Connect with us

Anglais

Jail medical staff gave Teresa Gratton methadone doses way above guidelines, and this caused her death

Published

on

[ad_1]

Teresa Michelle Gratton’s first dose of methadone should have been no more than 10 milligrams.

But the medical staff inside the maximum-security jail where Gratton was being held indefinitely as an immigration detainee started her at 30 milligrams.

Teresa Michelle Gratton, pictured here in an undated family photo, was being held indefinitely as an immigration detainee at the maximum-security jail in Milton. She died of “acute methadone intoxication” after receiving two doses of methadone from the jail’s doctors. Provincial guidelines for methadone treatment say Gratton should have received a much lower dose than she did.
Teresa Michelle Gratton, pictured here in an undated family photo, was being held indefinitely as an immigration detainee at the maximum-security jail in Milton. She died of “acute methadone intoxication” after receiving two doses of methadone from the jail’s doctors. Provincial guidelines for methadone treatment say Gratton should have received a much lower dose than she did.  (Gratton family photo)

That’s what caused her death.

Gratton died of “acute methadone intoxication in the setting of ischemic heart disease,” according to the coroner’s report, which was given to the Star by Gratton’s husband.

Provincial guidelines for methadone treatment say someone in Gratton’s position should have received a much lower dose than she did. The coroner states in his report that other factors may have contributed to her death, including Gratton’s pre-existing high blood pressure. She ultimately died of a heart attack in hospital. Three doctors who reviewed the coroner’s report for the Star say it’s clear she died of a methadone overdose.

Gratton, a U.S. citizen and permanent resident of Canada who lived in London, Ont., was not serving a criminal sentence or awaiting trial, though she was treated the same as those who were. She had been sent to a maximum-security jail because the Canada Border Services Agency was contemplating deporting her and feared she would not show up for her deportation if it were ordered. The agency based its decision on Gratton’s criminal convictions from 2013, for which she was sentenced to six months of house arrest. Some have argued she should not have been detained in the first place.

The 50-year-old grandmother was found unresponsive in her cell at the Vanier Centre for Women in Milton just after midnight on Oct. 30, 2017. About 40 hours earlier she was given her first dose of methadone, a long-acting opioid often used to treat addiction to shorter-acting opioids. Gratton had depended on prescription painkillers for many years, but the jail’s medical staff was trying to wean her off them. She received her second dose of methadone the morning before she died.

“I suspect if the physician who prescribed this could do it over again, he or she would start on a lower dose,” said Dr. David Juurlink, a medical toxicologist and senior scientist at the Institute for Clinical Evaluative Sciences, and one of three opioid-specializing doctors who reviewed Gratton’s coroner’s report at the Star’s request. All agreed she should have been started on a lower dose of methadone or a different drug altogether.

Gratton’s death was ruled accidental. A coroner’s inquest has been ordered but has not been scheduled.

Read More:

Family of immigration detainee who died in jail still waiting for answers

The Star first reported on Gratton’s case last December, and again in March when two women who were incarcerated with Gratton came forward to raise concerns about her treatment in the jail. But this is the first time her official cause of death has been reported.

Herb Gratton, Teresa’s husband and partner of more than 30 years, said he is frustrated and angry, but he mostly just misses his wife. “The system had her,” he said in a recent interview. “They were supposed to be responsible.”

Herb, who is a Canadian citizen from the Caldwell First Nation, says this time of year is particularly difficult. His wife was the one who organized the family get-togethers and did most of the cooking.

“Christmas does not seem like Christmas,” he said. “I can’t find a reason to celebrate. I have my children, my grandchildren. But there’s a void. No matter who’s around or what’s around, I can’t fill it, you know?”

