“…because … it’s part of our practice” (to give medication without consent)
It has been a disturbing couple of weeks at the Ashley Smith inquest.
The witnesses have been nurses and a psychiatrist from Joliette, and the primary focus has been incidents where Ashley received multiple injections of medications against her will. The descriptions of the events have been surprisingly contradictory, given the video evidence.
For example, there was an incident on 22 July, 2007:
Was it an emergency? (and therefore reasonable to give her 5 injections over the course of a few hours without her consent?) The video would seem to indicate that perhaps not so much, given that Ashley was in 4 point restraints and surrounded by a full team of people who were, presumably, quite capable of preventing the stretcher from tipping over even if she had struggled to that extent (which she did not). Even the nurse who testified that it was an emergency in her view (because Ashley might have potentially dangerous metal or screws stashed in a body cavity; because she was agitated; because there were drops of blood that might have indicated an injury; because she was on a stretcher which could tip if she struggled) – even she wasn’t concerned enough about the so-called emergency to actually give the medication which the psychiatrist ordered (based on her description of the emergency) ”stat” as directed. More than 2 hours later is not, by most standards, stat.
Was Ashley agitated? Again, the video would seen to suggest that she was actually rather less agitated than I would be in that situation. In fact, there was rather more agitation apparent in the voice of the nurse who was dealing with her (and reporting about the big “emergency” to the psychiatrist by phone) than there was to be heard in Ashley’s.
Did she consent to the medication? Again, the video seemed rather more clear than the testimony – she did not, and in fact clearly said “no” more than once. However, what was clear is that nobody who was present cared much, if at all, whether she did or did not. They had deemed it an emergency, and therefore that they were within their rights and responsibility, even, to strip her of her rights.
The testimony given at the inquest made clear that at the very least there were issues in the communication between the nurses and the psychiatrist:
Dr. Michele Roy testified she was “disturbed” a few weeks ago after seeing the videos of the July 2007 injections for the first time. In her view, nothing on the videos warranted giving Ashley medications without consent, the psychiatrist told the inquest.
The Commissioner’s Directives that deal with consent for medical treatment have since been updated – unfortunately, CSC CDs don’t seem to matter all that much. I’ve read many that were in place during Ashley’s time in CSC facilities – if they had been followed, she more than likely would not have died. The problem is not so much in the directives, it seems to me, but rather in the culture which disregards them.
Honestly am getting SO freaking fed up with this!
Once you have something working properly, it should not be so complicated to keep it working – don’t mess with it.
The live stream of the inquest is something that we – the taxpayers – are presumably paying for. They said they were going to provide it, so I did not make arrangements to go down in person every day - for me to go involves more than 5 hours/day of travel time & a great deal of $$. But I WOULD be there if they hadn’t promised the live stream.
Technical difficulties. Again
I am IRKED. Seriously IRKED.
I need to go do something else before I blow a gasket.
Yesterday’s inquest proceedings were extremely difficult to watch – the woman on the stand right now was a nurse at Jolliet, and involved in an incident in which Ashley was restrained – for hours – and injected against her will with anti-psychotic medications repeatedly.
and yes, frustrating … in no small part because the nurse speaks French, much of the conversation on the video is French, and therefore it must be translated by an interpreter, which would be fine, except that one must strain to hear him since he’s not sitting, apparently, anywhere near a microphone. Trying to watch the videos, and make out who is saying what and what is going on is always a challenge – usually I don’t worry much about it though, knowing that I’ll be able to watch them directly later … but later, for these, I will not have the benefit of the interpreter. Anyway … all very frustrating indeed….
- but not half as much as today’s shenanigans. Started without sound at all … then the video feed cut out completely …. thought that might be a good thing – maybe they’re fixing it? … sure enough, it came back on with sound.
For about 5 seconds.
Sure hope we’re not paying too much for this ~service~
Here’s a tip … once you get something working properly? LEAVE IT ALONE.
