Understanding any impacts after an order for such technology expires. An approach that is not one-size-fits-all. Provide support for training and capacity building for childrens aid societies and licensed residential facilities to meet the consultation requirements with bands and First Nation communities under sections 72 and 73 of the. When a community prescription for an opioid medication is discontinued or amended by a. Held at: OttawaFrom:April 20To: April 29, 2022By:Dr.Bob Reddochhaving been duly sworn/affirmed, have inquired into and determined the following: Name of deceased:Babak SaidiDate and time of death: December 23, 2017 at 11:30 a.m.Place of death:Morrisburg, OntarioCause of death:gunshot wounds to the right shoulder and right side of the back.By what means:homicide, The verdict was received on April 29, 2022Coroner's name:Dr.Bob Reddoch(Original signed by coroner). The ministry should conduct an Indigenous led study that consults with Indigenous community organizations and Indigenous healthcare providers to obtain information regarding Indigenous cultural and spiritual healing practices and use of Indigenous traditions known to assist in prevention of substance use, wellness and a means to address addictions in a culturally sound way. The verdict means the jury confirms the death is suspicious, but is unable to reach any other verdicts open to them. The ministry should provide educational opportunities to persons in custody and operational staff at correctional facilities about the Good Samaritan principles that it adopts in its operational policies and practices. It simply aims to gather information in order to answer these questions. The inquest into Julie's death finished last week with the Coroner giving a neglect conclusion in respect of the care which North Bristol NHS Trust provide to Julie. It would also provide a primary point of communication for emergency response and medical personnel. Consider including a case study focused on falling ice in excavations in future inspector training material. Continue to ensure that all young people in care have reasonable access to cell phones or other technologies they may need to communicate with their family, their First Nation and others important to them. This would both provide a warning and a specific ongoing reminder to any person entering such areas. Institute a policy to mandate regular debriefs with officers involved with incidents that engage the Special Investigations Unit to ensure that supports are in place and the incident to be used as a learning tool so that future incidents can be prevented. Once the ministry completes the consultations on tear-resistant sheets and blankets, if there are viable options, the ministry endeavor to implement the use of such bedding in all provincial institutions. Inquisition and narrative verdict - Catherine Hickman; Conclusion. For a young person in its program, engage with the guardian at the intake stage to set clear lines of responsibility regarding communication of information regarding the youth to those in the youths circle of care, including communication of self-harm attempts and leaving the property without permission. Consider an appropriate role for community members or organizations as part of the missing person investigation, or in a debrief with the missing person once the investigation is concluded. This will require consultation with and inclusion of a diverse group of Indigenous communities/agencies, in recognition of the fact that Indigenous cultures/traditions/ways of being are not monolithic and that Thunder Bay is home to Indigenous peoples from across the North who possess a spectrum of cultural values/languages/ways of being. whether the missing person is an Indigenous youth. Create guidelines for staff in making decisions regarding whether to issue, review, revoke, or add conditions to. Specifically: prioritize the Health Care Performance and Planning Units analysis of recruitment challenges for correctional health care staff. If there is no individual evaluation component, the ministry should consider implementing one. The ministry shall support the National Inquiry into Missing and Murdered Indigenous Women and Girls' Call to Justice 14.6 as it applies to provincial corrections services. Improve knowledge and awareness for police communicators, call takers, and dispatchers of the signs of mental health crisis, and ensure that communicators are trained to ask questions directed at determining whether a call involves a mental health crisis. An inquest jury examining the cases of two Oji-Cree men has released 35 recommendations after a four-week hearing in Thunder Bay, Ont. The following are few of the most commonly used inquest verdicts: Natural cause (this includes cases of fatal medical issues) Misadventure and/or accidents Industrial disease (you can get this as coroner's inquest for asbestosis that causes death) Unlawful killing Lawful killing (this includes cases of death by acts of war or self-defense) Another is David