Herb Gratton, the husband of Teresa Michelle Gratton, says he is frustrated and angry about how his wife died. But he says he mostly just misses her. "Christmas does not seem like Christmas," he said. "I can't find a reason to celebrate."
Herb Gratton, the husband of Teresa Michelle Gratton, says he is frustrated and angry about how his wife died. But he says he mostly just misses her. « Christmas does not seem like Christmas, » he said. « I can’t find a reason to celebrate. »  (Anne-Marie Jackson)

A mother of three who had lived in Canada since 2003, Teresa Gratton suffered from osteoarthritis and fibromyalgia, a long-term condition of the central nervous system that causes widespread pain. She relied on the opioid hydromorphone and was prescribed a high daily dose by her doctor months before she was incarcerated. When she couldn’t get her opioids from a doctor she got them on the street, her husband said. A month before her death she pleaded guilty to forging her doctor’s signature in an attempt to get an extended supply of hydromorphone. She also took several other prescribed medications, including ones for anxiety and depression.

The jail’s medical staff decided Gratton should not be on opioids. The coroner’s report references a physician’s note in Gratton’s medical file that reads: “SUD (substance use disorder), I agree, no indication for long-term opioid therapy.”

First they cut her dose by more than half. A week later they tapered her dose further and then withdrew her opioids completely for 10 days before giving Gratton her first dose of methadone.

Thirty milligrams, the amount Gratton received in each of her two doses, is the maximum starting dose for methadone treatment, according to guidelines published by the College of Physicians and Surgeons of Ontario. However, the guidelines state that if a patient has been “recently abstinent from opioids,” as Gratton was, the maximum starting dose should be no more than 10 milligrams. The guidelines do not specify how many days qualify as recent abstinence, but they do say that patients who have not used opioids “even for a few days” are at a higher risk of overdose.

The guidelines also state that patients who are also on benzodiazepines or any sedating drugs, as Gratton was, should be considered at a “higher risk for methadone toxicity” and therefore should be given a lower starting dose.

Two doctors, Dr. Abraham Shedletzky and Dr. Laura Middlestadt, are among the medical staff who work inside the jail. It’s not clear who oversaw Gratton’s treatment or if either doctor administered the methadone. The coroner’s report doesn’t name any doctor as being responsible for Gratton’s treatment. Middlestadt declined to comment for this story. Shedletzky did not respond to multiple interview requests.

Juurlink said he didn’t understand why the jail’s medical staff, even if they believed Gratton should be on a lower dose of opioids, would have tapered her off the drugs entirely. “Her brain and body would have become accustomed to that amount of hydromorphone,” he said. “She would have been physically dependent on it, and when you take it away people get horribly sick.” Tapering should be done slowly and generally with the patient’s consent, he added.

Even if there were compelling reasons to reduce Gratton’s opioid dose and replace it with methadone, Juurlink said someone in Gratton’s position shouldn’t be off opioids for as long as she was. “That’s 10 days of putting this patient through hell.”

Gratton wrote her husband regularly during her time in jail. In her letter she describes the agony of her withdrawal symptoms, which included vomiting, diarrhea, severe muscle pain, constant sweating and depression.

“I’d rather be dead than to keep going through this pain,” she wrote in one letter. “These doctors … think I don’t need to be on any of my narcotics. If something bad should happen to me please sue the hell out of them.”

The coroner’s report says that Gratton filed a complaint to the Office of the Ombudsman of Ontario regarding the reduction of her opioids by the jail’s medical staff. A spokesperson for the ombudsman said that for confidentiality reasons she could not confirm whether a complaint had been filed.

Juurlink also pointed to Gratton’s concurrent use of clonazepam, which she took to treat panic attacks, as a reason she should have been started on a much lower dose of methadone. Clonazepam belongs to the benzodiazepine class of drugs. It is a tranquilizer that, when combined with methadone, increases the risk of overdose.

“You have a one-plus-one-equals-five kind of effect,” Juurlink said. “They’re both depressants of the central nervous system and it’s really quite dangerous to combine opioids with drugs like that, especially for a patient who, for all intents and purposes, is opioid naive.” Juurlink said Gratton would have lost whatever opioid tolerance she might have had during her 10 days without the drug.

A spokesperson for Ontario’s Ministry of Community Safety and Correctional Services, which is responsible for provincial jails, said no one from the ministry would be interviewed for this story. They also declined to answer specific questions about Gratton’s case, citing the pending inquest.

