Better communication between police, corrections workers and health-care providers could save lives, a Manitoba judge concluded in her report on the 2017 death of Richard Kakish.
However, in Kakish’s case, it might not have been enough, wrote Judge Wanda Garreck in a judicial inquest into the 44-year-old’s death.
Kakish collapsed at the Winnipeg Remand Centre on Aug. 11, 2017, two days after Winnipeg police arrested and detained him.
He was then transported to Health Sciences Centre where he underwent emergency surgery for an injured spleen. During the episode, oxygen was cut off from his brain for up to 14 minutes, resulting in what was believed to be severe brain damage. He died Aug. 13 after being taken off life support.
An autopsy revealed the cause of death was due to hypovolemic shock due to laceration of the spleen due to blunt force trauma to the torso.
Kakish was arrested on Aug. 9, 2017 for possession of a weapon believed to be a firearm. During the arrest, an officer kicked Kakish in the stomach and punched him with a closed fist in the back of the head.
While being transported to the police station, Kakish began to complain about soreness in his left side, and those complaints would continue until his eventual collapse. He told police at the station that he needed medical attention.
During a combative encounter in a holding room, Kakish was again punched in the stomach by a different officer. Kakish slumped down and complained again about soreness in his ribs.
Kakish was transported to hospital and discharged soon after.
"There is no dispute that use of force during the arrest of Mr. Kakish resulted in the need for medical care," wrote Garreck.
Kakish ended up in the Winnipeg Remand Centre where he continued to complain of his injury.
"The video/audio from the admissions desk shows Mr. Kakish is in pain, he is repeating complaints of sore ribs, he is repeatedly asking not to be touched in the area of his ribs and he is in physical discomfort," Garreck wrote.
This led up to his collapse and subsequent death.
Garreck found a lack of policies ensuring adequate communication and sharing of health information between the parties as Kakish was transferred from one place to the next.
The use of police force was not noted, the discharge from hospital had no information, and corrections workers at the remand centre were only told via medical checklist that Kakish had "sore ribs."
A fractured rib was missed in Kakish’s examination, but Garreck said multiple doctors and nurses all testified that knowledge of the fractured rib wouldn’t have changed their medical advice. "All confirmed there is no medical treatment for a fractured rib other than management of pain," said Garreck.
She recommended that police develop a policy on gathering health information, particularly where police have used force, and that police and health care providers develop policy together to improve the sharing of necessary health information.
She made several recommendations to the Winnipeg Remand Centre to improve its policies on assessment, documentation and referrals of injured detainees.
"While it is difficult to say with certainty whether better communication would have changed the final outcome for Mr. Kakish because of the fact his condition deteriorated so rapidly," wrote Garreck, "I am satisfied that improved communication in similar situations could prevent deaths in the future."
The Independent Investigations Unit of Manitoba investigated police actions toward Kakish. Prosecutors ultimately declined to lay charges in October 2018.