West, the owner of Abracadabra restaurant in London, which . Led by the Chippewas of Georgina Island First Nation, support the development and delivery of a case study training module for childrens aid societies and residential service providers regarding the lessons arising from Devon Freemans life and death and incorporate information from the Narrative document (with the exclusion of personal identifiers or information that may identify individuals or otherwise assign blame). Reconvene one year following the verdict to discuss the progress in implementing these recommendations. A coroner's inquest . Held at: Thunder BayFrom:June 13To: June 13, 2022By:Dr.Steven Bodleyhaving been duly sworn/affirmed, have inquired into and determined the following: Name of deceased:Gabriel McKayDate and time of death:November 6, 2017 at 11:20 p.m.Place of death:St. Josephs Care Group, 35 Algoma Street North, Thunder Bay, OntarioCause of death:complications related to a severe brain injury sustained as the result of a workplace fall suffered September 14, 2016By what means:accident, The verdict was received on June 13, 2022Coroner's name:Dr.Steven Bodley(Original signed by coroner), Surname:LepageGiven name(s):RonaldAge:59. Time of death could not be determined.Place of death: Foymount, OntarioCause of death: shotgun wound of the chest and neckBy what means: homicide, The verdict was received on June 28, 2022Presiding officers name: Leslie Reaume(Original signed by presiding officer). Encourage review and participation in all best practices regarding cyanide safety put forth in the international Cyanide Management Code. Develop and deliver training for constables and sergeants on interpersonal skills, emotional intelligence, leadership, and team building. Court listings are held in the Avon Coroner's Court, Old Weston Road, Flax Bourton, Bristol BS48 1UL At this time Jury inquests are being held at Ashton Court Mansion House, Ashton Court Estate, Long Ashton, Bristol, BS41 9JN These listings are subject to change. Ensure that all police officers who interact directly with the public are provided with the four-day mental health training currently provided to incoming police officers in their first year of service. Report to the Thunder Bay Police Services Board on the above. Please note inquests can be changed at the last minute, please check before attending. Consider applying other ministry resources to support health care staff recruitment at the, Monitor how often inmates on suicide watch at the, Ensure that if any inmates on suicide watch at the, Provide an anonymized public report on the number of inmates on suicide watch at the. The task force would involve representatives from, and meaningful input from: Members of the Thunder Bay community including individuals with lived/living experience, members of the Thunder Bay District Mental Health & Addictions Network, Superior North Emergency Medical Services, Nishnawbe Aski Nation and Anishinabek Nation, other Indigenous and community partners who wish to participate. Held at: SudburyFrom:June 13To: June 16, 2022By:Dr.Geoffrey Bondhaving been duly sworn/affirmed, have inquired into and determined the following: Name of deceased:Ronald LepageDate and time of death:April 6, 2017 at 9:12 p.m.Place of death:Health Sciences North, 41 Ramsey Lake RoadCause of death:blunt force/crush injury to abdomen and pelvisBy what means:accident, The verdict was received on June 16, 2022Coroner's name:Dr.Geoffrey Bond(Original signed by coroner), Surname:BlairGiven name(s):Delilah SophiaAge:30. The ministry should explore the use of a scoring metric to determine risk in areas such as mental health and violence, assessed first at Intake and re-evaluated on a continuous basis. We recommend that significant and automatic fines should be levied against any company/constructor that fails to ensure that a dedicated Signaller be assigned to Hydro-vac crews and/or any crane operation when working in the vicinity of overhead powerlines. Service models in the areas of substance use and abuse, general criminal behaviour, mental health, fathering, and culturally specific services. It is most commonly used when none of the other verdicts are appropriate. Consider including conductive energy weapons training as part of the mandatory curriculum for police recruits at the Ontario Police College with a yearly re-certification. Ensure that the Central East Correctional Centre (. We recommend that an industry wide Hazard Alert be published, alerting end-users, and manufacturers of remote-control devices for booms and cranes, to the risk of inadvertent boom or crane movement associated to the OMNEX T300 Wireless Remote Control, or any similarly designed remote control used for boom or crane operation. The ministry should deliver alerts to persons in custody on an urgent basis regarding new and emerging threats from novel street drugs. Develop and implement a pilot project to explore the feasibility of dispatching crisis support workers to mental health service