…but have not, obviously, been writing as much about it lately.
Partly that is just because I’ve been busy – end of semester, job search, and busy time of year for hubby’s business…
but partly, I think, it is because it is getting so freaking frustrating!!
To spend so much time on establishing that CSC was incapable of managing Ashley’s behaviour, or even keeping her alive – while ignoring the 3 years that resulted in her being so very difficult to manage – seems to me to be an exercise in futility.
It seems clear to me that there will be important recommendations that arise from this inquest – but we already know that when committees and inquests and even public inquiries provide CSC with recommendations, they typically manage to twist their implementation into something entirely different – if they even bother to address them at all…. so I’m finding it hard to retain much hope that things will actually change enough to matter.
Another aspect of my frustration: so many of the issues that contributed to Ashley’s death are tied into the notion of “culture” within the prison – and for the most part, this “culture” is something that is talked about as something that can not be changed.
Children who throw apples at mailmen should not wind up in CSC to begin with….even if she had not wound up dead, she should never have been there…..and the scope of this inquest is going to do nothing whatsoever to address that.
So much of this inquest focuses directly on those issues of surveillance which are the focus of my research – and yet, still…we are choosing to look at only small bits in isolation… at data-streams instead of whole people. Looking, but not seeing.
One of the key issues that most/all of those testifying at the Ashley Smith Inquest are being asked is about their recommendations … what alternatives might have saved Ashley Smith? Were there any alternatives to (not) maintaining her in segregation? What would they have done differently?
Aside from stating the obvious – she should not have been there – few have offered any real practical alternatives.
A special centre of excellence which could offer highly specialized treatment is about the only real suggestion … an expensive and unlikely to happen any time soon plan – and even if/when it does, it seems highly likely that CSC will manage to stuff it up so that the people who most need it won’t qualify.
It is what they do.
Need examples? The dog training program at Nova, access to the Healing Lodge, DBT, educational programming, and inpatient psychiatric treatment at RPC or other facilities…. in each and every case, high need inmates like Ashley Smith do not qualify. Have to be a consistently good girl for CSC to trust you with anything that can be remotely considered special or a privilege, don’t you know? Yes, even the treatment you need.
And yes, I’m being a ~tad~ sarcastic about the whole thing… I have read the Arbour Report, and Creating Choices, along with a great many other reports and resources, and it is clear that CSC is very ~good~ at bastardizing recommendations during implementation …. they are made in good faith, but by the time CSC finishes twisting them through their power-and-control culture, they generally no longer have much to do with the original intent. In fact, in many cases, recommendations meant to help women will be twisted in such a way as to be ~implemented~ but in ways that harm or punish.
In any case… back to my original topic, which is the lack of solutions that people who are testifying are able to offer. This is not, to me, the least bit surprising.
The inquest is examining only Ashley’s time in CSC custody. Which was a ridiculous, brutal comedy of errors, bad judgement and nonsense that clearly contributed to…caused, even …. Ashley’s death.
But the problems to which solutions are needed did not begin with CSC.
By the time Ashley Smith arrived at CSC, she was already an extremely disturbed and difficult to manage young woman, with next to no ability to self-manage her behaviours in any sort of appropriate or productive way.
Clearly, segregation was doing nothing good for Ashley – but by the time she got to CSC, the possibility of managing her safely in any other setting was slim to none.
The damage was done – not by CSC, but by the agencies, mental health professionals and systems, schools, counselors, and most especially, the youth ~justice~ system which dealt with her in the 3+ years before she was sent to CSC.
The problems that led to Ashley Smith’s death began with her criminalization for nuisance behaviours… and spiraled out of control with her inability to be a ~good girl~ within the youth criminal ~justice~ system. She did not co-operate with searches, restraints, or video monitoring.
When they said jump, she did not ask how high, she said no, and dug in her heels but good… even if that meant pepper spray, tasers, the wrap, duct tape ….
