Evidence of meeting #22 for Public Safety and National Security in the 39th Parliament, 2nd Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was taser.
A recording is available from Parliament.
March 12th, 2008 / 4:50 p.m.
NDP
Penny Priddy NDP Surrey North, BC
Thank you, Mr. Chair.
I have about three or four questions. My first two questions are to either Dr. Butt or Dr. Hall.
Do you know the percentage of people who at any one time would be likely to be suffering from cardiac arrhythmia, just in their walking around time, that hasn't been diagnosed, hasn't been serious enough to be diagnosed?
Second, while I understand that a post-mortem would not show whether somebody had suffered from cardiac arrhythmia, if there were medical backup and somebody could get a monitor on as soon as the person was subdued, would we be better able to then tell whether there was a causal relationship between cardiac arrhythmia and death?
Dr. Savard, perhaps the same question can go to you and Dr. Lapierre. I rather laughingly said one day that I supported entrepreneurship for women, that I thought it was wonderful, but I had never envisioned it to be “Taserware” parties. In point of fact, that's exactly what we're seeing in the state of Arizona: “Taserware” parties, just as we saw Tupperware parties.
I asked, “What if somebody uses it on children?”, and people said that could never happen. Well, there are now stories coming out--either it's being used in a school, or a parent has bought it and it's being used against a child. That is absolutely terrifying to me. It's a question I'd be interested in having Dr. Lapierre respond to.
4:50 p.m.
Consultant, Pathfinder Forum, As an Individual
I could probably start this by talking a little bit about the issue of heart disease in the population.
Dr. Hall has had a lot more responsibility and experience in terms of the emergency ward. In my practice I haven't had a patient with a pulse since 1967, so I have to be careful what I say here.
There is a significant amount of coronary artery disease in the community. Professor Lapierre indicated what the statistics were of coronary artery disease. I'm going to make a parenthetical comment here, which Dr. Hall actually prompted me on. It is that in Professor Lapierre's statistics, there is no correlation between the coronary artery disease that was found in a very few people in the population and the fact that they might have been taking a drug. The drug is cocaine, and cocaine is very provocative in the background of coronary artery disease. It is a specifically provocative drug in terms of developing cardiac arrhythmias.
This is one of the big conundrums in this work. Dr. Hall, I think, has illuminated that and is certainly capable of developing the point better than I am.
There is not a lot of cardiac disease around that is identifiable at autopsy in the younger age group. Generally speaking, in terms of arrhythmias, there is a pathological or demonstrably anatomical background to the disease. That's because the largest cause of cardiac arrhythmias is the type of disease that Professor Lapierre spoke of, notably occlusive coronary artery disease, which, as I say, is aggravated by the use of cocaine.
4:55 p.m.
Emergency Department Physician, As an Individual
I think that's a really important point.
I understand what Dr. Savard's point was in illustrating that the predominance of coronary disease was extremely high in that population. Stats, damn lies--we've all heard it about statistics, but when you evaluate a statistic like that, you must control for the presence of illicit substance use.
Cocaine and methamphetamine are associated. There are no old methamphetamine addicts. It's a very devastating drug. People don't have years and years of meth use. There are old cocaine addicts. Cocaine plus alcohol makes cocaethylene, which is many times more productive of coronary atherosclerosis than even cocaine alone, which is enormously associated with cardiac disease. That's the confounding that I'm talking about in data.
4:55 p.m.
NDP
Penny Priddy NDP Surrey North, BC
If we could get a monitor on somebody immediately, would we have a better sense of that?
4:55 p.m.
Emergency Department Physician, As an Individual
That's exactly the question we're trying to address. There are a couple of important points about that.
In the ideal world, that's what would happen. People have experienced sudden in-custody death following restraint on a cardiac monitor with an advanced cardiac life support crew in attendance. Their rhythm was not ventricular fibrillation in the very few cases that have happened while on a monitor.
Why can't you get them on a monitor? It's because you can't get near them.
One of the great misconceptions that's been mentioned in this committee is that these people need medical care, and that could not be more true. The problem is how to get a 280-pound methamphetamine-intoxicated, violent, destructive, combative person into the back of an ambulance and into an emergency room, or, as happened in Black Diamond hospital just last week, what do you do when that person is throwing your oxygen cylinders through your glass, attacking your physician, and you have unarmed security?
4:55 p.m.
NDP
4:55 p.m.
