Inquest delves into inmate suicide, prevention for the future

He also asked Dion Dutchak, Jordan Chubey and Ryan Netmaker what officers know about the inmates they work with and their mental health status.

All agreed that while having personal knowledge of an inmate’s situation would help, there are too many prisoners, and they are moved too frequently – as are staff – for it to be feasible for correctional officers to be aware of potential triggers.

“If Robert had said something to me earlier I would for sure have followed up on it,” said Netmaker.

Training includes ways to build rapport between staff and inmates, but he found he largely used skills he learned in his personal life and said it also depends on the connection between two people.

“It depends on your rapport with that person. Does that person even want to talk to you,” he said. “I think the skills I depended on more so were the ones I developed on my own. I don’t know how you become more approachable.”

None of the three guards knew McAdam well, but Netmaker’s memory was of a normal person.

“He was a regular guy, he had a sense of humour about him,” he said.

Chaplains, nurses and Elders are available to the inmates that want to talk.

All inmates, of which there are about 500 at PACC, undergo a suicide screening when they are first incarcerated at the jail and, according to the province’s guidelines, should be screened again when they are moved into a different unit.

McAdam had been transferred to the segregation unit because of his behaviour and issues of functioning with the other inmates, Dutchak explained.

No evidence was presented that he had been screened again at the move.

McAdam was last seen alive by Dutchak after the 11 p.m. check on Dec. 26.

Dutchak was also the guard who first noticed McAdam’s cell window was covered shortly after midnight on Dec. 27 and sounded the alert.

He, along with Chubey and Netmaker, responded when the door was opened and found McAdam, pulling him down and removing the garment from his neck.

They also started CPR and called the ambulance.

None of the three noted any pulse or sign of life in McAdam and neither did Seth Helm, the paramedic who responded.

EMS was at the jail within six minutes of being called and by 12:21 a.m. were performing CPR.

Helm said that in his years of work in emergency medical services, he has responded to an estimated 50 to 75 calls for cardiac arrest.

Of those, maybe 10 people have survived despite intervention by paramedics.

The last testimony of the day was Dr. Ferdie Smit, an ER physician at Victoria Hospital.

ER staff also attempted to revive McAdam but, at 1:01 a.m., concluded there was nothing more they could do.

As Ritter and the presiding coroner, William Davern, pointed out to multiple witnesses and the jury, the purpose of the inquest is not to find blame but is to find ways to prevent similar incidents in the future.

The inquest resumes tomorrow morning at 9:30 a.m. at the Coronet Hotel.

—

susan.mcneil@pattisonmedia.com

On Twitter: @princealbertNOW

by Susan McNeil

Inquest delves into inmate suicide, prevention for the future

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