Jurors urged to find segregation-cell death of Ashley Smith a homicide


TORONTO – The death of a “precious daughter” who strangled herself in her segregation cell as prison guards videotaped but did not intervene should be deemed a homicide, a coroner’s jury was told Monday.

In closing submissions at the Ashley Smith inquest, the lawyer who speaks for her family said overwhelming evidence shows top managers ordered frontline staff to stay out of her cell as long as she was still breathing.

The order, Julian Roy said, was devised by Warden Cindy Berry — “the new sheriff in town” — and communicated through her “weak” deputy, Joanna Pauline, to underlings.

“It was not a big misunderstanding. There was no broken telegraph here. This was not a case of staff confusion,” said Roy.

“It didn’t come off the cuff. It wasn’t improvised. This was an order that was carefully thought out by those that issued it.”

The order was never written down because it was an “obscenity,” Roy said, but senior management’s actions contributed significantly to Smith’s death, making it a homicide.

Smith, 19, of Moncton, N.B., choked herself to death on Oct. 19, 2007, in her cell at Grand Valley Institution in Kitchener, Ont., just a few months after Berry took over as warden.

Roy traced how correctional officers, who initially rushed in when the disturbed Smith tied ligatures around her neck, succumbed to pressure from senior management to stay out of her cell unless her death was imminent.

At first, they resisted, Roy said.

“There is a mini-mutiny,” he told the five women jurors.

“They see a child in trouble who needs help and they can’t follow that order.”

Management, however, would hear none of the correctional officers’ protests, none of their warnings that Smith’s life was at risk, the lawyer said.

Instead, Berry threatened them with criminal excessive-use-of-force sanctions for entering the cell too quickly, according to inquest evidence.

A regional manager, brought in by Berry, also told officers that if Smith died, it would be “death by misadventure,” the lawyer noted.

“If you have decided it’s an accident before somebody dies, it’s not an accident,” Roy said.

Under cross-examination last month, Berry was adamant she had no idea guards were under orders to stay out of Smith’s cell as long as she was breathing. She insisted she relied on Pauline to tell them when to enter Smith’s cell.

Lawyer Howard Rubel, who speaks for frontline officers, urged against a homicide finding, saying guards might have been confused but never actually complied with the “illegal” no-entry order.

The officers, trapped in a “hellish relationship” with Smith, were given no information about her mental health, Rubel noted.

As Smith’s mother Coralee Smith watched, Rubel said the teen’s death was either a “tragic accident” or a suicide given her feelings of despair and her history of talking about killing herself.

Classifying her death as “undetermined” would be “perfectly acceptable,” Rubel said.

Either way, he said, what matters are the jury’s recommendations that will come from the exhaustive inquest.

“We have gotten the truth out there,” Rubel said. “We shone a light in a very dark corner.”

In submissions that reduced a juror to tears, Roy argued the teen did not mean to kill herself. She had told a guard she knew what she was doing and they would save her, he noted.

The lawyer urged jurors, who heard evidence from 83 witnesses over 109 days since Jan. 14, to recommend a ban on segregation for self-harming or mentally ill women, saying it only does more damage.

He also slammed Correctional Service Canada, which he said had no business looking after women like Smith, for its resistance to accountability and change.

“CSC has done almost nothing to respond to Ashley’s death,” Roy said.

“They have moved some boxes around in the org chart.”

Earlier Monday, coroner’s counsel Marg Creal presented 103 recommendations for the jury to consider.

The wide-ranging suggestions included limiting segregation to 30 days, and then only as a last resort.

Other proposals included restricting transfers of mentally-ill inmates, proper resourcing to implement a comprehensive care system for them, and enhanced whistleblower protection for prison staff.

Final submissions resume Tuesday.

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Jurors urged to find segregation-cell death of Ashley Smith a homicide

  1. Suicide can’t be homicide.

    Ashley did herself in.

    • How about criminal negligence causing death?

      • Hardly.

        They stopped her from strangling herself on numerous occasions, but if you strangle yourself often enough, it’s going to catch up to you eventually.

        • Glynn, their duty was to stop her from strangling herself no matter how many times she attempted to do it. If they found that duty onerous, then they should have quit their jobs and gone into a different profession which didn’t involve saving people from killing themselves. The fact is that they knowingly ignored her attempt to strangle herself and as such she is now dead. Therefore, they are very likely guilty of criminal negligence causing death.

