For Immediate Release
Federal Prison Ombudsman Releases
Study on Deaths in Custody:
Report Finds Some Fatalities Could Have Been Averted
Backgrounder: Deaths in Custody Study
DEATHS IN CUSTODY - Final Report
OTTAWA, June 27, 2007 - A report into federal
inmate fatalities has found some deaths of prisoners while in custody could have
been averted through improved risk assessments, more vigorous preventive measures,
and more competent and timely responses by the Correctional Service of Canada (CSC).
The study, commissioned by the Correctional Investigator of Canada, examined all
reported deaths in Canadian penitentiaries due to factors other than natural causes
from 2001 to 2005.
The Deaths in Custody Study
examined 82 reported suicides, homicides, and accidental deaths of prisoners while
in custody of the Correctional Service during the five year period. "The findings
are disturbing and indicate that the Correctional Service has not rigorously fulfilled
its mandate to keep all inmates safe and act on recommendations related to inmate
deaths," said the Correctional Investigator, Mr. Howard Sapers. The report found
the Correctional Service has failed to incorporate lessons learned and implement
corrective action over time and across regions, with the same errors and observations
being made incident after incident. The study found the Correctional Service of
Canada resists or fails to reasonably act on a large proportion of Coroners'and
Medical Examiners' findings and recommendations.
"This report confirms my Office's own assessment that similar observations and recommendations
are made year after year by the Correctional Service's national investigations,
provincial coroners, and medical examiners. Although the Correctional Service says
it takes corrective action to ensure similar situations do not occur again, the
same problems are repeatedly occurring, resulting in the tragic loss of human lives,"
said Mr. Sapers. "In order to reduce the number of fatalities, a timely and systematic
follow-up on corrective actions is required to ensure that preventive measures are
implemented", he added.
The Correctional Service has indicated a willingness to address many of the Deaths
in Custody Study's findings. The Office of the Correctional Investigator
is now working with the Correctional Service in an attempt to ensure that existing
procedures and requirements are adhered to. While the Correctional Investigator
characterized CSC's response to the study's findings as "encouraging", citing the
Correctional Service's commitments to improving the timeliness of its investigation
process, enhancing mental health services and better responsiveness to incidents
- he also noted his Office would be monitoring the actions of CSC for tangible signs
of real progress in the coming months.
The Correctional Investigator is mandated by an Act of Parliament to be an independent
Ombudsman for federal offenders. This work includes ensuring that systemic areas
of concern are identified and addressed. The Deaths in Custody Study, as well as
the latest Annual Report 2005-06, are on the Correctional Investigator's Website
at www.oci-bec.gc.ca.
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For further information:
Ivan Zinger, LL.B., Ph.D.
Director of Policy and Senior Counsel
Office of the Correctional Investigator
(613) 990-2690