Two Alberta paramedics forcing a disabled man detained by police to take medication is a case study of uncontrolled discrimination by incarcerated patients, lawyers say. Richard Mirasty, an Edmonton-based Cree defense attorney, said the case is an example of how Alberta’s health and criminal justice systems fail to protect vulnerable, marginalized individuals. “It’s horrible,” Mirasty said. “It’s accidental for the whole system.” The case came to light when an RCMP officer at Elk Point, 215 miles northeast of Edmonton, became concerned about treating the patient. The patient was not responding to a detention 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 stated that the patient had a history of traumatic brain injury and numerous episodes of “pseudo-epileptic activity to get his way and as an excuse for his action in life.” The patient was “more interested in ingesting alcohol and drugs on the street” than in drugs, Hingley wrote.

Patients accused of forgery

Both paramedics were found guilty of unprofessional conduct by the Alberta College of Paramedics (ACP) for improper use of medication and forceps – and for failing to properly assess a vulnerable patient. Hingley was also sanctioned for accusing the patient of pretending to have symptoms. Keppra is not used as a suppository and the use of forceps in this case is not an acceptable medical practice, the college said. According to the hearing documents, the college court asked the college if the case met the definition of sexual misconduct, but was told that ACP Complaints Director Jennifer Kirk had found that the conduct was contrary to the judgment. The patient had previously been evaluated 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. During the hearing last year, the college said it had tried to locate the man, but found the allegations so outrageous that his involvement in the investigation would not be necessary. Mirasty, who represents indigenous clients in northern Alberta, said the case is worryingly familiar.
People with addictions or mental health problems are struggling to access adequate medical care within the criminal justice system, and systemic racism remains rampant, he said. “It’s such a common stereotype for indigenous peoples,” Mirasty said. “Everyone is painted with the same brush.”

“Serious systemic problem”

The patient report is a glaring example of a dangerous mentality that is pervasive in Canada’s justice system, said Tom Engel, Edmonton’s attorney who chairs the Bar Association’s policing committee and serves as the Dean’s Advocate General. Inmates who are sick or injured are often overlooked, Engel said. “This is happening in prisons with healthcare staff that basically have a prejudice against inmates in general, that they are unreliable, that they complain about health problems because they have a hidden agenda,” Engel said. “It’s a serious systemic problem.” Hingley and Phils received formal reprimands and mandatory training and were ordered to pay fines and court costs totaling $ 1,000 each. Suspensions were initially imposed on men, but those sanctions were lifted last week after Kirk, the college’s director of grievances, made a rare internal appeal. Sanctions are weak and suggest the college has no teeth, Engel said. Paramedics are in positions of power and must face strict control, strict supervision and decisive discipline, he said. The case should have prompted an external review by Alberta Justice to see if the allegations were justified, he said. It seems that the lives of the marginalized do not matter so much to regulators.-Richard Mirasty
In a statement to the CBC, the college declined to comment on whether law enforcement officials were consulted as part of its investigation. “It seems that the lives of the marginalized do not matter so much to regulators,” Mirasty said. “To say that court costs and fines are enough punishment … the college should be ashamed.” Discrimination against marginalized patients goes far beyond holding cells, said Dr. James Makokis, Kri’s orthopedic surgeon in Alberta. Makokis suggests that the paramedics failed in their duty of care and instead judged their patient. “Racism kills people,” he said. “Underlying assumptions and prejudices kill people because of the inferior care they receive.” The case must cause changes in the way medical malpractice is reported and investigated, Makokis said. Regulatory colleges need to ensure that their grievance procedures are accessible and provide restorative justice to abused patients, he said. Demographic information should be collected from the patients involved to determine if stigma or racism was a factor, he said. “If the discrimination is not named, it cannot be addressed,” Makokis said. “Was racism named and treated as a possible component of this research?” “And if it is not, then how can we think that in a health care system as large as Alberta’s health services – where there is systemic racism and discrimination – we will actually do anything about it.”