          • Had that been their duty they would have been permitted to stop her from doing it, but there is easily enough Court and Supreme Court precedent to prevent the staff from interfering with her stuffing things up into her various body cavities.

          • Glynn, of course if was their duty to stop her from wrapping ligatures around her neck. They have special scissors for cutting the ligatures off.

          • They needed to stop her from getting the ligatures in the first place.

            Because the more often you strangle yourself, the more likely it’ll be that you succeed.

            And every time they entered her cell, they risked sanction for violating her civil rights.

          • “…every time they entered her cell, they risked sanction for violating her civil rights.”
            My goodness GynnMhor, you certainly drank the koolaid on this one. Entering the cell doesn’t violate a person’s civil rights. Saving a person’s life doesn’t violate their civil rights either. Who ever taught you such silly rhetoric?

          • It’s a use of force on the inmate that has to be declared as such, reported, and catalogued precisely because the use of force is regarded as an assault on the inmate.

            And entering her cell was almost always in order to force her to stop doing whatever it was she was doing, and since she stupidly resisted all reason in her efforts, force and restraint was essential.

          • Glynn, Of course you have to record your interventions just like a nurse has to chart any interventions they do. Do you think we don’t cut off ligatures? Do you think we don’t have to chart EVERYTHING we do? We must maintain a full legal chart. We actually legally commit people to our facilities under mental health acts which means they cannot leave. The units are locked. Of course, we must restrain people at times. We cannot medicate people against their wishes except in very specific circumstances or that is assault. People have rights whether they are incarcerated or held under the mental health act. That is what makes Canada a great country because we always respect people’s rights. Do you know what Ashley Smith was incarcerated for?

          • The staff get shit and abuse if the interventions exceed a certain threshold, under the bureaucratic theory that more than a certain number means the staff are being mean and cruel to the inmate.

            Within the CSC paradigm, it makes the facility and its staff look bad to the higher authorities.

            Ashley had a basic right to strangle herself, to stuff her orifices with contraband, and the facility was (and is) driven to respect that right.

            BTW, Ashley was put into solitary for repeatedly assaulting other inmates and staff members.

          • Glynn, I am a psychiatric nurse versed in what occurs in corrections. I am sorry but you are wrong in your assertion that “Ashley had a basic right to strangle herself” in a corrections facility in Canada without the staff stopping her from killing herself. Whether you believe this on some level or not, neither you nor anyone else has the right to take your life on government property while you are their prisoner. They won’t allow it. Regardless of why Ashley was in solitary confinement, she still was not allowed to take her own life and the employees of the institution were not allowed to stand back and let her do it. Had their behavior been unremarkable, this enquiry would have never taken place.
            I do not doubt that there might be a belief that the need to be continually intervening with a prisoner “makes the facility and staff look bad” to their superiors but the alternative which results in the death of a prisoner and a nationwide black mark against a facility and its staff certainly is much worse. It is my understanding that Ashley Smith was originally incarcerated for throwing crab apples at a postal worker and that her short sentence was then prolonged due to incidents that occurred while in custody. Likely, Ashley’s behavior was exacerbated by her being in custody because if she had BPD, people with that disorder decompensate steadily while in institutional settings. I believe you and the management at the prison expected something of her that she was never reasonably capable of accomplishing. You expected her to behave in a rationale fashion when she had never done so in her life and showed no indication that she had the ability to do so.

          • When the staff does not have the right to cavity search her for her ligatures and other contraband, then that gives her the de facto right to strangle herself.

            A system cannot function if the staff is handicapped and prevented from acting effectively.

            And just waiting until she has the ligature on her neck is way late for intervening. Fine tuning as to whether she’s still breathing or whatever doesn’t make such intervention effective.

            Depriving her of what she needs to make the ligatures in the first place, however, is even now not an available option for the staff.

            It’s an absurdity.

            And I don’t “expect” anything in particular from Ashley. If she did not have the ability to refrain from risking her life, the staff should have had the ability to make her attempts impossible.

            Instead she was able to manipulate the staff into intervening after the fact.

            But political correctness and human rights wussiness prevailed, and still does.

