After seven days in solitary confinement, Brett Crane told prison staff he wanted to transform into a werewolf. As his days in "the pit" marched on, he says he saw demons, heard voices and predicted that an imminent earthquake would wipe out humanity.
Health staff at the Surrey Pretrial Services Centre decided that jail was no place to treat Mr. Crane's apparent afflictions and arranged for a transfer to a psychiatric hospital.
But a psychiatrist who suspected that Mr. Crane was exaggerating his symptoms intervened, cancelling the transfer – a decision that left the prisoner languishing for more than nine months in solitary confinement, where his symptoms worsened, according to a complaint filed with the College of Physicians and Surgeons of British Columbia.
The 15-page complaint details the inmate's alleged psychological decline in isolation and questions the judgment of a medical practitioner who allegedly declined to send him away for treatment. In so doing, the document offers a new path for prison reformers trying to align Canada's static approach to imprisonment with evolving international guidelines.
"If medical professions stand up more to practices like this and report signs of torture and cruel treatment or punishment, that will put pressure on corrections to change policies and reduce the use of solitary confinement, especially for people with mental disabilities," said Jennifer Metcalfe, executive director of Prisoners' Legal Services, the legal-aid group that filed Mr. Crane's complaint.
The complaint demonstrates the pervasiveness of a prison practice that has long been a target for reformers. A Globe and Mail investigation has found that Canada's federal and provincial prison systems continue to isolate a high proportion of inmates with mental-health issues. Solitary confinement is used over the strong objections of national and international bodies – including the United Nations and Canada's correctional ombudsman – who say it can exacerbate existing health conditions and create entirely new ones.
"One of the most important systemic issues we come across is inmates with mental-health issues who spend significant time in solitary confinement," Ms. Metcalfe said. "It is probably the issue we're most concerned about. I think it represents a really significant human-rights violation."
The B.C. complaint obliges the college to investigate the psychiatrist's conduct. Mr. Crane alleges that the psychiatrist provided inadequate treatment and failed to comply with international guidelines on the treatment of prisoners, according to the complaint, obtained by The Globe on the condition that the psychiatrist remain unnamed.
Questions sent to the psychiatrist last month have gone unanswered. The college declined to comment on the complaint, citing privacy issues.
Mr. Crane has been in provincial custody since July, 2014, when he was charged with mischief and car theft. Early on, jail staff flagged him for mental-health issues, states the complaint, which references medical records from throughout his time in custody.
In December, 2014, he allegedly began "hearing things and blacking out." Within a month, he was claiming to be an angel and reporting other religious delusions to health staff. He was sent to solitary confinement, where he punched doors, declined medication and stated a desire to "turn into a werewolf."
In April, 2015, after an assault on a fellow inmate who he insisted was a demon, Mr. Crane was certified for involuntary admission to a mental-health facility. Four physicians signed the paperwork and listed a host of symptoms, including paranoia and auditory hallucinations.
But while health staff waited for a mental-health bed to open up, the unnamed psychiatrist assessed Mr. Crane and decided that he was "malingering." His certification was cancelled, along with hopes of a hospital transfer, the complaint says.
In the months of isolation that followed, it was observed that Mr. Crane's delusions continued. Two physicians, a psychiatric nurse and a psychologist all argued for a transfer, to no avail.
Mr. Crane's complaint contends that the psychiatrist's decision contravened both the Canadian Medical Association's code of ethics and the United Nations' new Mandela Rules on the minimum treatment of prisoners. Both documents guide doctors against involvement in practices that might violate basic human rights. The Mandela Rules go one step further by defining several types of solitary confinement as potential torture, including the segregation of inmates with mental disabilities.
But the Mandela Rules have little sway within Canadian prisons. Approved by the UN's General Assembly last December, they are guidelines only.
"I would imagine that most prison physicians are currently unaware of the UN's new Mandela Rules, because these are quite recent," said Ruth Elwood Martin, a former prison doctor and now director of the Collaborating Centre for Prison Health and Education at the University of British Columbia.
But even guidelines can be valuable in navigating the tricky ethical demands of working behind bars. "It is incredibly rewarding to work as a correctional physician, and also incredibly challenging," Dr. Martin said. "As illustrated by [this] case, challenges for a correctional health-care provider arise from ethical dilemmas posed when the security needs of the institution are in apparent conflict with the perceived health needs of the client."
The ultimate governing body for physicians in B.C. is neither the Canadian Medical Association nor the UN, but the College of Physicians and Surgeons. When Ms. Metcalfe wrote the college last year suggesting they work together to codify the Mandela Rules, she was rebuffed.
"While the college shares concerns regarding the potential for maltreatment of individuals in the prison system, the college has no role in the development of institutional policy related to the conduct of guards, or the institution's procedures and practices for dealing with prisoners," Susan Prins, a spokeswoman for the college, said in an e-mail to The Globe, adding that the college receives roughly 25 complaints a year from patients in prison.
Still, Ms. Metcalfe said she sees appealing to the principles of doctors as an important new means of reforming prison practices.
"The point we are trying to make is that it is the duty of health-care professionals to not participate in torture of prisoners, actively or passively," she said. "The Mandela Rules make it clear that it is health-care providers' business to speak up. ... It is not necessarily their decision to put someone in solitary, but they have an ethical duty not to rubber-stamp those decisions and say it's not causing harm when it is."