As medical staff were trying to manage an immigration detainee’s delirium — a common occurrence among patients out of the ICU — options were already being explored to transfer him back to the jail or to another hospital for care, an inquest has heard.
The move, wrote the physician in charge of Abdurahman Ibrahim Hassan’s treatment at Peterborough Regional Health Center in the patient’s notes, would be “more of a political issue than medical.”
“I was often dealing with problems with various organizations who had various rules, who had silos built up about things. And I think, over the years, I just got in the habit of calling that medical politics,” Dr. Warren Wilkins on Tuesday told the inquest that is reviewing Hassan’s June 2015 death.
“I was already involved with the (jail) guards telling me that they were probably not going to be able to move him back to the jail. I really didn’t know much about what the jail could do. I know the policy for the Peterborough hospital was to move this fellow back if I felt it was safe to go back to the Lindsay hospital or the jail.”
Hassan, who had been held at Central East Correctional Center since 2013 awaiting deportation to Somalia, was taken to Ross Memorial Hospital in Lindsay, Ont., for seizures and transferred to the Peterborough hospital on June 3, 2015, for more aggressive care.
The 39-year-old man died after a struggle in his hospital room under the guard of two paid-duty officers, OPP Const. Andy Eberhardt and Peterborough police Const. Alice McGriskin. Both constables were cleared of wrongdoing by the Ontario Special Investigations Unit that reviews civilian deaths and injuries involving police officers.
The 15-day inquest is meant to review the circumstances of Hassan’s death in order to avoid such incidents in future. The coroner’s counsel has suggested the cause could have been cardiac arrhythmia related to schizophrenia and antipsychotic medication, physical struggle and restraints, or asphyxia.
The inquest has heard that Hassan, who had schizophrenia and bipolar disorder and PTSD, was heavily sedated in the intensive care unit before he was released to the surgical unit on June 7, 2015, for further assessments and observation.
The man appeared to be confused and disoriented and had difficulties maintaining focus, thinking clearly and responding to questions posed to him. At times, he was agitated and aggressive.
Wilkins, who took over Hassan’s care in the surgical unit, said those symptoms were consistent with the definition of delirium, something that affects more than half of the patients coming out of intensive care. The now retired physician said the question to transfer Hassan to the hospital’s psychiatric unit was never raised.
“I was very knowledgeable of what psychiatry would and wouldn’t take on their unit. I was involved in meetings as my role as chief of medicine between psychiatry and medicine about who should end up in a psychiatric versus a medical bed,” Wilkins testified.
“I thought it was just my feeling that Mr. Hassan was not going to end up in a psychiatric unit, more because of him being on insulin, being a diabetic and some of the other issues.”
In normal practice, Wilkins said, once a patient’s medical conditions stabilize and intensive care is longer required, the person will then be transferred back to the sending institution or family. And that’s what he recommended in his notes on June 9 after an assessment on Hassan.
Wilkins acknowledged that delirium “waxes and wanes,” but a patient with the condition can be sufficiently medically stable for a transfer.
“The major thing was what the jail could offer this gentleman. ‘Could they provide the care that he was going to need?’ There’s a big difference between transferring somebody back to an acute care hospital versus a jail versus home,” he explained.
“You have to be far more ready to be able to go to the bathroom on your own and control of most of the things, be able to eat, et cetera and do to function quite well.”
In the end, a decision was made on June 10 to transfer Hassan to Ross Memorial Hospital after the corrections guard escorting the inmate and the medical staff at the Lindsay jail raised concerns about the logistics of the transfer and their ability to provide the care the man needed.
“Unfortunately, that (transfer) never happened,” said Wilkins, “because of what happened to Mr. Hassan in the early morning hours of the 11th.”
The inquest will resume Wednesday.
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