First Nations man had 'quite good' chance of survival if taken to hospital instead of cell, inquest told

WARNING: This story describes distressing details about deaths in custody.

Don Mamakwa of Kasabonika Lake First Nation had a 97 per cent chance of surviving the night if he had been brought to hospital instead of a Thunder Bay, Ont., police cell in August 2014, an emergency-room physician told a coroner's inquest Tuesday.

Instead, the Oji-Cree man, 44, died alone in custody at the Thunder Bay police headquarters after he was arrested on suspicion of public intoxication, his pleas for help and medical attention ignored for hours, according to evidence provided so far during the inquest.

Dr. Alim Pardhan testified Tuesday during the second week of the inquest, which is investigating the circumstances surrounding the 2014 death of Mamakwa and the 2017 death of his uncle, Roland McKay, 50, of Kitchenuhmaykoosib Inninuwug. Each man was found without vital signs while in a police cell.

Ina Kakekayash, Mamakwa's mother, previously testified the saddest part for her is knowing he told police he needed medical attention, but was brought to the police station instead.

"Don was a person. He was our brother. We loved him and took care of him best we could. I want to tell the police to treat him with respect. I'm just sad he had to die alone in that place," Mamakwa's sister, Rachel, said during her testimony.

Mamakwa was found without vital signs in the early hours of Aug. 3, 2014. No personal checks were done on him for upwards of five hours, according to an investigation report by the Special Investigations Unit (SIU), a police watchdog.

During a particularly emotional period of the inquest, video from the police cells showed Mamakwa reaching out for help, rocking back and forth, holding his chest and struggling to move and stand before lying down and no longer moving.

He died from ketoacidosis, a serious complication of Type 2 diabetes, alcohol use disorder and sepsis (when the body's response to an infection damages its own tissues), said the autopsy report.

"All three of those conditions are quite treatable, and so the survivability chances" would have been "quite good" if he had been brought to hospital, said Pardhan in his testimony.

Most of the witnesses and evidence presented so far to the five-member civilian jury have focused on the death of Mamakwa, who was homeless and living with alcohol use disorder and other physical and mental health issues.

The evidence has demonstrated clear failures on the part of the entire emergency response, health-care and justice systems to take care of a vulnerable person, said Asha James, a lawyer representing both the Mamakwa and McKay families.

"As we've heard, the death was completely preventable and it's a shame that [Mamakwa] fell through the cracks. But he fell through many cracks," she told CBC News

The problems with Mamakwa's treatment by police and paramedics began almost immediately, the inquest has heard.