How authorities responded to the advice of an NWT coroner’s inquest

Nearly one year ago, a jury in a coroner’s inquest issued 11 recommendations to prevent the in-custody deaths of intoxicated people in the NWT. What have authorities done since?

In October 2024, the jury concluded that Sylvia Panaktalok, 54, had died of alcohol poisoning while in police custody in Tuktoyaktuk in July 2021.

Over three days, the six jurors heard about the lack of emergency medical services in Tuktoyaktuk, as well as the need for safe places other than RCMP cells for people who are intoxicated to spend the night, among other issues.

More: Read the jury’s verdict

To help prevent similar deaths in the future, the jury issued four recommendations to Tuktoyaktuk’s RCMP detachment, four to NWT RCMP more broadly, and three to the NWT government. Lawyers for the coroner, RCMP and GNWT had jointly suggested many of those recommendations.

One recommendation suggested ensuring all RCMP officers are aware of the NWT health authority’s policy that nurses can not attend emergencies outside health centres. Others called for the establishment of ambulance service and a sobering centre in Tuktoyaktuk.

In a recent statement, spokesperson Josh Seaward told Cabin Radio that NWT RCMP had completed a comprehensive review of operations following the inquest and reported back to the territory’s chief coroner in January.

Seaward said among actions taken was a direction that NWT detachments should complete an immediate review, followed by bi-annual reviews, of cell block policies and an RCMP operational manual. He said policies on inmate care were also updated to address limitations in communities without ambulance service.

Seward added that steps were taken to ensure officers are aware that nurses cannot attend emergencies outside health centres.

“It is important to recognize that the limitations faced by communities that do not have their own ambulance services is not a shortcoming that rests with the RCMP, which is a police service,” he wrote.

“The RCMP supports having local emergency medical services in all NWT communities.”

All NWT RCMP detachments were also directed to conduct an audit of cell block operations before the end of 2024, Seaward said, and quarterly reviews of cell block operations are already mandated.

According to Seaward, the RCMP criminal operations branch completed an audit of all detachments to ensure compliance with mandatory rousability assessment training, which addresses the monitoring of intoxicated people to ensure their wellbeing.

Ambulance service ‘a known gap’ across NWT

Matthew Mallon, a spokesperson for the NWT’s Department of Health and Social Services, told Cabin Radio ambulance and emergency medical services are “a known gap in many NWT communities, including Tuktoyaktuk.”

He said the health department and Department of Municipal and Community Affairs are “actively working to address this issue.”

The departments are now “assessing existing local solutions,” Mallon said, with the aim of sharing “lessons learned and a scalable blueprint” for communities that want to establish emergency medical transportation services.

“This work is still in its early stages, but it reflects a commitment to finding scalable, community-driven approaches that can help fill the gaps in emergency transport and ensure residents can access care when they need it most,” he wrote.

According to Mallon, some communities in the NWT provide emergency medical transport with the support of volunteer firefighters, other community members or paramedics.

He acknowledged, however, that not every community has the resources to consistently provide those services.

No plans to open sobering centre in Tuk

The NWT government is not planning to establish a sobering centre in Tuktoyaktuk, Mallon said. He instead pointed to the territory’s broader efforts to “enhance culturally relevant addictions and harm reduction services.”

Mallon referenced the NWT’s Mental Wellness and Addictions Recovery Fund, which provides funding to Indigenous governments and organizations to support community-based projects that address mental health and addictions.

He also highlighted efforts to develop medical detox and withdrawal management in the territory, the managed alcohol program at Spruce Bough in Yellowknife, and a transitional housing addiction recovery program in the city, which opened in May. He said a planned transitional housing addiction recovery program in Invuik is expected to open this fall.

It is unclear what, if any, addictions and harm reduction services are being planned in Tuktoyaktuk.

There is currently only one year-round sobering centre in the NWT, located in Yellowknife and operated by the territorial government.

It first opened in 2017 to provide people who are intoxicated and have nowhere else to go with a safe place to spend the night, reducing pressure on emergency services such as RCMP.

By the end of 2026, the territory plans to open a permanent facility in the city – described by the GNWT as a wellness and recovery centre – to replace the current sobering centre and temporary day shelter in Yellowknife.

There is also an emergency warming shelter in Inuvik that provides people who are intoxicated with a place to sleep at night during the winter months. The year-round homeless shelter does not allow people who are intoxicated.

Experts in Canada have advocated against putting people who are intoxicated in police cells.

A CBC investigation published in late 2021 found that since 2010, 61 people had died after being taken into police custody related to public intoxication across the country, including three in the NWT.

According to that investigation, half of those cases nationwide took place in RCMP detachments and the majority in rural communities, where there are often no sobering or detox centres.

RCMP said they recorded 161 in-custody deaths across Canada from 2009 to 2021. Of those incidents, 24.8 percent were related to drug or alcohol toxicity.