It’s easy to suggest that everything that happened as a result of her “failure” to co-operatively relinquish control of her body to others was Ashley’s own fault… that her death was her own fault… and indeed, that is a recurrent theme of those testifying at the inquest. Oh, they never say it outright… but it’s there, under the surface….
She refused to comply, she refused treatment, she demanded transfers, she never asked…, she waived her right to a parole hearing … it sickens me.
The problems did not begin at CSC. And in fact, I would bet that the same could be said about many of the other ~problem~ women in CSC’s ~care~ (using the term very loosely).
Just imagine if people could get mental health treatment when it was needed.
Children like Ashley Smith…. Kinew James…. and thousands of other Canadian young people.
And adults too.
I will never forget the case I heard about shortly before I quit working with people who suffered from mental illnesses in any capacity.
A middle aged woman with a serious mental illness was refused treatment, repeatedly. Her family kept taking her to emerg, begging for help… but being turned away.
One day, a teenage girl was pulling a wagon with a 2 year old innocent child in it…and the woman killed him. Stabbed him to death… devastating so many lives. The ill woman and her family’s … the family of the child…. the teenage girl….. and probably others as well.
Sure, sometimes people with mental illnesses refuse all treatment and do not ask for help – but when they – and their families DO – and we, as a society, say no, no, no… you are not sick enough to qualify for help…. no, she/he will be fine…. no, but we’ll put your name on this wait list and get to you when we can ….
what the HELL do we think is going to happen?
Fortunately, most mentally ill people will never act out to such an extent that innocent people are killed or maimed. But it does, in a small number of cases, happen.
And even if they are not likely to actually kill anyone other than themselves – is that a reasonable criteria to require before we, as a society, can be bothered to CARE? To provide support? To offer treatment?
When they – or their families – know they need help and ASK FOR IT? Appropriately, even?
How can we say no? I couldn’t – that is why I left the field of mental health after Mike Harris became premier of Ontario.
In my ideal world, people with mental illnesses receive just as much support and treatment – with just as much urgency – as people with a diagnosis of cancer. We know that treating cancer early saves lives…. well guess what? Treating mental illness early – before people lose their jobs, connections, self worth, housing…. also prevents suffering and saves lives.
NOT offering treatment and support costs society in every way that matters.
Criminalizing people with mental illnesses – which is what we did to Ashley Smith – costs society in every way that matters.
People suffer. Families suffer. Communities suffer. And people die.
As much as I dislike many of CSC’s policies and practices, and as much as I blame them for failing to keep Ashley Smith…and Kinew James… and all of the other far too many inmates, both male and female, alive, I think that expecting them to fix people like Ashley Smith is ridiculous.
NBYC had Ashley for much of the 3 and 1/2 years between the time she threw crab apples at the mailman and the time she was bounced to CSC. THEY couldn’t manage her, they engaged in ridiculous power struggles with her, they punished her by continually adding to her charges so that she earned enough time to qualify for transfer to CSC, and they kept her in segregation – sorry, ~therapeutic (my arse) quiet~ for the majority of the time she was with them.
If we really cared about solutions and alternatives, we would be looking at what actually happened … from the beginning, not just at CSC’s failures.
CSC has a LOT that they need to do a LOT better. And when it comes to Ashley Smith, they have a lot to answer for. BUT the problems did not develop there, and the solutions or alternatives will not be found there.
A proper inquiry is needed.
Unfortunately, as long as the Harper Cons have a majority, we’ll have no such thing… and no actual resources for anything BUT punishment.
But that’s a topic for another rant.
And if they don’t wind up dead, does that mean we don’t have to care about their suffering?
I was home watching the Ashley Smith inquest today.. hubby, though, was out killing bedbugs…and on his way back, happened to catch The Story From Here on CBC radio. He told me I needed to go listen to it. Silly man – he knows these stories just get me going.