From the 2017 Star Investigation | Teresa Michelle Gratton died Oct. 30 while being indefinitely detained in a maximum-security jail by the Canada Border Services Agency. Her grieving family wonders why she was there at all.

The spokesperson provided a written statement, which reads, in part: “Decisions about health care matters are between inmates and medical staff. The ministry does not interfere with medical decisions or direct medical professionals.”

Dr. Ramesh Zacharias, the coroner, writes in his report that it’s unclear whether Gratton should be considered “a completely naive user in the context of methadone maintenance therapy.” Zacharias notes that although Gratton had not consumed opioids for 10 days before her first dose of methadone, “prior to that period she was a longtime user and abuser of hydromorphone.”

Dr. Meldon Kahan, medical director of the Substance Use Service at Women’s College Hospital, said it is “unusual” for just two doses of 30 milligrams of methadone to cause death. However, given Gratton’s recent abstinence from opioids and the fact she was on other sedating medications it “might have been more prudent” to start her on a different drug or a lower dose.

Kahan said it would have been better for the jail’s medical staff to prescribe buprenorphine, another long-acting opioid used to treat addiction, rather than methadone.

“It’s much safer than methadone,” he said. “It’s much safer than simply stopping the opioid, and it’s much safer than keeping them on the opioid that they’re already on.”

Juurlink agreed, calling buprenorphine “an infinitely safer medication.”

A ministry spokesman refused to say whether buprenorphine was available to doctors inside the jail.

Gratton died after suffering a heart attack in hospital roughly nine hours after she was found unresponsive in her cell. Zacharias writes in his report that he couldn’t attribute methadone intoxication as the sole cause of death because of uncertainties around Gratton’s tolerance, his inability to determine the peak concentrations of methadone in her blood when she lost consciousness, and because her body did not immediately respond to naloxone — a drug that can reverse the effects of opioids — when it was administered by paramedics. It’s not clear for how long Gratton had been unconscious when her cellmate, who had been sleeping, alerted jail guards.

Zacharias also notes that a methadone overdose can itself increase the risk of a heart attack.

The doctors who reviewed the report for the Star said it’s clear an overdose of methadone was the cause of death, whether or not she suffered other heart complications. Juurlink said that the vomiting and diarrhea Gratton experienced during her withdrawal would have left her with lower potassium and magnesium, which would have “amplified” the effects of methadone on her heart. “Methadone can kill you in more than one way,” he said.

Besides how she died, there are also questions about why Gratton was detained in the first place and why she was held in a maximum-security jail — questions that could be raised as part of the inquest.

The CBSA’s grounds for stripping her permanent residency were for “serious criminality,” which is defined in part as any conviction that leads to a “term of imprisonment” of more than six months.

Gratton came to be in police custody in September 2017 after she was arrested for shoplifting at Walmart, but the CBSA’s finding of “serious criminality” was related to convictions from 2013, when she pleaded guilty to forging a former employer’s signature on cheques for amounts ranging from $100 to $250. (Gratton admitted forging the signatures, but she believed the man owed her the money for house cleaning, according to a court transcript.) She also pleaded guilty to unlawfully being in the man’s house, although she did not break in. She was given a nine-month conditional sentence, which included six months of house arrest but no jail time.

The CBSA interpreted Gratton’s conditional sentence as a “term of imprisonment” of more than six months, meaning she would have no right to appeal her deportation. On Oct. 19, 2017 — 11 days before Gratton died — the Supreme Court of Canada struck down such interpretations, ruling it was unreasonable for immigration authorities to equate conditional sentences, such as house arrest, with jail time.

Immigration authorities have also not clarified why Gratton, who was not considered a danger to the public and had no history of violence, was classified as a “high-risk” detainee and sent to a maximum-security jail. By the CBSA’s own policies her minimal, non-violent criminal record should have made her eligible for the Immigration Holding Centre, a far less restrictive facility.

A CBSA spokesperson has said the agency decided maximum-security jail was a “better choice” for Gratton due to “various case-specific factors.” The spokesman would not explain the factors that led to their decision, citing a need to protect Gratton’s privacy.

