WARNING: This story contains distressing details.
Two Alberta paramedics forcing medication on an unfit man in police custody is a case study in the endemic discrimination faced by incarcerated patients, advocates say.
Richard Mirasty, an Edmonton-based Cree defense attorney, said the case is an example of how Alberta’s health care and criminal justice systems are failing to protect vulnerable and marginalized people.
“It’s awful,” Mirasty said. “It’s symptomatic of the whole system.”
The case came to light when an RCMP officer at Elk Point, 215 kilometers northeast of Edmonton, became concerned about the patient’s treatment.
The patient was unresponsive in a holding cell in October 2020 when paramedics Donald Hingley and Ryley Pals inserted Keppra – an oral epilepsy drug – into the man’s rectum using forceps.
In a patient report, Hingley said the patient had a history of traumatic brain injury and numerous episodes of “pseudo-convulsive activity to achieve his ends and as an excuse for his action in life.”
The patient was “more interested in ingesting alcohol and illicit drugs” than medication, Hingley wrote.
Patients accused of pretending
The two paramedics were found guilty of unprofessional conduct by the Alberta College of Paramedics (ACP) for the improper use of medication and forceps – and for failing to properly assess a vulnerable patient. Hingley was also disciplined for accusing the patient of faking his symptoms.
Keppra is not used as a suppository and the use of forceps in this case is not accepted medical practice, the college said.
According to court documents, the college court asked the college if the matter met the definition of sexual misconduct, but was told that CPA Complaints Director Jennifer Kirk had determined that the conduct was rather an error in judgement.
The patient had previously been assessed at Frog Lake First Nation, but it is unclear whether the man – referred to only as Patient A in court documents – is a member of the Cree community. The college declined to comment on his identity.
At last year’s hearing, the college said it had tried to locate the man but believed the complaints were so egregious that its involvement in the investigation would not be necessary.
Mirasty, who represents Indigenous clients in northern Alberta, said the case was eerily familiar.
People with addictions or mental health issues struggle to access adequate medical care within the criminal justice system, and systemic racism remains rampant, he said.
“It’s such a common stereotype of Indigenous people,” Mirasty said. “Everyone is painted with the same brush.”
“A serious systemic problem”
The patient’s report is a glaring example of a dangerous mentality permeating the Canadian justice system, said Tom Engel, an Edmonton lawyer who chairs the Criminal Trial Lawyer’s Association policing committee and is president of the Association. Canadian Prison Law.
Sick or injured incarcerated people are often ignored, Engel said.
“It happens in prisons with healthcare staff who basically have a bias against prisoners in general, that they are not credible, that they complain about health issues because they have a hidden agenda,” Engel said.
“It’s a serious systemic problem.”
Hingley and Pals received official reprimands and mandatory training, and were ordered to pay fines and court costs totaling $1,000 each.
The men were initially suspended, but those sanctions were lifted last week after Kirk, the college’s complaints director, issued a rare internal appeal.
Penalties are weak and suggest the college lacks teeth, Engel said.
Paramedics hold positions of power and face tight scrutiny, strict supervision and decisive discipline, he said.
The case should have triggered an external review by Alberta Justice to determine if charges are warranted, he said.
It seems that the lives of marginalized people do not matter as much to regulators.-Richard Mirasty
In a statement to CBC, the college declined to say whether law enforcement officials were consulted as part of its investigation.
“It seems the lives of marginalized people don’t matter as much to regulatory bodies,” Mirasty said.
“To say that court costs and a fine are punishment enough…the college should be ashamed.”
The discrimination faced by marginalized patients goes far beyond cell detention, said Dr. James Makokis, a Two-Spirit Cree physician from Alberta.
Makokis suggests the paramedics failed in their duty of care and instead passed judgment on their patient.
“Racism kills people,” he said. “Underlying assumptions and biases kill people because of the substandard care they receive.”
The case should trigger changes in the way medical offenses are reported and investigated, Makokis said.
Regulatory colleges must ensure their complaint processes are accessible and provide restorative justice for patients who have been abused, he said.
Demographic information should be collected about the patients involved to help determine whether stigma or racism was a factor, he said.
If the discrimination is not named, it cannot be addressed, Makokis said.
“Has racism been named and treated as a potential element in this investigation?
“And if not, then how can we think that in a health care system as large as Alberta Health Services – where there is systemic racism and discrimination – that we’re actually going to do something about it.”