TORONTO - A doctor who examined a mentally ill man days before he died at an Ontario jail believed sending him to hospital for an assessment could put his safety at risk with no guarantee he would be admitted, a coroner's inquest heard Wednesday.
Dr. Brent MacMillan first saw Soleiman Faqiri at the Central East Correctional Centre in Lindsay, Ont., on Dec. 9, 2016, and could tell the 30-year-old man was “quite sick” and experiencing delusions, he told the inquest.
He referred Faqiri to the jail's psychiatrist, not knowing the psychiatrist was unavailable, and prescribed antipsychotic medication, the inquest heard.
The doctor wrote in his notes that if Faqiri was released from jail, he would need to go to hospital for a mental health assessment. However, MacMillan opted not to transfer him at that time because he felt it would not be in Faqiri's best interest, he told the inquest.
While admission to hospital has many benefits, including the ability to force someone to take medication, the hospital instead typically sent inmates back to jail after administering one dose, MacMillan said. That's generally not what happens when someone in the community is sent to hospital for an assessment, he said.
“The risk associated with trying to corral a man who's frightened and vulnerable with a team of men who are trained to deal with potentially violent situations - I was quite concerned that would instigate a reaction in this man who was in that mental state at the time that would cause him harm, mental or physical harm,” the doctor said.
If there had been a guarantee Faqiri would be admitted, it would have offset the risk, but under the circumstances, it wasn't worth taking that chance, MacMillan said.
The doctor said his priority was to get Faqiri the medication he needed, regardless of where that happened, and he believed Faqiri would see a psychiatrist at the jail the next day. He was aware that Faqiri did not consistently take medication, he said.
The inquest has heard Faqiri was arrested in early December 2016 after allegedly stabbing a neighbour while experiencing a mental-health crisis. He died after a violent struggle with corrections officers on Dec. 15, 2016.
In his time at the institution, Faqiri never saw a psychiatrist. The inquest has heard the jail's psychiatrist was on vacation at the time and there was no one to fill in.
When MacMillan next saw Faqiri on Dec. 13, there was no note from a psychiatrist in the file, so the doctor said he may have inferred that the referral hadn't happened.
At that time, MacMillan was able to observe Faqiri himself, he said. He could see Faqiri talking to himself and gesturing in a cell that was strewn with garbage and smelled like urine. Faqiri came to the door naked, the doctor said, and there was a note in his file that he had been smearing and eating feces.
MacMillan saw it as “a marker that this guy is deteriorating mentally,” but he still felt sending him to hospital was too risky, he told the inquest.
The doctor decided to give Faqiri an injectable medication himself and Faqiri agreed to it after a short interaction, he said. The medication's effects wouldn't fully kick in for about two weeks, but the goal was to get Faqiri stable, he said.
MacMillan said he wasn't aware at the time of a government policy that called for inmates to be sent to hospital if their care needs exceeded what was available at the institution. That policy had not been communicated to him, he said, adding he only learned of it recently.
This report by The Canadian Press was first published Nov. 29, 2023.