When it comes to Toronto's supervised injection sites, who's in charge? Here's what you need to know

A Toronto supervised consumption site has been in the spotlight after an employee was charged in connection with a fatal daytime shooting near the centre in July, spurring a provincial government review of all sites in the province. 

But when it comes to who's responsible for the sites, the answer is complex.

The federal, provincial and municipal governments are all part of a system of approvals, funding and oversight that allow the sites to operate. According to Toronto Public Health, there are 10 sites in the city and six of them — including the South Riverdale Community Health Centre (SRCHC) — are provincially funded consumption treatment services. Among the sites that are not provincially designated consumption treatment service locations, one is not open to the public, one is Toronto Public Health's and another relies on donations.

People in the community around the SRCHC have pointed to increasing concerns in the past year on safety and cleanliness in the area. As a not-for-profit, the site says the more funding it dedicates to security, less gets spent on providing care for clients. Meanwhile, the city councillor for the area hopes the province will provide more funding to help offset that cost.

Jeri Brown lives in the community and helped organize a town hall for residents to voice their concerns around the centre after 44-year-old Karolina Huberner-Makurat was killed by a stray bullet. 

"There's no clarity at all in terms of how these programs are supposed to run from a government and city perspective in terms of who's responsible for what," Brown said. "It's a tangled web that we've been working hard for the past several weeks to try to untangle."

One man has been charged with second-degree murder in connection with the death of the mother of two. A second man has been charged with manslaughter, robbery and failure to comply with probation. And a woman employed by the centre, charged with accessory after the fact to an indictable offence and obstructing justice, is currently on bail.

Supervised consumption sites do provide multiple benefits, says Dr. Ahmed Bayoumi, a physician and researcher at St. Micheal's Hospital in Toronto. Bayoumi was part of a team that was tasked with looking at whether the cities of Toronto and Ottawa would benefit from the implementation of supervised injection facilities.

"There is research showing that people who use supervised consumption sites have lower rates of overdose and lower rates of fatal overdose than people who don't," Bayoumi said. "The sites help to connect people to other services that are useful, both social services and health services, things like stable housing and employment."

Sites go through federal and provincial applications

Before a site is approved, it must apply for a federal exemption under the Controlled Substances Act. Provincially, there's an application process that unlocks funding. Municipally, the city is tasked with some oversight duties by the province such as inspecting for infection control and responding to needle cleanup requests. The sites themselves are tasked with developing community engagement and security procedures, according to the application guide for provincial funding.

"An application includes consultation with a broad range of people in the community," Health Canada told CBC Toronto in an emailed statement.

The application also asks that procedures be in place for disposing of sharp materials and dealing with unidentified substances, as well as security measures "to minimize risks to the health, safety and security of all persons at the site." 

One aspect of both the federal and provincial approvals process is community engagement. The province's application guide says the centre needs to develop an engagement and liaison plan that would include "engagement mechanisms to identify and address community concerns on an ongoing basis." 

To hold the centres accountable, the centres report to the province on "issues raised and how they have been mitigated," reads the application guide for provincial funding.

After the fatal shooting in Leslieville, the province went a step further and launched a "critical incident review" of consumption and treatment services sites. That review will start with the SRCHC.

Meanwhile, the city inspects the sites and provides complaint-based needle clean-up for public spaces, according to Toronto Public Health. Any security complaints filed to the city are re-directed to police.

Councillor wants more funding for security

Coun. Paula Fletcher, for Ward 14, which includes the Leslieville neighbourhood, says the site is responsible for maintaining security within a 15-metre perimeter and wants the province to help them do that.

"[The province] should be funding for the clients that use it inside and they should be funding for the perimeter, to make sure there's enough security people working there outside as well," she said. 

The provincial ministry of health did not directly respond when asked if it would consider increasing funding for the centre to step up security.

The province did not respond to multiple questions from CBC Toronto about its role in supervised consumption sites in Toronto, including if it would consider increasing funding for the centre to step up security, if the province provides funding for security specifically already, and the number of sites it funds in Toronto and Ontario. 

Instead, a spokesperson for the ministry of health shared links to the province's application guide and an enforcement protocol document.

As for the SRCHC employee now on bail, the centre said in a statement last week: "These allegations are deeply concerning to us and to the community. They are also devastating and disappointing to the many SRCHC staff who work professionally and compassionately every day to deliver a range of essential health and wellbeing services to patients and clients in the area."

The centre is focused on working with residents, the city, police and community organizations on measures to improve safety locally, it added at the time.

Meanwhile, Fletcher says the SRCHC has increased security since the tragic death of Huebner-Makurat. But she's worried about the long term. 

"I don't think that's sustainable without some funding." 

When asked if the security implemented by the centre was sustainable, the SRCHC said most of its funding goes toward servicing its clients and patients. 

"We are a not-for-profit organization with limited resources, so putting more funds into security means fewer resources for other areas of our operations. If this is identified as an effective long-term solution to community safety concerns, we will look for ways to ensure that this service can be sustainably funded." 

When asked if the SRCHC agrees with Fletcher that it needs more money for security, it said its open to effective solutions that support community safety. 

"We want to ensure that any changes we implement are supported by evidence that they help our clients and community," the centre said in an email.