calls that do not require police involvement, similar to Peel Regional Police Mental Health Strategies. The OCC use the findings to generate recommendations to help improve public safety and prevent future deaths in similar circumstances. The data should be standardized, disaggregated, tabulated and publicly reported. The ministry should ensure that all correctional officers are trained regarding recognizing behaviour of Inmates that might pose a risk to the Inmate or others. Ensure that the employer continues to properly identify and review Potential Chemical Hazards of cyanide at the mine site and modify the training, procedures and medical response as required. Acknowledgement of i) and ii) by the competent assistant. Held at: Toronto, virtuallyFrom: August 22To: August 26, 2022By: Dr. Bonnie Goldberg, Presiding Officer for Ontariohaving been duly sworn/affirmed, have inquired into and determined the following: Name of deceased:Alexander PeterWettlauferDate and time of death: March 14, 2016 at 1:21 a.m.Place of death:Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, TorontoCause of death:gunshot wounds to chestBy what means:undetermined, The verdict was received on August 26, 2022Presiding officer's name: Dr. Bonnie Goldberg(Original signed by presiding officer), Surname: PigeauGiven name(s): RichardAge:54. The orientation should include hazards, work processes and medical issues, that may be unique to that work site. However, the Coroner may decide to hold an inquest to establish the facts. This should be a focus for performance management and quality assurance processes. It's different to a trial in a criminal court; no-one is convicted at an inquest. Consider reviewing the mandatory frequency of refresher courses for Suspended Access Equipment Training. Consideration should be given to two-way information sharing including of case notes, and opportunities to order treatment in institutions for those with existing probation orders who are on remand. Establish clear guidelines regarding the flagging of perpetrators or potential, Recognize that the implementation of the recommendations from this Inquest, including the need for adequate and stable funding for all organizations providing, Create an emergency fund, such as the She C.A.N Fund, in honour of Carol Culleton, Anastasia Kuzyk and Nathalie Warmerdam to support women living with. The ministry should create and implement a policy that requires the use of specific language by correctional officers and healthcare workers at each correctional facility which prioritizes humanizing people in custody by addressing them as patients, persons in custody and/or persons who use drugs. . Show entries Require all police services to immediately inform the Chief Firearms Officer (, Create a Universal RMS records management system accessible by all police services (including federal, provincial, municipal, military and First Nations) in Ontario, with appropriate read/write access to all. The ministry should conduct regular reviews to ensure its complement of nurses is sufficient to allow thorough assessments of each Inmate. The ministry should explore safer alternatives to wooden pencils being provided to Inmates. The Toronto Police Service should continue to build a diverse. 10am Neil Parsonage, aged 66, from Windsor, died 26/03/2022 in JRH; Tuesday 14 March Inquest to conclude. how to prevent heat stress and other heat related illnesses that may arise from working in high temperature conditions, and. The ministry shall ensure that supports are put in place to assist all the people in custody who experienced a death while in custody. All physician assistants and doctors ensure that workplace hazards are incorporated into the assessment of any medical emergency. Verdicts into the deaths of six people and the Coroner's recommendations. Why was the coroner's inquest suspended despite it was open for public and the Russian Investigative Committee was duly represented there? Held at:North BayFrom: November 21To: November 24, 2022By:Dr.S.C. Bodleyhaving been duly sworn/affirmed, have inquired into and determined the following: Name of deceased:Gordon Dale CouvretteDate and time of death: February 22nd 2018 06:21Place of death:North Bay Regional Health Centre, 50 College Dr, North Bay, Ontario, P1B54ACause of death:Sudden death with no anatomical cause associated with acute-on-chronic cocaine and amphetamine abuse/intoxication, forcible struggle and possible Autonomic Hyperactivity SyndromeBy what means:accident, The verdict was received on November 24, 2022Presiding officer's name:Dr.S.C. Bodley(Original signed by presiding officer), Surname: Blackett,Given name(s):CraigAge:41. For a free, no-obligation, initial discussion of how we may be able to help, please contact us today. Coroners' appointments . The Office of the Chief Coroner should consider conducting inquests within a timely manner, within 24 months from the incident date with the exception of extraordinary circumstances. The implementation plan should be