The episode is called Courage of the Caregiver, and this story is near the beginning of the episode.
And indeed, this is one of those stories that makes me sick – and also hopping mad.
24 year old young woman with multiple issues, including outbursts/occasional acting out …she WAS doing well in a placement that was able to support her with people that were able to provide her with what she needed. She was enjoying her life, maintaining positive connections with her family and others, and working. Is that not what we as a society WANT for people with such challenges?
Apparently not. When the family she was living with wanted to make a change in the way they provided that support, it all fell apart. And the Province’s solution for this young woman?
A totally inappropriate placement, with people far more delayed than she is, and staff that clearly are not prepared to deal with her issues.
So … they call the police, and she winds up in jail. So far, only for relatively short periods… but with 17 police contacts over the last 5 years, and now that she’s on probation, how long do we figure it’ll be before she does something that deserves a death sentence in Canada… like gee…I dunno…throws a crabapple at a mailman or something?
And yeah, the Quest website mentions psychological and psychiatric services and all sorts of good things, but if you listened to the interview with Mom, it’s pretty clear that they are limited and NOT being provided to this young woman.
How did we become a society where people matter so little to us?
How did we become a country that no longer can be bothered to care for the most vulnerable among us?
What is it going to take before we find some humanity and common sense again?
As Coralee Smith, Ashley’s mom, testified this week at the inquest, a broader inquiry is needed.
The report by Ombudsman and Child and Youth Advocate of New Brunswick, Bernard Richard, is a valuable contribution to the examination of some of the precursors that led to Ashley’s incarceration at CSC. It is not, however, by itself enough to address the many issues and systems failures that contributed to Ashley’s death.
To spend so much time looking at how this severely damaged young woman spent the last months of her life in a very bad place, and how she was able to die while the very adults who were charged with caring for her stood by and did not intervene does not address the issue of how she came to be so severely damaged, nor how she came to be there.
She was a brat. Not always – at least no more than any other young child. But as she became an adolescent, she began to exhibit significant behavioural issues. Still, even then, while clearly troubled, and difficult to manage, she cared for family and for others. She was not prone to violence, but rather, acted out in ways that were disruptive and obnoxious.
Pulling fire alarms, refusing to follow directions, shoplifting a cd, swiping a hat, mouthing off at strangers on the bus… throwing crab apples at a mailman… none of these are behaviours worthy of a death sentence.
And yet, Ashley died.
It is clear that by the time she arrived at CSC, the damage had been done. Incredible amounts of damage that changed a difficult-to-manage but still much loved brat into a deeply disturbed young woman – but still, we should remember, a young woman who did not set out to harm others. Ashley acted out her difficulties by harming herself.
Ashley had opportunities to harm others – she did not take them. In one situation, for example, she was present during a hostage taking incident and was invited to participate. She declined. On at least 3 occasions that we have heard about so far, she was ~accidentally~ released from her cell and could have grabbed weapons with which to seriously harm others – she focused on finding materials for self-harm instead. And she had shards of glass at her disposal for weeks, it seems, towards the end of her life, and yet she is not reported to have used that glass to harm any of the corrections officers who worked with her. She used it to cut ligatures from her security gown, with which to self-harm.
She was, however, charged with assault and property damage on more than one occasion – these are, reportedly, the sorts of charges which led to her less than 30 days sentence extending into what must have felt to Ashley as to infinity and beyond…
So far, every instance of these that we have knowledge of has resulted not from Ashley setting out to harm others, but rather, to prevent others from invading her person, or from leaving her cell.
Imagine, a 15 year old girl who resists strip searches and video surveillance….who resists giving up her intensely private nature, her dignity, to a bunch of adults not related to her….who resists being under the constant glare of security cameras…. and later, after years of solitairy confinement and abuse, who resists being abandonned…alone …. in a cold metal cell without so much as a mattress…a blanket…. toilet paper, tampons, deoderant…a book.
