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Doctor in charge of Faqiri's care in jail defends decision not to send him to hospital amid 'crisis'

The doctor overseeing Soleiman Faqiri's care before his death at an Ontario jail has defended his decision not to send the 30-year-old man to hospital even as he acknowledged Faqiri was in "acute psychiatric crisis" and deteriorating day by day.

WARNING: This story contains graphic details and images

The Central East Correction Centre is located in Lindsay, Ont. east of Toronto.
Jurors heard Tuesday that Dr. Brent McMillan was the only physician on contract with the Central East Correction Centre in Lindsay, Ont., in December of 2016, when Soleiman Faqiri was detained there. The doctor typically saw 35 to 45 patients per day. (Google Streetview)

The doctor overseeing Soleiman Faqiri's care before his death at an Ontario jail has defended his decision not to send the 30-year-old man to hospital even as he acknowledged Faqiri was in "acute psychiatric crisis" and deteriorating day by day.

Dr. Brent McMillan spoke publicly for the first time about Faqiri's case at the inquest into his death Wednesday, saying his priority was to make sure Faqiri got the medication he needed. 

Asked if Faqiri was indeed taking those medications, McMillan said it was "hit and miss."

A person in Faqiri's condition, were they sent to hospital, would normally receive an anti-psychotic injection before being sent back to jail, McMillan said. Beyond that, he said, Faqiri would require the use of a specialized tactical intervention team, which he believed would only make matters worse.

"To do this to this man would cause harm, and for anyone to suggest otherwise, you have no idea what you're talking about, I'm afraid," McMillan said.

"Sending in a group of large men dressed in camo and shields ... that's going to frighten this man."

LISTEN | The latest on the inquest into the death of Soleiman Faqiri on The Current: 

In 2016, Soleiman Faqiri was being held at the Central East Correctional Centre in Lindsay, Ont., awaiting trial. But 11 days after he went into custody, Faqiri, who lived with schizophrenia, died in a violent confrontation with guards. An inquest into Soleiman Faqiri's death is underway. CBC’s Shanifa Nasser walks us through the details.

As for whether he broached the topic of voluntarily going to hospital with Faqiri, McMillan said he couldn't recall.

Jurors heard that McMillan was the only physician on contract with the jail in December 2016, when Faqiri was detained there, and typically saw 35 to 45 patients per day.

Faqiri set to see psychiatrist — visit never happened

McMillan first became aware Faqiri was in crisis on Dec. 7, two days into his stay at the Central East Correctional Centre. Based on the information available, he prescribed a moderate dose of an anti-psychotic medication and referred Faqiri to the jail's psychiatrist.

That appointment was booked for Dec. 10. Jurors have heard the psychiatrist was on vacation at the the time, unbeknownst to McMillan. At no point during his stay was Faqiri seen by a psychiatrist or sent to a hospital.

McMillan saw Faqiri in person on Dec. 9, noting in his records Faqiri was behaving bizarrely, babbling, refusing to put on clothes, and his room was smelling strongly of urine. McMillan noted Faqiri might have needed to be sent to hospital on what's known as a Form 1 for an involuntary psychiatric hold, but decided against it that day.

WATCH | Jail guard filmed Faqiri to raise awareness about his condition:

Inquest into Soleiman Faqiri's death reveals how and when force was used on mentally-ill man

5 months ago
Duration 3:27
WARNING: This video contains violence and some viewers may find it disturbing. CBC News has annotated surveillance video of Soleiman Faqiri's final moments to document the extent of the force correctional officers used on him before he died in a jail cell on Dec. 15, 2016. The timeline is based on an agreed statement of facts entered at the Ontario inquest into Faqiri's death, which is currently underway.

That decision, jurors heard, was based on his experience of patients quickly being sent back from hospital, and because Faqiri was scheduled to see the jail's psychiatrist the following day. On a typical day, McMillan said, there might four to eight people like Faqiri at the jail, and he was concerned about overwhelming the hospital.

McMillan noted Faqiri would need be "formed" upon his release or if he deteriorated, deciding again that the priority would be to medicate him.

Asked about the benefits of sending Faqiri to hospital, McMillan acknowledged the hospital could administer involuntary medication while the jail could not, would assess him for possible medical treatment and would include daily psychiatric visits. The choice not to send him to hospital was governed not by what Faqiri needed, he acknowledged, but because of his concerns about use of the crisis team and the concern that he'd be quickly sent back to the jail.

The plan instead was for the jail's mental health nurse to try to collect information from his family and doctors outside the jail to prescribe him something that would help.

Faqiri called out for mother as he deteriorated

On Dec 13, McMillan met with Faqiri again. It was clear from his chart that Faqiri had not been seen by a psychiatrist as planned. McMillan acknowledged he didn't follow up as to why.

During that visit, McMillan noted Faqiri was smearing and eating his feces, had rubbed it in his eyes, and was banging on the walls of his cell and calling out for his mother.

"He is deteriorating before your eyes, that's correct?" coroner's counsel Julian Roy asked McMillan.

"That's correct," the doctor replied. 

Despite his condition, McMillan concluded Faqiri was not displaying physical deterioration. 

WATCH | Video shows final moments before Faqiri's deadly restraint: 

Soleiman Faqiri inquest: As his condition deteriorated, guards filmed inside his cell

5 months ago
Duration 1:25
WARNING: This video contains violence and some viewers may find it disturbing. The Ontario inquest into the jail cell death of Soleiman Faqiri in 2016 was shown video recorded by corrections officers showing the challenges of caring for the mentally-ill man.

There was no doubt Faqiri needed psychiatric admission, McMillan said, noting Faqiri would not be able to function at home or in society. At this point, McMillan was "desperate" to get Faqiri properly medicated and Faqiri was injected with an anti-psychotic.

It would be 10 to 14 days before that shot would take full effect, McMillan said, but he was relieved Faqiri finally got it.

"Here I was thinking I was on track," McMillan said.

Faqiri died two days later after being repeatedly struck by guards, pepper sprayed twice, covered with a spit hood and placed on his stomach on the floor of a segregation cell. His cause of death, previously deemed unascertained, was later deemed to be restraint in a face-down position and injuries from his struggle with guards. 

At the time of his death, Faqiri, who suffered from schizoaffective disorder — a combination of schizophrenic and bipolar symptoms — was awaiting a medical evaluation at the Ontario Shores Centre for Mental Health Sciences. He had been charged with aggravated assault, assault, and uttering threats following an altercation with a neighbour, but had not been convicted of any crime.

No one was ever charged in his death.

Asked if he would do anything differently in retrospect regarding Faqiri's care, McMillan responded that conditions being what they are and the prevalence of mental health issues in jails only growing, he would not. He did acknowledge it would have been helpful for Faqiri's family to have been able to see him and for health-care providers involved in a person's care outside the jail to see them inside.

As for his own actions, he said: "I know that I wouldn't change anything."

ABOUT THE AUTHOR

Shanifa Nasser

Reporter-Editor

Shanifa Nasser is a journalist with CBC Toronto interested in the justice system, national security and stories with a heartbeat, with a focus on underrepresented communities. Her reporting on Canada's spy agency in 2020 earned an Amnesty International Award and an RTDNA. Her work has also been the basis of two investigative documentaries at The Fifth Estate. Contact her at: shanifa.nasser@cbc.ca

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