Brent Abrams' right hand looked swollen and deformed by the time an attentive jail guard took notice.
Mr. Abrams, an inmate at Toronto South Detention Centre, had slipped and fallen on Dec. 31, 2014. A nurse examined the hand in short order and decided he needed to see a doctor to avoid permanent damage. Emergency care would have to wait, however, owing to a health care crisis behind the reinforced walls of Ontario's new flagship jail.
With a capacity of 1,650 inmates, Toronto South Detention Centre is Canada's second-largest penal institution, but its highly touted medical infirmary didn't open until June – 17 months after the prison began accepting inmates – due to a combination of staffing problems and design glitches. Before that opening, conditions within prompted rare and pointed denunciation from several judges, prison staff and a collection of criminal lawyers who represent clients at Toronto South.
"How do you open a jail without being adequately prepared for the population?" lawyer Jeffrey Hershberg asked. "People are being treated in ways at this jail that right-minded individuals will find objectionable. It flies in the face of innocent before proven guilty."
A spokesman for the Ontario Ministry of Community Safety and Correctional Services says an institution the size of Toronto South takes time to get up and running.
"The Ministry continues to work to commission the Toronto South Detention Centre, the second-largest correctional institution in Canada," Brent Ross said in an e-mail. "As you can appreciate, such a large endeavour takes a significant amount of time."
He added that both the institution's 30-bed medical unit and 16-bed mental-health assessment unit were open before the infirmary.
In the case of Mr. Abrams, his hand puffed up before the vigilant guard happened by and summoned a second nurse to take a look. "The guard was supposed to go home at 9:30 that night," Mr. Abrams told a courtroom a day later, last Jan. 6, a full week after his fall. "He didn't go home until 11 because he kept coming back, brought me a nurse, brought me an ice pack, asked me if I'm okay, told me to elevate my hand. … He did more for me than any [health] practitioner did."
The second nurse's conclusion was the same: Mr. Abrams needed a doctor and an X-ray immediately. But what is a routine medical matter outside jail proved impractical inside Toronto South. The doctor was unavailable until the following week and the X-ray machine has been in and out of service since opening day, one of a series of technical and construction bugs to plague the jail since a consortium of Canadian and American corporations completed work on the private-public partnership last year.
When Mr. Abrams recounted the story to Judge Andrea Tuck-Jackson in the Toronto courtroom on Jan. 6 where he was facing gun charges, the judge took the unusual step of halting his court proceeding and ordering court staff to whisk Mr. Abrams to a local hospital.
He returned almost four hours later wearing a cast. "It did turn out that his hand his broken," his lawyer, Shannon McDunnough, told the court, adding that hospital staff had informed him "he would have had to get his hand re-broken" if he'd waited any longer.
Justice Tuck-Jackson was firm but restrained in her criticism of the jail. "I hope that it would be communicated to the Toronto South Detention Centre what the outcome of this gentleman's condition was," she said. "It's very important that they know that."
The injury is now the subject of a pending lawsuit.
By law, inmates are entitled to an equivalent level of care as any other citizen. When the Toronto South opened in January, 2014, the province hyped the cutting-edge medical care offenders would receive within its walls. The complex included at 26-bed mental-health assessment unit, eight-bed intensive-needs unit and two medical units combining for a 120-bed capacity, according to a press release.
In the days after health staff received their first tour of the medical facilities, however, several nurses left the institution, citing safety concerns, according to sources at the jail. Complaints by staff filed with the Ministry of Labour show a multitude of concerns over everything from the potentially dangerous temperature of hot water provided to inmates to the durability of glass panes to a lack of fresh air to understaffing.
"At Toronto South, nurses are right there with the offenders rather than having barriers protecting them," said Rodger Noakes, president of the OPSEU union local representing Toronto South guards, referring to the "direct supervision" architecture of the jail that promotes more direct contact between inmates and staff. "That has been a major concern with nursing folk along with workload."
The departure of nurses left the facility with a gaping hole in its medical staffing at the same time it was struggling to hire hundreds of guards to run the rest of the facility. As a result, some offenders with medical ailments were held in segregation cells rather than medical beds.
"Anybody who has a physical or psychological ailment should be receiving proper medical treatment," said Shane Martinez, one of a small number of laywers in the country practising in prison law. "They should be in an infirmary at the Toronto South for the purposes of providing care to people. The provincial government clearly is showing that's not a priority right now and that they're content with subjecting people to the great psychological stress and anxiety that comes with being in segregation instead of investing the proper time and funding in ensuring the infirmary is operational."
Other judges have noted a discrepancy between the legally mandated health care standards and that provided behind the walls of Toronto South.
On Jan. 13, Justice Diane Oleskiw openly criticized health care at Toronto South when Franklin Afrifa, a man accused in a drive-by shooting, appeared before her after being transferred on the minus-17-degree day wearing a T-shirt. He had been denied medical care for an arm injury and was being confined to a solitary cell without warm bedding, according to his lawyer, Mr. Hershberg.
"Nobody in this minus-17-degree weather should be exposed to the cold without a coat, a warm winter coat on," the judge said. "That's completely unacceptable in this community and this society."
She amended Mr. Afrifa's warrant to specify that he needed warm clothing, bedding and proper medical attention.
By April, Toronto South's reputation had spread throughout the judiciary. During a day of proceedings in Guelph, Ontario Court Justice J. Elliott Allen twice diverted offenders from possible jail time at Toronto South, defending the decision saying he had no "confidence that anyone will be treated properly medically in our custodial institutions."
In the first case, he said a repeat drunk driver deserved at least 45 days in jail, but decided against it on account of the man's recent skin-cancer surgery.
"In the circumstances I think my hands are tied by his medical condition and the disgraceful things that I hear about the conditions of incarceration," he said. "I'm not going to put a medically vulnerable person in that environment based on these facts."