Saint John inmate knew he was sick and was scared, ER doctor tells coroner's inquest

Skyler Sappier knew he was sick and was scared, a coroner's inquest into the Saint John inmate's death heard Wednesday.

Dr. Mark McGraw, the emergency room physician who treated him at the Saint John Regional Hospital on Jan. 29, 2022, testified he was worried, too.

Although he had dealt with many COVID-19 patients, it was very unusual to see such rapid deterioration and severity of illness within one day of testing positive, he said.

Sappier was visibly unwell, said McGraw.

Based on a physical exam, and with his breathing having the tell-tale coarse "Darth Vader" sounds, it was quite obvious the 28-year-old had severe pneumonia, he said. A portable X-ray later confirmed this diagnosis.

Sappier was double vaccinated, but had been bunked with a COVID-positive cellmate during an outbreak at the Saint John Regional Correctional Centre because of chronic overcrowding, the Saint John courtroom heard. There was no mask mandate and within a week, 64 of 137 inmates were infected, along with 59 of 117 staff. At the peak of the outbreak, 80 inmates tested positive.

Sappier first reported feeling unwell to jail staff on Jan. 28 and tested positive for COVID-19 on Jan. 29, shortly before he was transferred to the hospital, the court heard earlier in the week.

Sappier's blood work showed "severe systemic illness," said McGraw. His heart rate was 144 beats per minute, instead of the normal rate under 100, and his breathing rate was 24 to 30 per minute, when a healthy young man should be between 16 and 20.

"I certainly as much as I could … tried to reassure him," said McGraw, noting it can be difficult to develop a rapport when wearing full personal protective equipment. "But he was sick and unfortunately he did appear scared as well."

Sappier died Jan. 31, shortly after 3 a.m. — just nine days before the father of two was scheduled to be released from custody.

Emotional day for family

During Wednesday's proceedings, several members of Sappier's family looked on from the front row of the courtroom, where a blanket with images of him and the message "Forever in our hearts," was spread out for the jury and presiding regional coroner Michael Johnston.

The family, members of Neqotkuk First Nation, also had sprigs of cedar scattered at their feet, and taped above the courtroom doorways, with the intent, they said, that it absorb all the negative energy of the day and later be burned.

During a morning recess, one of Sappier's sisters, Raeann Michaud, sobbed in the hallway.

May have had pneumonia for days 

The family heard that the ER doctor realized soon after Sappier's arrival at the hospital that he would have to be transferred to intensive care and intubated — "the most aggressive form of care anyone can get," and not something they do lightly.

"Despite everything we had done, he continued to deteriorate," McGraw said, noting Sappier had no underlying conditions that would explain his rapid decline.

Crown prosecutor Patrick Wilbur asked if Sappier could have had pneumonia for a number of days before he was admitted to hospital.

"That was my concern at the time," McGraw replied. "It's hard to say with any level of certainty."

He told me to do whatever I could for him.- Mark McGraw, emergency room physician

He said he told Sappier he was "unfortunately critically ill," and while he didn't think he was going to die, they did have to intubate him. He asked Sappier if he wanted the hospital to call anybody for him, but he refused.

"He told me to do whatever I could for him."

There was a "huge war going on inside his body," according to respiratory therapist Peter Triantafillou, who said he was optimistic because Sappier had a "fighting spirit" and was fit. 

By about 8:53 p.m., Sappier was in a medically induced coma and on a ventilator.

He was subsequently put on a machine which pumps a patient's blood outside their body to an artificial lung. This is aggressive and only done if you "absolutely need it to save your life," said McGraw. Triantafillou called it a last resort. Sappier never recovered.

Jail not informed of death

The jail was unaware of Sappier's death until an elder from his community called to ask whether talk of his death was true, according to Stephan Pouliot, a staff sergeant with the Department of Public Safety's professional standards unit.

He conducted a critical incident review after Sappier's cellmate alleged Sappier had been banging at the cell door for an extended period of time on Jan. 28 and that the correctional officer on duty had refused to provide him any medical assistance.

Pouliot concluded the complaint was unfounded, but learned through his investigation that the superintendent had to call a Horizon official to verify Sappier had died.

Sappier had been granted a temporary absence while hospitalized, which meant short-staffed correctional officers didn't have to stay with him, but he was still an inmate, said Pouliot. "There was a breakdown there," he said.

Pouliot noted he was not allowed to interview any medical personnel or review any medical information, due to privacy concerns, which would have provided "a better understanding as to making sure that everybody did what they were supposed to be doing."

Case prompts recommendations

The evidence portion of the inquest concluded Wednesday, after hearing from 23 witnesses over two days.

A jury of four women and one man will now determine the facts surrounding Sappier's death and have an opportunity to make recommendations aimed at preventing deaths under similar circumstances.

A critical incident review conducted by the Department of Public Safety already resulted in eight recommendations, the jury heard. None have been implemented, but jail superintendent Gerry Wright said he intends to adopt them. He did not provide a timeline.

Those recommendations include developing policies around note-taking by correctional officers, more frequent checks of inmates in the medical unit and improved communication between the jail and the hospital, since staff weren't notified of Sappier's death for several hours.

Horizon Health Network also conducted its own review and came up with three recommendations. They include clarifying the roles between nursing personnel and correctional officers when a sick inmate requires hospital transfer, looking into adding blood analysis and ECG equipment at jails, and potentially adding paramedics. All three are being considered, regardless of the what the jury recommends, according to a director.