Naloxone is an opioid antidote. Ontario’s Ministry of Health restricts the distribution of this first-aid treatment to clinics that hand out clean needles to addicts. Public health doctors have asked the government for the last three years for take-home kits to just-released provincial inmates, who can be in particular danger of overdosing on opioids after they leave jail.

In spite of requests from a Ministry of Community Safety and Correctional Services’ senior medical consultant to regional medical officers of health for these kits, Health refused to act. Dr. Eric Hoskins, Ontario’s health minister stepped in and ordered his ministry’s staff to begin distributing naloxone ‘immediately’ to newly released inmates at high risk of overdosing.

Regardless of the benefit expanding the program may have, what is most notable here is that a politician stuck out his neck in support of what he sees as a good cause, and contrary to his bureaucrats’ policy. In spite of the support some CSCS officials have for the project though, a monitoring oversight is needed to ensure orders are followed.

Instructions from ‘head office’ can become corrupted ‘in the trenches’, and the case of Christina Jahn examples how orders go unheeded. Ms Jahn was held in solitary confinement for a total of seven months in 2011 and 2012 at the Ottawa-Carleton Detention Centre without the support and medical attention she needed. She filed a human rights complaint, and the two sides agreed to a settlement on the first day the hearing was to begin in 2013.

Ms Jahn was awarded a sum of money, and Correctional Services was required to commit to 10 “public interest remedies” so no one would be in the same position again. But, her lawyers took action against the government in 2015 for violating the terms of the settlement, alleging some Ontario jails were failing to live up to their obligations. New explicit mandates and directives were subsequently issued by CSCS officials to all institutions. The matter is considered as resolved but there is no process to ensure compliance, and third party surveillance would still uncover some failures.

Nevertheless, Minister Hoskins deserves a laurel for the action he took.

July 11, 2016

The Honourable Dr. Eric Hoskins,
Minister of Health & Long-Term Care,
Hepburn Block, 10th Floor,
80 Grosvenor Street,
Toronto, ON M7A 2C4

Re: Congratulations! Naloxone program.

Dear Minister Hoskins:

The 1980s Britcoms “Yes, Minister” and “Yes, Prime Minister”, knowledgeably written by Antony Jay and Jonathan Lynn, offered an advanced study of how civil service bureaucrats stymie the best intentions of Ministers of the Crown.

It’s refreshing for a government member in your position to overrule staff and order the immediate distribution of naloxone to some newly released provincial inmates. (How refreshing too for ‘immediate’ to appear in government lexicon.) This writer wonders if anyone described the decision as courageous for a politician. Regardless, we need more of this from all areas of administration.

After almost thirty years of observing CSCS, I offer a note of caution. An instruction in place is not the same as an instruction followed. I give you but one sample of good work undone.

After seven months in solitary confinement at the Ottawa-Carleton Detention Centre in 2011 and 2012, Christina Jahn filed a human rights complaint, and settled in 2013 for a sum of money and a commitment by MCSCS to 10 “public interest remedies”. Her lawyers took action against Ontario in 2015 for violating terms of the settlement, alleging some Ontario jails didn’t follow instructions despite direct orders from CSCS officials. Even today, compliance can be an issue.

Consider employing at-arms-length program inspectors.

Yours truly,

Charles H. Klassen
cc David Orazietti, MCSCS