Witnesses at inquest into deaths of 2 Oji-Cree men all agree Thunder Bay needs a sobering centre

A safe sobering centre would provide better care for people who are publicly intoxicated in Thunder Bay, Ont., and could ease pressure on the first responder and emergency medical systems, say witnesses at the inquest for two Oji-Cree First Nations men who died in police custody.

The inquest, which is in its fourth week, is examining the circumstances surrounding the 2014 death of Don Mamakwa of Kasabonika Lake First Nation and the 2017 death of Roland McKay of Kitchenuhmaykoosib Inninuwug. Both men experienced medical complications while in cells at Thunder Bay Police Service (TBPS) headquarters after they were arrested for public intoxication.

A safe sobering centre would see and treat public intoxication and substance use as a medical issue, and not a crime, testified Shannon Smith-Bernardin, an expert and consultant on safe sobering centres and assistant professor for the University of California in San Francisco.

"One of the main goals of the sobering centre is to provide an environment that is welcoming, trauma informed, meaning it's comfortable for the client to be there, and ideally with compassionate staff trained in substance use disorders, effects of poverty, trauma, homelessness," Smith-Bernardin said.

"The individual will come in and be in an environment where they are supposed to be versus locked up in a jail cell or in an emergency department where they often don't need to be because they aren't medically ill."

Sobering centres have been opened in communities across Canada, including the Northwest Territories, Manitoba and British Columbia. However, in Thunder Bay, there's no full centre — only a handful of safe sobering beds at select facilities. 

During the inquest in Thunder Bay, witnesses testified such a centre would help support people struggling with alcohol use disorder, addictions or homelessness, and prevent the deaths of people who may be intoxicated in public. 

"Every witness who has testified, from every police officer, every paramedic, every expert, everybody has testified that a sobering centre would be a good solution for this problem," said Peter Keen, one of the lawyers representing the coroner presiding over this inquest. 

Mamakwa died from ketoacidosis, a serious complication of Type 2 diabetes, and McKay died from hypertensive heart disease, according to autopsy reports filed as exhibits in the inquest.

Both Mamakwa and McKay should have received significantly more medical attention and supervision than were provided at the police station, according to a significant amount of evidence presented before the four members of the inquest jury — an all-white panel of citizens selected through a jury roll.

In the case of Mamakwa, no personal checks were done on him for hours while he was in the police cell, and an expert testified there was a 97 per cent chance he would have survived the night of Aug. 2, 2014, if he received appropriate medical care or went to the emergency room that night.

He was also experiencing Kussmaul breathing, a deep and laboured breathing pattern often associated with ketoacidosis, which signals the need for life-saving medical intervention.

Similarly, McKay was experiencing abnormal breathing, suggesting he should have received medical care instead of being left in the police cell, according to evidence provided throughout the inquest.

Both of those changes in their medical conditions likely would have been observed and cared for if the men were in a sobering centre, Smith-Bernardin testified Monday.

The sobering centre would provide a number of other advantages, Smith-Bernardin said.

People requiring those services would have the opportunity to comfortably sleep, receive rehydration and food, as well as have access to showers and laundry facilities, all while being monitored by staff to check medical signs and ensure there are no other emerging medical conditions.

The staff also become specialized in supporting people who are intoxicated and can identify common issues that may emerge as they are sobering up. Certain community members will also be admitted to a sobering centre multiple times within one year, which allows staff to observe their health changes over time, and connect them to other resources or programming, Smith-Bernardin said.

Thousands of calls for suspected substance abuse 

A safe sobering centre could also reduce the pressure on first responders like police, who respond to thousands of mental health calls for service that don't require their intervention, and paramedics, who are almost daily experiencing Code Blacks, where there are no ambulances available to respond to calls.

Data presented before the inquest showed paramedics in Thunder Bay have responded to more than 3,500 calls for suspected substance use every year since 2019. 

That results in paramedics spending thousands of hours in the Thunder Bay Regional Health Sciences Centre's emergency room, waiting for the hospital to admit their patients and tying up ambulances, which cannot respond to other calls. This issue is called "offload delay," and has been raised repeatedly by police and paramedics throughout the inquest. 

While it could take hours for police or paramedics to bring an intoxicated individual to custody or the hospital, bringing someone to a safe sobering centre would take just minutes, Smith-Bernardin said.

"In all the research shown so far, it's an average of seven to nine minutes, I've never seen anything longer than 10 minutes … for a police officer or [paramedic] to drop off at a sobering centre."

Smith-Bernardin estimated Thunder Bay would likely require a safe sobering centre with 10 to 15 beds, but as a hub for people across northwestern Ontario, may need more. 

There are some beds available right now, but not at the scale Smith-Bernadin suggests is needed, and access is limited. 

The provincial health agency Ontario Health North West funds four safe sobering beds at each of the following: Dilico Anishinabek Family Care, Keewaytinook Okimakanak and Matawa Health Cooperative. Those beds are reserved for First Nations people from those communities. 

There is also money from Indigenous Services Canada through the Nishnawbe Aski Nation's Choose Life mental wellness funds for safe sobering beds at Keewaytinook Okimakanak, Matawa Health as well as the Northern Nishnawbe Education Council, which administers the Dennis Franklin Cromarty High School in Thunder Bay.

Ontario Health North West also supports the Kwae Kii Win-managed alcohol program and the Balmoral Withdrawal Management Centre, two other supports for people experiencing alcohol use disorder or addiction to other substances.

Molly Boyce, a graduate of the Kwae Kii Win program, testified this week, and spoke about how important the managed alcohol program is in the city. 

Ultimately, it will be the inquest jury that decides what recommendations need to be made and who would be responsible to ensure they're implemented.

Their report is expected later this week following closing arguments.