The location of detention for immigration detainees is decided solely by the CBSA and not subject to any external oversight.

Brendan Kennedy is a Toronto-based investigative reporter. Follow him on Twitter: @BKennedyStar

[ad_2]

Source link

قالب وردپرس

Anglais

Nostalgia and much more with Starburst XXXtreme

Published

on

By

Get a taste of adventure with Starburst XXXtreme based on the legendary NetEnt Game. The nostalgic themes are sure to capture fans of the classic version as they get treated to higher intensity, better visuals, and features. The most significant element of the game is its volatility. Patience will not be an essential virtue considering the insane gameplay, and there is a lot of win potential involved. It retains the original makeup of the previous game while adding a healthy dose of adrenaline. 

Starburst Visuals and Symbols

The game is definitely more conspicuous than before. The setting happens over a 5-reel, 3-row game grid with nine fixed win lines, which function if a succession from the left to the right reel is present. Only those players that that attain the highest win per bet line are paid. From a visual standpoint, the Starburst XXXtreme slots illustrates lightning effects behind the reels, which is not surprising as it is inherited from the original version. Available themes include Classic, Jewels, and Space. The game is also available in both desktop and mobile versions, which is advantageous for players considering the global pandemic. According to Techguide, American gamers are increasingly having more engaging gaming experiences to socialize to fill the gap of in-person interaction. Starburst XXXtreme allows them to fill the social void at a time when there is so much time to be had indoors. 

Starburst XXXTreme Features

Players get to alternate on three features which are Starburst Wilds, XXXtreme Spins, and Random Wilds. The first appears on reels 2,3, or 4. When these land, they expand to cover all positions while also calculating the wins. They are also locked for a respin. If a new one hits, it also becomes locked while awarding another respin. Starburst XXXtreme offers a choice between two scenarios for a higher stake. In one scenario with a ten times stake, the Starburst Wild is set on random on reels 2,3, or 4, and a multiplier starts the respin. The second scenario, which has a 95 times stake, starts with two guaranteed starburst wilds on reels 2,3, or 4. it also plays out using respin game sequence and features. The game also increases the potential with the Random Wilds feature to add Starburst Wilds to a vacant reel at the end of a spin. Every Starburst Wild gives a random multiplier with potential wins of x2, x3, x5, x10, x25, x50, x100, or even x150.

The new feature is sure to be a big hit with the gaming market as online gambling has shown significant growth during the lockdown. AdAge indicates the current casino customer base is an estimated one in five Americans, so Starburst XXXtreme’s additional features will achieve considerable popularity. 

What We Think About The Game

The gambling market has continued to diversify post-pandemic, so it is one of the most opportune times to release an online casino-based game. Thankfully Starburst XXXtreme features eye-catching visuals, including the jewels and space themes. These attract audience participation and make the gameplay inviting. The game also has a nostalgic edge. The previous NetEnt iteration featured similar visuals and gameplay, so the audience has some familiarity with it. The producers have revamped this version by tweaking the features to improve the volatility and engagement. 

That is characterized by the potential win cap of 200,000 times the bet. Starburst XXXtreme does not just give betting alternatives for players that want to go big. The increase of multipliers also provides a great experience. If the respins in the previous version were great, knowing that multipliers can go hundreds of times overtakes the game to a new level. 

Players should get excited about this offering. All of the features can be triggered within a single spin. Whether one plays the standard game or takes the XXXtreme spin route, it is possible to activate all of the features. Of course, the potential 200,000 times potential is a huge carrot. However, the bet size is probably going to be restricted and vary depending on the casino. It is also worth pointing out that a malfunction during the gameplay will void all of the payouts and progress. Overall, the game itself has been designed to provide a capped win of 200,000 times the original bet. 

Continue Reading

Anglais

‘We’re back’: Montreal festival promoters happy to return but looking to next year

Published

on

By

In downtown Montreal, it’s festival season.