She threw crab apples at a mailman…and the cost of that was her privacy, her dignity, her family, her connections to the world, her education, her adolescence…and her life.
No, one report that examines Ashley’s stay in the NBYC is not enough. Especially when within that report …and others… and within the inquest testimonies we have heard so far… there are plenty of glimpses of the terrifying reality that there are, within Canada, many many other Ashley’s.
This is Canada. These things are not supposed to happen here.
We need to make sure that they never ever do again.
I agree with Coralee Smith. A full inquiry is needed.
It should not be restricted to Ashley Smith’s tragic life, or to NB… but rather should examine the systems which are meant to provide support to young people and their families struggling to deal with mental illness and behaviour problems. The mental health system – throughout Canada – is failing our children, our families, our citizens. People – many, many people – are dying throughout our supposedly developed, humane country.
It is past time to care.
I have, especially since our whole tenant-from-hell nightmare, been paying attention to how many things are messed up in Ontario right now. There are, it seems to me, very few services provided by the province that are NOT seriously messed up.
$230 million (or more) spent to NOT build power plants…. and the apparent inability of people to even manage to pull together the relevant documents.
And on a related topic, when we are all good green citizens and do as we’re asked to conserve power, they “have” to sell off the surplus at ridiculously low prices, or even, apparently, pay other places to take it.
The Office of the Coroner, and the inquest system.
The ORNGE scandal
Unsafe nursing home facilities, where acting out individuals are places with passive people and staffing is inadequate to maintain safety. Also, inadequate services for seniors living in the community.
The Ontario government has, over recent years, made a mess of pretty much everything they’ve touched, it seems to me… education, the DriveClean program, health care, energy, etc. etc. etc…. SO many examples I could keep going for days yet. And now they’re crying poor, so it’s only going to get worse….and of course, it’s all the economy’s fault, nothing to do with them. How stupid do they think we are?
I feel for Kathleen Wynn… she has stepped into a huge mess and I see no hope of fixing any of it given the hash the Ontario Liberals have made of things so far. And the fact that she kept – never mind promoted!!!! – Deb Matthews – provided more than enough evidence for me that she is NOT going to be the leader Ontario needs. It is time for change. Big change.
Personally, I think that at all levels of government, there is too much building on systems already in place, and far too little attention paid to actually getting to the root of things, throwing out what doesn’t work, and starting from scratch to get things right. And far, FAR too little common sense….REAL common sense, not the sort that most politicians use.
Finally made it to the inquest in person today …. have been trying to get there since it started, pretty much, but between bad weather, lots of marking & other work-work to do and illness, haven’t managed it. So was thinking that I would go either today, or next week… but when I heard that Coralee Smith, Ashley’s mom, would be testifying today, that was the kicker… got me off my butt to go even though the roads really weren’t all that great.
Driving down to Barrie was a bitch – driving home was a BITCH… but I made it. Even managed to do it without getting lost this time …. I’m a small town hick (or so my oldest tells me) …getting from the GO Train to the subway to the right place is challenging… and getting back to the right platform even more so. 3 hours there, almost 4 to come back thanks to poor visibility… fun times. SOOOOOOOOOOOOO glad that the inquest is being live streamed so that I can keep up with it without all that travel time and expense.
But it was good to go in person today…. many familiar faces from the first time ’round… a few new ones…. and met a couple of twitter connections (made through following the inquest online).
The morning was spent finishing up cross-examination of CX Michelle Lombardo – was very glad when the rep from the Empowerment Council asked her questions, as many of those were exactly MY questions.
Once upon a time, I was a Rights Advisor in Ontario …. fully trained in the Mental Health Act, and used to spend a lot of time at various treatment facilities advising people about what was happening and what they could do about it when they were placed on a form, or when they were deemed incapable of consenting to treatment.
