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More on MTC death.
Prisoner's death raises questions - Man dies 4 weeks after receiving cut in jail and kin want answers

By Bob Klager, Ottawa Sun
Sun, December 7, 2003

Tom Elliott knew it was his boy by the leg shackles. His face, swollen to the size of a pumpkin, was no longer recognizable. His hands, once so adept at mechanics and steering that shiny new bicycle as a kid, now lay cold and limp at his sides.

His torso taped tightly, perhaps to control the bloating of his abdomen as he bled inside, barely registered his final breaths. Unconscious, intubated and just hours from death, Jeffrey Elliott was only days from ending a one-year jail sentence he was determined to serve.

And his lifeless legs, blackened by lesions from infection, were still shackled by chains.

It was two days after Jeffrey was rushed from his cell at the Central North Correctional Centre (CNCC) in Penetanguishene to a Midland hospital and eventually to Mount Sinai Hospital in Toronto before Tom was notified that his son's condition had become so critical.

The last time the two had spoken, a cut on Jeffrey's finger had already become secondary. Instead, Jeffrey was focused on Sept. 26, the day he was to be freed after serving time for robbing the Pembroke McDonald's the previous October.

'Dad, Did Wrong'

"I said to him, 'You know, Jeff, when you get out, you should really think about going to college,' " Tom recalls. "He was excited about that. He was originally sentenced to house arrest but he said, 'Dad, I did wrong and I have to do my time.' He said he'd go to jail and serve the time, and at least it would be acknowledgment on his part that he was guilty."

Jeffrey arrived at CNCC on July 25 -- transferred, Tom says, from the overcrowded Ottawa jail. His cellmate in Penetanguishene tells the family that on Aug. 1, Jeffrey approached an agitated inmate's food hatch to try to calm him down during a verbal altercation. The prisoner kicked the hatch shut, causing a 1-cm gash on Jeffrey's left ring finger. It was an innocuous -- and fatal -- cut.

The Elliotts contend Jeffrey sought and was refused treatment for 2-3 days at the jail. On Aug. 12, he was sent to a specialist at the Royal Victoria Hospital in Barrie, where he was treated with antibiotics and then sent back to CNCC. Five days later, the infection had not improved and he returned to hospital for a three-day stay.

On Aug. 25, Jeffrey was found unconscious in his cell.

Shortly after 3 p.m. on Aug. 29, only four weeks after Jeffrey was cut and just days before he was to be released, Tom watched his son die in a Toronto hospital room.

"I was with him right up until ... I was standing there and watching the machine as they slowly unplugged it," he says quietly. "I don't uphold what Jeffrey did; it was wrong. But nobody should have to pay a death sentence like that."

Adversity walked in lock step with Jeffrey Elliott through most of his 20 short years. Abandoned at age two by a biological mother who likely still doesn't know that her son is dead, he was raised alone by Tom in Ottawa, saw a younger brother only a few times and was shuttled through the region's foster care system when alcoholism and the law caught up with his dad.

"Jeff always wondered why his mother left him. You could see the hurt in his eyes," Tom says, sitting at his mother Elizabeth's kitchen table.

"But as soon as he was old enough to get out (of foster care), the first place he came was here.

"He loved his grandmother. He was going to take care of his grandma."

Jeffrey made a special effort to visit Elizabeth every day and once confided to her that he had been sexually abused while he was a ward of the state. But he didn't linger on the horror. Just like that last conversation they shared on Aug. 24 -- the date is circled on the phone bill like some desperate memento -- when he assured her that he was fine.

"He was my pride and joy," Elizabeth says, shaking her head, still in denial over the last time she saw him in a hospital. "It was a horrible, horrible sight. It was neglect. He was on his way out before he even left the jail."

Dr. Martin McNamara, the former chief of emergency medicine at the Huronia District Hospital in Midland, was on duty the night Jeffrey "crashed" in the ER.

"He was admitted quite ill and while he was in our ICU, he deteriorated significantly -- to the point where he actually needed to be resuscitated," McNamara recalls.

"That was the night before he was airlifted to Mount Sinai. While I can't tell you much about his condition, I can tell you that he was a very sick young man."

>From Day 1, McNamara's criticisms of medical treatment at CNCC have been met with suspicion at the facility operated by the Utah-based Management & Training Corp.

"The jail people have accused me variously of having my own agenda, of being anti-privatization," McNamara says. "But my only concern in this is patient care and safety.

"My interest is the fact that patients show up at our door that should have been seen days before, that should have received other types of care, that should be getting follow-up that they're not getting," he says. "I've got case after case after case that shows that."

Triage Guidelines

McNamara never hid his opinions from CNCC management or provincial bureaucrats who monitor their compliance. He'd meet on a monthly basis with jail officials and at one point even tried to help the superjail establish triage guidelines similar to the hospital's. And he was summoned to Queen's Park to articulate his concerns to ministry staff.

While he says he was promised action would be taken, he hadn't seen any change by the time he resigned his position as ER chief two months ago.

"There's a certain way that the American corporation does business, and one of their favourite quotes to me was: 'These are prisoners and we don't mollycoddle them,' " McNamara says. "Be that as it may, they're here to pay a debt to society -- not to be tortured through medical neglect. That's still my stand.

"I don't care if you're in as a pedophile, a rapist or an accountant who embezzled $50,000 -- you're still entitled in Canada to a certain modicum of human dignity and care, and that certainly is not being met."

CNCC facility administrator Dave Thomson couldn't view the situation more differently.