In the city’s entertainment district, a musical act was conducting a sound check on stage Friday evening — the second day of the French-language version of the renowned Just For Laughs comedy festival. Tickets for many of the festival’s free outdoor shows — limited by COVID-19 regulations — were sold out.

Two blocks away, more than 100 people were watching an acoustic performance by the Isaac Neto Trio — part of the last weekend of the Festival International Nuits d’Afrique, a celebration of music from the African continent and the African diaspora.

With COVID-19 restrictions continuing to limit capacity, festival organizers say they’re glad to be back but looking forward to next year when they hope border restrictions and capacity limits won’t affect their plans.

Charles Décarie, Just For Laughs’ CEO and president, said this is a “transition year.”

“Even though we have major constraints from the public health group in Montreal, we’ve managed to design a festival that can navigate through those constraints,” Décarie said.

The French-language Juste pour rire festival began on July 15 and is followed by the English-language festival until July 31.

When planning began in February and March, Décarie said, organizers came up with a variety of scenarios for different crowd sizes, ranging from no spectators to 50 per cent of usual capacity.

“You’ve got to build scenarios,” he said. “You do have to plan a little bit more than usual because you have to have alternatives.”

Continue Reading

Anglais

MELS new major movie studio to be built in Montreal

Published

on

By

MONTREAL — MELS Studios will build a new film studio in Montreal, filling some of the gap in supply to meet the demand of Hollywood productions.

MELS president Martin Carrier said on Friday that MELS 4 studio construction will begin « as soon as possible », either in the fall or winter of next year. The studio could host productions as early as spring 2023.

The total investment for the project is $76 million, with the Quebec government contributing a $25 million loan. The project will create 110 jobs, according to the company.

The TVA Group subsidiary’s project will enable it to stand out « even more » internationally, according to Quebecor president and CEO Pierre Karl Péladeau. In the past, MELS Studios has hosted several major productions, including chapters of the X-Men franchise. The next Transformers movie is shooting this summer in Montreal.

Péladeau insisted that local cultural productions would also benefit from the new facility, adding that the studio ensures foreign revenues and to showcase talent and maintain an industry of Quebec producers.

STUDIO SHORTAGE

The film industry is cramped in Montreal.

According to a report published last May by the Bureau du cinéma et de la télévision du Québec (BCTQ), there is a shortage of nearly 400,000 square feet of studio space.

With the addition of MELS 4, which will be 160,000 square feet, the company is filling part of the gap.

Carrier admitted that he has had to turn down contracts because of the lack of space, representing missed opportunities of « tens of millions of dollars, not only for MELS, but also for the Quebec economy. »

« Montreal’s expertise is in high demand, » said Montreal Mayor Valérie Plante, who was present at the announcement.

She said she received great testimonials from « Netflix, Disney, HBO and company » during an economic mission to Los Angeles in 2019.

« What stands out is that they love Montreal because of its expertise, knowledge and beauty. We need more space, like MELS 4, » she said.

There is still not enough capacity in Quebec, acknowledged Minister of Finance, the Economy and Innovation Eric Girard.

« It is certain that the government is concerned about fairness and balance, so if other requests come in, we will study them with the same seriousness as we have studied this one, » he said.

Grandé Studios is the second-largest player in the industry. Last May, the company said it had expansion plans that should begin in 2022. Investissement Québec and Bell are minority shareholders in the company.

For its part, MELS will have 400,000 square feet of production space once MELS 4 is completed. The company employs 450 people in Quebec and offers a range of services including studio and equipment rentals, image and sound postproduction, visual effects and a virtual production platform.

Continue Reading
Actualités6 mois ago

Ces légendes du baccara vous dévoilent leurs secrets

Affaires9 mois ago

Retard de vol : le devoir de la compagnie envers ses passagers

Anglais1 année ago

Nostalgia and much more with Starburst XXXtreme

Opinions1 année ago

Même les jeunes RÉPUBLIQUES se lassent du capitalisme, selon les sondeurs américains — RT USA News

Opinions1 année ago

« Aucune crise climatique ne causera la fin du capitalisme ! »

Opinions1 année ago

Innovation : le capitalisme « responsable », faux problème et vraie diversion

Opinions1 année ago

Vers la fin du Capitalocène ?