Emergency Department Physician, As an Individual
It's an excellent point that you raise. The problem is that when these people die in sudden in-custody death, regardless of taser application, what happens is the person very suddenly becomes quiescent, and at that point there is no pulse. By the time you get the monitor on, if the paramedics are present, the horse has left the barn.
4:55 p.m.
NDP
Penny Priddy NDP Surrey North, BC
On the expanded use to children, Professor Lapierre, do you have any comment? It really scares me.
4:55 p.m.
Ethicist, philosopher and lecturer , École Polytechnique, University of Montreal, As an Individual
I go back to the question of the weapon's purpose. We need to ask ourselves if the taser, this non-lethal weapon, truly corresponds to our values, to the kind of society and police officers we want to have in Canada. If the answer is yes, we need not think any further.
We are talking about violent people, but there is a difference between violent, aggressive people—cocaine addicts or not—and the people we were just talking about. It seems as though we are becoming desensitized to this weapon. Could this go so far as to having the weapon used on children? I think we are slipping, as little as possible, when it comes to integrity and human dignity. The use of such a tool on children is barbaric. One need not be a philosopher to see that.
It is barbaric. Even when it comes to using this weapon on passive or ill individuals, I really have to wonder. It would put a lot of responsibility on our police officers to give so much leeway. They would have to have medical knowledge, and so on. That does not make any sense. I am not a doctor, but based on the statements made by the doctors here, it is clear that these situations are medical emergencies.
5 p.m.
Ethicist, philosopher and lecturer , École Polytechnique, University of Montreal, As an Individual
A medical emergency can require the use of force, but I do not know if the taser is the appropriate tool.
5 p.m.
Conservative
The Chair Conservative Garry Breitkreuz
Thank you.
We're going to move over now to the government side.
Mr. MacKenzie.
5 p.m.
Conservative
Dave MacKenzie Conservative Oxford, ON
Thank you, Chair, and thank you to the witnesses.
Actually, the last question was a little bit nonsensical, because taser use is not allowed in Canada to civilians; it's only used by police officers. So children here will not get it, and if you wanted to have that debate, you'd have to take it to the U.S.
I really appreciate the vast differences here. One is from a practical side and the other is a little bit from theory. I can tell you what used to happen before we had pepper spray and before we had tasers, and how we used to subdue people. I don't think the vast majority of Canadians would object to the difference in the new tools the police officers have in their toolboxes. In the past, it used to be simply force.
Dr. Hall, you've probably seen in emergency wards in the last 10 years, when we talk about the change.... Could you tell us whether, in the last 10 years, you have seen a change in emergency medicine, with patients coming in who have either been attacked more violently or who are more violent? Is that, in fact, the case?
5 p.m.
Emergency Department Physician, As an Individual
There are a couple of answers--and I'll be brief, I promise.
The Drug Abuse Warning Network in the U.S., whose data you can pull, revealed that six years ago, I think it was, 50% of the American population had experimented with an illicit substance, a psychoactive drug such as cocaine. People over the age of 65 we now routinely screen for street drug use, such as cocaine, because it's common. If you don't ask, you don't know, especially when they're in having a heart attack.
My emergency medicine experience medically is restricted to my residency, which was five years long, and to my clinical practice, and I'm entering my seventh year, so I have 12 years of medicine, but I was also a nurse before, for 15 years. Little did I know, when I moved to sleepy little Victoria, how much methamphetamine I would encounter. I can tell you that in my daily practice in Victoria I encounter over-stimulated, hypertensive, tachycardic, agitated, psychotic individuals probably every other day.
My first day in Victoria, my patient stood up with a stretcher on his back and crashed into the glass door in the trauma room—stood up, with a stretcher on his back, in four-point restraint.
That kind of agitation, most members of the general population have never experienced. People who talk about psychological interactions and therapeutic talk with these people have never seen an agitated psychotic person. Whether they're psychotic because they have organic schizophrenia—which is a terrible, debilitating disease, and you can have psychotic breaks if you're perfectly compliant with your medications.... If you have schizophrenia and you use cocaine, which is startlingly common, then you are even more likely to have a psychotic break.
For these people, delirium is defined by an altered level of consciousness with two things: impaired thinking and impaired input from the senses. These people perceive things differently and they cannot think their way out of it.
