Remand Centre nurses stressed, lack clear guidelines, inquest into Errol Greene's death hears

A nurse who works at the Winnipeg Remand Centre told the inquest into the death of Errol Greene that medical staff at the centre are stressed and lack clear guidelines for giving out medication.

"I think there's a problem with the distribution of medication. It can be so busy there and it's time consuming. I'm sure if any pharmacist went and saw how they did business there they would say, 'Oh my god, you're in the [1960s],'" said Kathryn Berens.

She also said collaboration between nurses, doctors and pharmacists should be improved.

Berens has decades of experience working in remote communities and worked on a casual basis at the Remand Centre in April and May 2016.

Greene, who had epilepsy and had been prescribed medication, died there after suffering two seizures on May 1, 2016.

The inquest has heard from several witnesses that Greene had not been given his anti-seizure medication, valproic acid, while in custody from early Saturday, April 30 to Sunday, May 1.

The inquest, which began Jan. 29, is seeking to find out why Greene didn't have enough medication in his system, and to identify ways to improve systems at the Remand Centre in order to prevent similar deaths.

Nurses restricted in dispensing medication

During the hearing on Tuesday, Berens described how nurses use hand-written cards to indicate when patients have received medication, and said paperwork often isn'tfilled out properly.

"The processes there are not, in my opinion, well documented I'm used to working with clinical guidelines, policies and procedures of what to do so that there's go-to manuals if you're not sure. I've looked and there isn't any [at the Remand Centre]."

Last week, the inquest heard from Beverley Reeves, the senior health manager at the Remand Centre. She told the inquest that because Greene's prescription had only been filled twice in six months, medical staff decided he should see the doctor on Monday before getting his medication.

Berens expressed frustration with the limited ability of nurses to give out certain kinds of medication.

"How come I can start HIV drugs without the doctor's order?" she said. "In my opinion, the limited guidelines that they do have signed off by doctors is too limited."

Berens would like to see a list of medications that nurses could initiate without a doctor's permission drawn up bythe pharmacy the Remand Centre works with.

She also said nurses at the Remand Centre are stressed, often picking up the slack for other medical professionals, and said guards at the centre often don't understand the importance of the role nurses play.

"I think the nurses there work in a very, very trying environment. I also think the guards don't understand our role there. I don't think it's a very happy workplace, but that's my opinion."

Berens said she has cut back on how much she works at the Remand Centre because of the working conditions.

'No reason' to be denied medication

The inquest is nowon a break, and will resumein October.

The lawyer representingErrol Greene'swidow at the inquest,Corey Shefman, says the family ishopeful for the second half of the inquest.

"We're quite confident in what we've been saying and what Rochelle [Pranteau, Greene's widow]has been saying since the day after Mr. Greene died, which is that there was no reason for Mr. Greene to be denied his medication," he said.

"We're looking forward to hearing in October evidence about policies and procedures at the Winnipeg Remand Centre and how they can be changed."

Shefman said inconsistencyin how nurses prescribe medication has emerged as a significant issue.

"One of the interesting things we've heard is that what that policy is, and whether it even exists, changes depending on who you talk to. Some nurses have told us they wouldn't give medication without first going to a doctor.

"Other doctors, including the nurse we heard today, said very clearly that [they] absolutely would have given the medication before or even without seeing a doctor. That's something we've heard from other nurses as well," he said.

"We also heard from the expert in the treatment of epilepsy that there are no circumstances in which a person with epilepsy should be denied their medication."