made public in order to ensure accountability. This should emphasize the importance of open communication and positive relationships in carrying out police work, and conflict resolution tools. Names of the deceased: Blumberg, Alexsey; Bondarevs, Aleksandrs; Fayzullo, Fazilov; Korostin, VladimirHeld at:remote inquestFrom:January 31To: February 4, 2022By:Dr.John Carlisle, coroner for Ontariohaving been duly sworn/affirmed, have inquired into and determined the following: Surname:BlumbergGiven name(s):AlexseyAge:38, Date and time of death: December 24, 2009 at 4:30 p.m.Place of death: 2757 Kipling Avenue, TorontoCause of death:multiple injuries due to a fall from a suspended work platformBy what means: accident, Surname:BondarevsGiven name(s):AlexsandrsAge:24, Surname:FazilovGiven name(s):FayzulloAge:31, Surname:KorostinGiven name(s):VladimirAge:40, The verdict was received on February 4, 2022Coroner's name: Dr. John Carlisle(Original signed by coroner). Expedite the processing, and provision of support (if warranted), to front-life provincial corrections staff claims when they are involved in inmate suicides. The ministry should take steps to actively promote awareness of information, services and programs available to persons in custody regarding opioid/other substance use. Contact Kent and Medway Coroner. At the end of an inquest, the Coroner will read out a formal verdict to record: the identity of the deceased; how the death happened ; . The Chief Firearms Officer should work with appropriate decision-makers to: The Information and Privacy Commissioner of Ontario should: Surname:McKayGiven name(s):GabrielAge:36. Inform staff and affected personnel that resources are available to support them with respect to work related stress. Establish the frequency of review, for currency, accuracy, and protectiveness, of cyanide-related procedures. The coroner will open the inquest in order to issue a burial order or cremation certificate (if not already issued immediately after the post-mortem examination) as well as hearing evidence confirming the identity of the deceased. Held at: WindsorFrom:June 20To: June 30, 2022By:Dr.David Edenhaving been duly sworn/affirmed, have inquired into and determined the following: Name of deceased:Delilah SophiaBlairDate and time of death: May 21, 2017 at 8:58 p.m.Place of death:Windsor Regional Hospital Ouellette CampusCause of death:hangingBy what means:suicide, The verdict was received on June 30, 2022Coroner's name:Dr.David Eden(Original signed by coroner), The term SWDC/ministry means SWDC and the ministry, Surname:FerranteGiven name(s):FrankAge:44. It should be clear that it is broadly accessible and not limited to a particular kind of relationship. This unique intersection of Blackness and lived experience of mental health issues must be specifically addressed in any training on use of force, de-escalation, and police interaction with such persons. Blackburn. That the Thunder Bay Police Service review its jailer academic programming and, if not already included, incorporate an educational component on the Human Rights Code and training on cultural sensitivity. Implement recommendation #20 from the inquest into the deaths of Arun Rajendiran, Darrel Tavernier and Stephen Kelly. The ministry should engage with Indigenous communities, organizations and health care providers in the development of corporate strategies, such as the Correctional Health Care Strategy and the Mental Health and Addictions Strategy for Corrections. Commission a study to examine the creation and implementation of a province-wide, civilian-led crisis intervention system to respond to persons in crisis, including mental health crisis. That the sobering center meet the criteria for the designation of an alternate level of care by the Ministry of Health to permit paramedics to transport patients to the sobering center rather than an emergency room. Time of death could not be determined.Place of death: Wilno, OntarioCause of death: shotgun wound of the chest and neckBy what means: homicide, Surname: WarmerdamGiven name(s): NathalieAge: 48, Date and time of death: September 22, 2015. Try to find out: the date the. Ensure that security patrols are completed during shift changeovers. As part of routine staff training, continue to train staff on the rights of children under relevant legislation, including privacy rights. Sometimes a coroner uses a longer sentence describing the circumstances of the death, which is called a narrative verdict. Develop, establish, and provide regular training to, circumstances in which the policy is applicable, including when an individual would be considered potentially dangerous, involving a supervising officer in the planning of the arrest, when possible, completing an arrest decision tool, which may include a checklist of criteria, how to identify possible factors that could complicate an arrest, such as possible mental health issues, unpredictability, past incidents with police, and violent history, In support of the planning