If I told you right now that a little unicorn pranced through the middle of this room, you'd all look at me and say, “No, it didn't”, and I would say, “You're right; I'm sorry.” But if you cannot realistically think your way past that and are fighting for your life in your mind.... It's amazing the strength these people exhibit. Anyone who has ever tried to take blood out of a two-year-old knows what I'm talking about: the strength of millions.
But in specific answer to your question, there is no doubt that methamphetamine and cocaine use in this country is on the rise, and it's on a logarithmic rise.
The City of Calgary collected data, I think two years ago, on the incidence of cocaine-related interactions with police, and it was up 300% in one calendar year. In the same calendar year, injuries to police officers were up by 300%. So we are seeing a different person on our streets and in our hospitals and in our psychiatric units than we saw 10 or 15 years ago.
It's not progressing across the country in a very straightforward pattern. It is west to east, and you haven't seen anything yet in Ontario.
5:05 p.m.
Conservative
Dave MacKenzie Conservative Oxford, ON
Thank you.
Dr. Butt, if I recall, you said we saw a rise in the numbers of deaths starting in about the 1970s. I appreciate many of your comments and your background, but as a pathologist, in most of the cases of deaths that you would have seen in that time and up to and including today, I'm sure you would do toxicology.
5:05 p.m.
Conservative
Dave MacKenzie Conservative Oxford, ON
Would those tests have risen, from the perspective...? We used to see a lot of what we call speed freaks. It began in the 1970s, and it's rising, I think, as Dr. Hall has indicated. Is the number of both of those—not as a scientific datum but as an observation—increasing as these deaths are also increasing?
5:05 p.m.
Consultant, Pathfinder Forum, As an Individual
I have to qualify that. I rarely do autopsy work, and that includes the last eight years. It's plain from what Dr. Hall said that with the increase in the use of drugs there's an increase in the amount of sudden death. This means that those cases are referred to the system, where autopsies are mandatory. It's prudent and I think most common, as you imply, to do the tests you're thinking about. Dr. Hall has said this in terms of the emergency people and the patients who go there, where they're tested as well.
The answer is yes. The toxicology tests are done. As to the frequency with which they come back positive, I don't know the statistic.
Thank you.
5:05 p.m.
Conservative
Dave MacKenzie Conservative Oxford, ON
You indicated, I think, Dr. Butt, that there was no correlation that you could determine from medical exams between the use of the taser and the deaths of individuals, or any knowledge of it. But there is lots of evidence, I believe, of correlation between death and people who have experienced excited delirium. That hasn't only occurred within the police community or with people who have been tasered.
I suspect you could tell us about those cases in which people have been in, perhaps, institutions or hospitals and where there's been no use of force.
5:05 p.m.
Consultant, Pathfinder Forum, As an Individual
It's a very good point.
Here's a scenario and a question that came out of it. Some of you would be aware that on South Granville Street, which is quite a nice street in Vancouver, in about the middle of November a gentleman had a substantial chain and struck out at the police and was shot dead. This man had serious bipolar disorder and had of his own accord withdrawn his medication and become uncontrollable.
The questions that arise out of that are many, obviously, but one of them is, what happens under those circumstances in a psychiatric ward in a hospital? The answer is, in part, that these things are controlled by medication, which also leads, as a parenthetical comment, I would say, to the issue of paramedics responding to the scene when these people have this condition. But also, it leads into the issue of whether these deaths occur in hospital.
I think of one death.... One swallow clearly doesn't represent a summer, but let me assure you that these deaths do occur in the emergency wards, in the portal to the emergency ward, and I have actually investigated a death that occurred in the hospital after several days of a person who had a serious bipolar disorder and was confronted during a manic episode and died. We don't know exactly what the details were, but one suspects there was some form of restraint offered.
So these deaths occur in a wide spectrum, not only of cause but under a variety of circumstances.
I can't do any better than that, but I probably have said more than I needed to.
5:10 p.m.
Liberal
Roy Cullen Liberal Etobicoke North, ON
Thank you, Mr. Chair.
Thank you to the panel. This has been a very interesting panel.
I have a number of questions and five minutes, so I'm going to head right into them.
Mr. Savard, in your presentation there's reference to a University of Washington study in which they looked at people who had died as a result of these interventions. If I read it right, 76% of those people had been in a state of excited delirium.
5:10 p.m.
Professor, École Polytechnique, University of Montreal, As an Individual
Yes, that's what they report.