          • Glynn, are you aware that there is a medical unit in every prison and it is staffed by nurses who are psychiatric nurses? Those nurses can and do care for patients such as Ashley Smith under the orders of a family physician and psychiatrist who order medications, etc. Patients who are in crisis in corrections can also be sent temporarily out to forensic psychiatry centres where they are cared for indefinite periods of time by psychiatrists and psychiatric nurses. Ashley Smith likely could have and should have received care in a medical unit or a forensic psychiatric facility. It seems that there was some sort of power struggle going on between the management and Ms. Smith but the management made a wrong assumption. They assumed Ms. Smith would stop before she died. They didn’t understand anything about her condition or her low level of functioning. Ms. Smith also was in way over her head. She likely believed they would save her. It was like a game of chicken that went horribly wrong and now Ms. Smith is dead and do not kid yourself, Glnn heads are going to roll. Someone is going to pay. This is a complete nightmare. It isn’t about political correctness or “wussiness”. It is about stupidity and pissing contests leading to foolish decisions that are a no win for everyone involved.
            Are you aware of a case where a pregnant prisoner gave birth alone in her cell because no one would respond to her cries for help? Are you familiar with a case in Calgary where a man got picked up for jaywalking or some ridiculous thing and then got beat so badly in the remand that he is now in a coma? Glnn, the system is broken. Perhaps this case will lead to some meaningful reforms.

          • I don’t think you quite see the problem.

            The staff was not allowed to stop her. Not allowed to bar access to the materials she used. Not allowed to do anything until after the fact, until after she had produced a ligature and applied it.

            They were not allowed to cavity search her, they were forced to provide her with ligature materials in the form of clothing and bedding. That’s the proximate cause of her death.

            Had they been able to remove the materials, there would no longer have been a problem of ‘tying up’.

            The more times she ‘tied up’, the higher became the likelihood that something would go wrong, be it due to changes in orders to prevent her from manipulating the staff, or a mere few minutes distraction from monitoring, or some other factor. It was close to an inevitability, a probability approaching 1.0, that she would succeed at some point in killing herself.

            She should have been kept naked and sleeping on the floor in order to prevent her death.

            And it was indeed political correctness and the application of supposed ‘human rights’ that are at fault here.

            And if she had been sent to the care of some psychiatric nurse and strangled herself there, or assaulted the nurse, or wreaked havoc on the nursing facility, then the staff would again be blamed for not keeping her in isolation, for not controlling her violence, or for not maintaining the security of the staff.

            As to the pregnant woman, had she not been screaming the whole time prior to giving birth the staff would not have decided to ignore her.

            And the solution to inmates assaulting other inmates again runs afoul of the rights of the prisoners not to be isolated from one another except under severe circumstances.

        • She was suffering from a mental illness which was exacerbated by constantly moved from one institution to another & by the amount of time she spent in solitary confinement! How in hell can you place the blame for her death solely on Ashley?

          • I believe Ashley suffered from something known as borderline personality disorder. It is not a mental illness exactly but a personality trait that makes a person do all sorts of behaviors to gain attention. Most of the behaviors are very negative and some are damaging to both the individual and others around them. People with borderline personality disorder (BPD) are not usually suicidal but they might act suicidal (perform suicidal gestures to get attention). Unfortunately, accidents happen and if someone doesn’t save them they do end up dying, like in the case of Ashley Smith, who was not high functioning and was really only acting in the dysfunctional way she had always acted. One philosophy is to ignore the negative behaviors of people with BPD but that can turn out badly as it did in Ashley’s case. The other is to try and get them to deal with people in a straightforward approach where they just ask for attention instead of acting out. That one takes a lot of patience because they have been acting in a dysfunctional way to get attention their whole lives and they can’t change on a dime no matter how much we might wish they could. There is a good therapy for these patients. It is called dialectical behavioral therapy. It is expensive and very intensive but it does seem to work.

      • Certainly the managers who imposed the “don’t intervene” policy are guilty of criminal negligence at the very least.

        • The other issue is that they didn’t ensure that she did not have the means to strangle herself. She was hiding pieces of cloth in her body cavities. From that we can only conclude that she was somehow able to rip parts of her clothing and blankets apart to make ligatures and she was not being adequately strip searched to prevent her from accessing the means of strangling herself.

          • There is sufficient Court precedent to make it a violation of her supposed civil rights to cavity search her often enough to prevent her from carrying the sort of contraband that she used to kill herself.

          • Well, she needed a different kind of bedding a clothing. Something that she could not rip to make ligatures.

          • Or break the TV and stuff broken glass inside her.

          • In segregation there are no tv’s.

          • She managed to access a TV at some point in her incarceration, and stuffed her box with broken glass.

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