"The offenders in custody here have got a greater access to health care services than you or I do in the community in terms of doctors and timely (care)," Thomson says. "I think there was some misconception that we were actually operating a hospital here at Central North and, clearly, we're not.

"We've worked pretty diligently with our community health care centres to make sure they understand the correctional system, different levels of care we can provide and what resources are required in the community. Medical care at our facility is subject to ongoing review and monitoring to ensure we meet standards.

"We just have to ensure that the appropriate care is provided, and we continue to do that," he says. "There are a lot of offenders who come and go from these size facilities and medical issues are a part of life."

Thomson won't comment about specific circumstances surrounding Jeffrey's case, except to say that the incident which caused his original injury was jointly investigated with the OPP and events leading up to his death were thoroughly reviewed.

"In this particular case, the offender had gone through a variety of medical interventions, obviously to prevent the offender from passing," he says. "There was a lot of medical intervention -- both internally and externally.

"I can't speculate in terms of what led (to his death) or if there was anything the doctors and medical professionals could have done in this particular case," Thomson adds. "That will be addressed during the coroner's inquest."

$85M Superjail

The Elliotts say Jeffrey's personal belongings and ID have never been returned. Thomson says they're at the jail, available for pick up, adding: "Obviously, our thoughts and condolences go to the family and friends."

When the Central North Correctional Centre accepted its first inmates in November 2001, the move heralded a new era in how the correctional system is managed in Canada. As the country's first privately operated adult facility, the $85-million, maximum-security superjail can house 1,184 inmates in its six state-of-the-art units. It was billed by the government as a milestone in a long-term strategy to transform Ontario's correctional system into one that is "more safe, secure, efficient, effective and accountable." But there has been controversy.

The Penetanguishene superjail lies at the centre of a philosophical debate over privatization. And despite Thomson's assurances that standards of health care at CNCC are being met, last January the provincial government issued 12 recommendations to improve medical care at his facility.

Complaints

Such challenges within the correctional system are of special interest to Ontario ombudsman Clare Lewis. Of 21,757 complaints and enquiries his department received during the 2002-03 fiscal year, the largest number -- 7,271, or 33% -- concerned correctional facilities. Of those, 2,767, or nearly 40%, pertained to health-related issues. Adequacy of health care topped the list at 798.

In his 2002-03 annual report, Lewis notes that while he recognized the government's intention to be tough on crime, he was concerned that it take steps to ensure humanity and fairness are observed in the correctional system.

"While the ministry has many sound policies and procedures, my investigations have repeatedly revealed that they are not followed consistently," the ombudsman writes. "It is imperative that the ministry ensure that its staff is aware of the obligations to uphold the rule of law within correctional facilities and that ... inmates still have basic entitlements."

Lewis won't say what portion of complaints are generated by individual facilities in Ontario. But he confirms that a certain number of the recommendations made by the province to CNCC administrators last January originated in his office.

"Some certainly did but not all," he says. "I have concerns about all health care facilities in prisons ... but I'm not going to point the finger specifically at that facility.

"I am watching it with considerable interest because it's our province's first attempt (at privatization) and I think there have been some significant issues regarding implementation and growing pains," says Lewis.

"But health care is something I always have in mind because, let's face it, these people are captive. Whatever you may think of the people or what got them there, once they're there, they're vulnerable and we have a responsibility."

Brant Liberal MPP Dave Levac, the party's corrections critic when it sat in opposition to the Conservatives, has long believed the province is shirking its responsibility at the Penetanguishene jail. In an open letter to the editor of a local newspaper one year ago, less than a year before Jeffrey died, Levac outlined the scope of his concerns:

"My office has been flooded with calls over the past year from family members of inmates at CNCC that have been refused access to medical care," the MPP wrote. "I have even witnessed the wrath of the CNCC management when they find out an employee has contacted my office to discuss activities at the superjail."

In statements to the Ontario Legislature, Levac spoke of "questionable medical practices" at the facility. He likened privatization of the jail to a failed experiment. And he's on record as saying there needs to be a public inquiry into the way inmates are treated in Penetanguishene.

At one time the Liberals' most outspoken critic of Ontario's correctional system, Levac now refuses to discuss his concerns. He instead defers comment to Community Safety and Correctional Services Minister Monte Kwinter. Kwinter says he sees no need for an inquiry beyond individual, mandatory inquests in Ontario whenever someone dies in custody.

"I certainly knew that there were concerns and that these concerns were addressed by having additional safeguards and oversight measures in place to improve it," Kwinter says. "And if we find that these are not adequate, then we will respond to them in a way that addresses those concerns.

Accountability

"When it's brought to my attention by a responsible authority that there are additional shortcomings then we will certainly respond to them."

Lewis says he's not so naive as to think that everything will ever be perfect.

He admits the "jury's still out" on Canada's first privatized jail, that it will require more time before he'd be prepared to make any definitive statements about the facility's success.

But Lewis says he, too, is confident the safeguards for accountability are in place.

The Elliotts are counting on public disclosure through an inquest that is yet to be scheduled into Jeffrey's death. They have retained a lawyer but insist no decisions will be made about pursuing anything until after his death is fully investigated.

"It's not a money factor," Tom says. "Money will never, ever, ever bring Jeffrey back, but by making this noticeable to the public eye, maybe it will stop it from happening to somebody else.

"All we're left with is pictures," says Tom, "and a whole lot of unanswered questions."

Questions about why the system didn't do more. And the agonizing realization that all he could do by the time he reached Jeffrey's side was make sure his son didn't die in leg chains.

Tom Elloitt

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