Inquest for 6 Hamilton-Wentworth Detention Centre inmates to review 2018 recommendations

The coroner's inquest into the drug-related deaths of six men in custody at the Hamilton-Wentworth Detention Centre will revisit 2018 recommendations relating to eight other inmate deaths to determine what's been done to implement them, the inquest's lawyer said Monday on the first day of hearings.

Kristin Smith also told the jury that inquest officials have been in contact with the families of the six men, and that each was "loved and cherished."

Jason Archer, Paul Debien, Nathaniel Golden, Igor Petrovic, Christopher Sharp and Robert Soberal died between 2017 and 2021, either in the Ontario government jail or in hospital. Five of the men had been in the jail between five and 15 months, and one was there for under a day. 

"Losing a loved one is the most difficult thing most people experience in their lives," Smith said, noting that reliving those deaths through an inquest is an exceptional challenge. "We sincerely hope the process can answer some of their questions and bring them some manor of peace."

Smith said the inquest, which is expected to last until at least Dec. 13, will put a lot of focus on the opioid crisis and how to manage it within correctional facilities.

Six years ago, a coroner's jury overseeing the six-week inquest for the eight inmates heard testimony from dozens of witnesses who spoke of overcrowding, easy access to drugs, limited monitoring of inmates and little access to methadone for inmates with addictions. The jury's recommendations included limiting the number of inmates allowed in a cell, possible random searches of staff and having every guard carry naloxone.

The Hamilton-Wentworth Detention Centre, a maximum-security jail, houses people serving sentences of under two years or individuals awaiting trial or sentencing.

The virtual inquest is being broadcast publicly online, with Dr. John Carlisle as the presiding officer. Carlisle and his counsel, Smith and Julian Roy, work for the coroner's office.

Inquests for inmates are mandatory in Ontario under the Coroner's Act. Juries are tasked with answering five questions: who died, when, where, how and by what means (natural causes, accident, suicide, homicide or undetermined). They may make non-binding recommendations designed to prevent future deaths but aren't allowed to make findings of legal responsibility or blame. 

The inquest that began Monday is scheduled to hear from witnesses including senior leaders at the jail, health-care workers, a physician with expertise in substance use disorder, a panel of Hamilton Public Health staff, and officials with the Ministry of the Solicitor General, which oversees corrections in the province. 

There are several parties to the inquest (people allowed to question witnesses), including the families of Sharp and Soberal, and lawyers representing the John Howard Society of Ontario and the Prison Harm Reduction Coalition.

As part of the morning proceedings, the jury heard statements from family members of some of the six men. In the afternoon, inquest counsel questioned Andrea Monteiro, a corrections consultant with diverse experience in the field.

Monteiro was provided with over 8,000 pages of documents, including health and corrections records, related to the inmates. She produced a report outlining the events leading up to and following the men's deaths that will inform the inquest. 

Monteiro answered questions about Archer, Petrovic and Sharp. She's scheduled to discuss Debien, Golden and Soberal on Tuesday.