process, develop and provide guidance and training on circumstances where it may be appropriate to contact a subject to ask them to attend a police detachment for the purpose of effecting an arrest. The ministry shall update policy so that phone calls by persons in custody are not referred to as a privilege. Explore the possibility of developing and including crisis intervention training as part of the mandatory curriculum for police recruits at the Ontario Police College and the requirement that all officers re-qualify at a determined interval. Amend the Construction Regulations to include a mandatory requirement for training of Health and Safety Representatives who work on construction projects. Presiding Coroner: Witness List: Livestream Instructions: Note or copy the passcode BEFORE clicking on the Livestream Link Click on the link above When prompted, enter passcode, your name and email address You will automatically be connected when the Inquest is in session The Office of the Chief Coroner (OCC) for Ontario provides death investigations and inquests, when necessary, to ensure that no death is overlooked, concealed or ignored. Ensure that housing support personnel communicate the options for both the policing and community-based options to address mental health crisis to affected tenants. The ministry should investigate how security is assessed concerning spiritual elders, knowledge keepers, and traditional teachers. In recognition of the fact that law enforcement agencies in the City of Thunder Bay lack the appropriate training, cultural competency, and resources to provide appropriate services to individuals suffering from alcohol/substance use disorder and/or chronic housing insecurity, work to ensure that community-based programs which provide outreach and services to such individuals are maintained and continued, including and not limited to: the Care Bus, operated by NorWest Community Health Centre, the WiiChiiHehWayWin street outreach initiative, operated by Matawa First Nations Management. Name of deceased. Consider re-allocating more time to scenario-based de-escalation training during annual use of force certification at the, Post the verdict and recommendations of this inquest on the. II. That all police officers be trained that paramedics cannot medically clear any person, and that an assessment by a paramedic does not mean that a patient does not require medical treatment. Consider the viability of a requirement for dump trucks to be equipped with back-up cameras that provide 360 degree visibility. Ensure the Corporate Health Care Unit completes an action plan directed at recruiting and retaining health care staff at the. If it cannot be done immediately, the correctional officers should then bring the Inmate to admit and discharge pending re-assignment to a cell. Regular refresher training on mental health issues should be provided to all police officers who interact with the public. Regularly consult with bands and First Nation communities and Indigenous stakeholders on program implementation and service delivery for new and existing initiatives; and report back within a reasonable period of time. There are no fees attached to this service. Strike a sub-committee of industry partners to review hazards presented by the formation of ice on excavation walls and develop best practices for eliminating or mitigating those risks. The summary should be placed at the front of each health care record and should list all serious medical diagnoses, including opioid use disorder. In consultation with organizations like Hamilton Childrens Aid Society and other agencies servicing high-risk youth, develop a joint process whereby, Establish the role of an Indigenous Liaison within the. Physicians should be encouraged to communicate with a patients community health care providers when discontinuing or amending a prescription for an opioid medication, when consent is provided by the patient. Explore options for privacy screens or barriers around toilets in cells to avoid the need for inmates to fashion their own privacy sheets. consider the need for Navigators, in addition to resource persons, adult ally and circle of supportive persons to assist First Nations youth, as both a prevention and protection resource and for youth both on and off reserve, in navigating various systems such as child welfare and protection, mental health and criminal justice. Held at:Toronto (virtual)From: December 6To: December 9, 2022By:Mr. Etienne Esquega, Presiding Officer for Ontariohaving been duly sworn/affirmed, have inquired into and determined the following: Name of deceased:Jose AmaralDate and time of death: November 25, 2015 at 2:40 a.m.Place of death:Musselwhite MineCause of death:blunt force trauma to head and neckBy what means:accident, The verdict was received on December 9, 2022Presiding officer's name:Mr. Etienne Esquega(Original signed by presiding officer), Surname:MilletteGiven name(s):Denis Stanley JosephAge:52.
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