Opinions1 année ago

Le “capitalisme viral” peut-il sauver la planète ?

Opinions1 année ago

Livre : comment le capitalisme a colonisé les esprits

Opinions1 année ago

Patrick Artus : « Le capitalisme d’aujourd’hui est économiquement inefficace »

Opinions1 année ago

Zemmour candidat “sous-marin” pro-Macron, ce complotisme autorisé…

Opinions1 année ago

La durée des vols bientôt divisée par deux. Merci le capitalisme !

Opinions1 année ago

Economie politique. «Brevets et capitalisme»

Opinions1 année ago

Le Parti communiste d’Afrique du Sud a cent ans

Opinions1 année ago

Le wokisme est un anti-libéralisme

Opinions1 année ago

Au moment où la critique du capitalisme ultralibéral et financiarisé obtient un plus large consensus, il devient crucial de ne plus se limiter à elle : aujourd’hui, l’enjeu cardinal est celui de l’alternative à un modèle discrédit.

Opinions1 année ago

Ce que le capitalisme fait aux femmes

Mode1 année ago

Louis Vuitton crée Charlie, sa première basket unisexe et écoresponsable

Mode1 année ago

L’Événement Evening Dresses Show Retourne À Salerno Du 1 Au 3 Septembre 2021 Inaugurant La Saison Internationale Du Prêt-À-Porter

Mode1 année ago

LVMH continue son ascension, tiré par son activité Mode et Maroquinerie

Anglais4 années ago

Body found after downtown Lethbridge apartment building fire, police investigating – Lethbridge

Santé Et Nutrition3 années ago

Comment aider un bébé à développer son goût

Styles De Vie4 années ago

Salon du chocolat 2018: les 5 temps forts

Anglais4 années ago

This B.C. woman’s recipe is one of the most popular of all time — and the story behind it is bananas

Santé Et Nutrition4 années ago

Gluten-Free Muffins

Anglais4 années ago

Man facing eviction from family home on Toronto Islands gets reprieve — for now

Anglais4 années ago

27 CP Rail cars derail near Lake Louise, Alta.

Santé Et Nutrition4 années ago

We Try Kin Euphorics and How to REALLY Get the Glow | Healthyish

Anglais4 années ago

Condo developer Thomas Liu — who collected millions but hasn’t built anything — loses court fight with Town of Ajax

Anglais4 années ago

Ontario’s Tories hope Ryan Gosling video will keep supporters from breaking up with the party

Styles De Vie4 années ago

Renaud Capuçon, rédacteur en chef du Figaroscope

Anglais4 années ago

Ontario Tories argue Trudeau’s carbon plan is ‘unconstitutional’

Mode4 années ago

Paris : chez Cécile Roederer co-fondatrice de Smallable

Anglais4 années ago

100 years later, Montreal’s Black Watch regiment returns to Wallers, France

Anglais4 années ago

Trudeau government would reject Jason Kenney, taxpayers group in carbon tax court fight

Styles De Vie4 années ago

Ford Ranger Raptor, le pick-up roule des mécaniques

Affaires4 années ago

Le Forex devient de plus en plus accessible aux débutants

Anglais3 années ago

The Bill Gates globalist vaccine depopulation agenda… as revealed by Robert F. Kennedy, Jr.

Anglais4 années ago

Province’s push for private funding, additional stops puts Scarborough subway at risk of delays

Styles De Vie4 années ago

Super Soco TC, l’électrique de bonne facture

Trending

Situs sbobet resmi terpercaya. Daftar situs slot online gacor resmi terbaik. Agen situs judi bola resmi terpercaya. Situs idn poker online resmi. Agen situs idn poker online resmi terpercaya. Situs idn poker terpercaya.

situs idn poker terbesar di Indonesia.

List website idn poker terbaik.

Permainan judi slot online terbaik

slot hoki gacor

daftar slot online
judi slot pulsa