When that happened, pre-Harris, it was taken as THE single most important sort of loss of rights and a rights advisor would be dispatched immediately. All other issues had longer turn around times….48 hours for forms; up to a week for financial capacity issues – but drop and go for treatment…. because that one is a very big deal.
From everything we’ve heard so far, though, Ashley was never actually deemed incapable of consent…. she was just treated as if she had been. On at least 2 occasions, we’ve heard, she was transported from GVI to Grand Valley Hospital for cavity searches, which she clearly did not consent to. She was physically and forcibly restrained and searched – in spite of her clear insistance that she was not consenting. CX Lombardo was apparently under the impression that these searches were legal because she had been placed under a Form 1 at the time….so not so! A form 1 states that an individual is being held for a mental health assessment for up to 72 hours because they are considered to be at risk of serious harm to themselves or others. Period.
In no case is a Form 1 sufficient to strip a person of their right to consent – or not – to any treatment, never mind the sort of intrusive treatment Ashley was subjected to.
What was rather funny – in a non-ha-ha kind of way – was that Cx Lombardo and other Corrections Officers apparently did not take issue at being party to the internals – but when asked about any medications that might have been given to Ashley to reduce her stress re: transport or whatever, Cx Lombardo stated that they didn’t use them and probably couldn’t because she would have to consent to medications.
Yeah…so we won’t force medication on her, but we’ll tie her to a bed and search her body cavities without consent. For God’s sake!!!!
The test of whether a person is capable to make their own medical decisions is – or, more accurately, is supposed to be – whether they are capable of understanding the treatment and the consequences of consenting to it or not.
In my experience, unfortunately, the reality more often is that a person is deemed to be capable as long as they agree with the doctor – if they disagree, they are clearly incapable, right? But even that did not happen with Ashley… apparently, those laws didn’t apply to her.
In any case, I was becoming exceedingly frustrated listening to Cx Lombardo talk about her ~understanding~ of the mental health act ….and then 2 lawyers for doctors who have standing in the case who clearly are on the defensive about their clients’ roles in the whole mess…. So it was a relief when Mary Birdsell, lawyer for the Empowerment Council, got to her questions – both about the mental health act, and about CSC’s (mis)management of self harm behaviours.
Coralee Smith’s testimony began with some pictures of Ashley as a young girl… heartbreaking, but I am glad I was there to hear about Ashley in better times. Aside from discussion about Ashley (and the rest of the family) before Ashley wound up in custody, testimony covered the various psychological and psychiatric assessment reports Coralee obtained about Ashley, and the difficulties of arranging visitation with Ashley while she was in the ~care~ of CSC.
Ashley was moved 17 times in 11.5 months – and the paperwork that needed to be completed in order to permit Coralee to have phone calls and visits with her was clearly not transferred with her. We saw examples of 2 of the forms that Coralee had to complete to visit – one was for Nova, the other for RPC … they weren’t even the same FORM, for crying out loud. The child was in the custody of CSC – surely they could have one form that would apply to permit visitation at any/all CSC facilities? No such luck… each time she moved, the process had to start over. Charming.
We’ve heard several times from COs that Ashley didn’t have visits from her family throughout the majority of her stay – which didn’t fit with what I knew about her family…. now we know why that was: stupidity… incompetence… or just poorly thought out red tape…. in any case, this child who so badly needed her mom was prevented from having contact with her most of the time. Infuriating.
The other issue that came out in this afternoon’s testimony was re: assaults Ashley experienced while at RPC. I had known about one of these – and had quite a number of rants on the topic, actually – but there were 2 others that Ashley told Coralee about. Charming. ~Funny~ how so much of what happens in CSC custody is videotapes, but no tapes were available for these incidents, innit?
This is Canada. A developed country – supposedly a good place to live. These sorts of things are not supposed to happen here.
CSC is the focus of the inquest – but they are not solely responsible for what happened to Ashley Smith…. a topic for another day though… I’ve had a long enough day as it is, I think.