

Timely information would be helpful, said Dr. Maggie Hulbert, a resident physician at the University of Toronto and co-chair of the group that requested the inquest.

"But we believe this was predictable and it was directly related to the COVID outbreak response," she said of the recent cold-related homeless deaths in Toronto. "We believe it warranted an inquest."

Health-care practitioners and outreach workers have said beds inside Toronto's shelters and warming units are difficult to find, especially on cold nights.

COVID-19 restrictions on an already-stretched shelter system combined with restrictions on indoor dining and the use of washrooms have left many on the outside looking in, unable to warm up in their usual haunts when temperatures drop.

A man froze to death in a Toronto bus shelter in January and at least one homeless person died at a downtown Toronto hospital from hypothermia.

Street Pastor Doug Johnson Hatlem with Sanctuary, a Toronto drop-in centre, said another man was found dead in an encampment in the Don Valley while one more was found dead in a bus shelter. He said a fifth man was found dead and frozen to the ground a few weeks ago.

Data hard to find

Those deaths and cold-related injuries don't currently go into any central repository, said Dr. Stephen Hwang, a physician and researcher at the MAP Centre for Urban Health Solutions at the Unity Health Toronto hospital network.

There's also currently no legislation that mandates systematic reporting of hypothermic injuries, unlike COVID-19 or tuberculosis cases, he said.

"I'm not sure if the problem of hypothermic injuries and deaths has got better or worse over the last year compared to previous years," he said.

Hwang sought to get a better sense of hypothermic injuries and deaths in Toronto on his own several years ago. He had to comb through records of emergency departments and coroner records between 2005 and 2015.

He found 79 hypothermic injuries, such as severe frostbite, and 18 deaths in Toronto during that stretch.

Cathy Crowe, a street nurse who works with the homeless, said a group of 250 advocacy organizations currently regularly share what they know about homeless deaths with Toronto Public Health but the system has many holes.

"It's hard to influence policy without data," Crowe said, "but we do know it's Canada and we do know people get hurt from the cold and die from the cold."

Toronto Public Health said three people who were homeless died from hypothermia between 2017 and the first half of 2021, although it notes there is no systematic data collection from police, hospitals or paramedics. There have been 560 deaths among those experiencing homelessness in that time, but upwards of 25 per cent have an unknown cause of death.

Dr. Andrew Boozary, the executive director of social medicine at the University Health Network, said the lack of data on the issue is symptomatic of a greater problem.

"This speaks to the systemic discrimination toward people surviving homelessness, and we just have not made it a priority from the data collection to the resources needed in providing quality health care," he said.

"The treatment for this problem is housing, it's simple."