TORONTO - A teenager who choked herself to death in her prison cell was extraordinarily challenging in light of her severe mental illness but she was not unique, a psychiatrist testified Tuesday.
Unlike many previous witnesses who said they had never encountered anyone so intense and bent on self-harming as Ashley Smith, Dr. Olajide (Jide) Adelugba was more sanguine.
"She was a difficult patient but there was no behaviour that she exhibited that I saw for the first time," Adelugba told the five-women inquest jury.
"She was different, she was difficult, she was challenging. But she was not alone."
Adelugba was clinical director at the Regional Psychiatric Centre in Saskatoon, a psychiatric prison operated by Correctional Service Canada and the only one in Canada to take women.
Smith, then 18, was sent there in December 2006 because staff at a prison in Nova Scotia couldn't cope with her self-harming, disruptive behaviour.
Adelugba described the teen as a textbook case of antisocial personality disorder.
The "Diagnostic and Statistical Manual of Mental Disorders," the official guide to diagnosing psychiatric illness, lists 10 criteria for the disorder, among them a disregard for the safety of self and others.
Smith met all 10, Adelugba said.
But her ongoing crises prevented getting her from becoming "treatment ready" — gaining insight into her condition and developing therapeutic relationships.
Given her illness, Smith spent her entire four-month stay at RPC on "intensive psychiatric care" status — essentially in segregation.
A study published in the Journal of the American Academy of Psychiatry and Law in 2001 — based on data from 1996 to 1999 — showed the maximum time a patient spent in isolation at RPC was 908 hours — almost 38 days.
While regular prison segregation requires periodic reviews, no such mechanism exists for IPC status, the inquest heard.
"A woman could be on IPC status for months or even years without anyone outside of the hospital knowing that?" asked Breese Davies, lawyer for the Canadian Association of Elizabeth Fry Societies.
"No, we keep records," Adelugba countered, adding those records are passed to regional and national levels.
He also said patients on IPC status — which is clinically driven — have frequent, even daily reviews.
At RPC, Smith was seen by psychiatrists 117 times, but her behaviour showed few signs of improvement.
Smith, Adelugba agreed, was involved in "one long episode of disruptive behaviour that never completely abated."
Nevertheless, he insisted she was making slow progress.
He noted Smith had been kept constantly in segregation at Nova in Truro, N.S., but was, on occasion, allowed out of isolation for a few hours at RPC.
Also, guards used force on Smith 51 times in 61 days at Nova. At RPC, the relative incidence of force was cut in half to 45 over four months.
At RPC, the troubled inmate racked up about 30 institutional charges, most related to having ligatures she used to choke herself.
Smith family lawyer Meaghan Daniel noted the contradiction of guards charging the inmate for having self-harming objects while clinicians were trying to treat her for the same behaviour.
Adelugba said the clinical team had "no control" over the charges, but said he tried to mitigate their impact by noting the teen's mental illness.
The decision to keep Smith in segregation — where she spent almost her entire incarceration — was made by a team, he said.
"Ultimately, the buck stops with you," Shayne Kert, lawyer for the guards' union, said to Adelugba.
"It's not that kind of dictatorial approach to patient care," he said.
Smith was moved to Philippe-Pinel Institute, a forensic psychiatric hospital in Montreal, in April 2007.
The transfer decision came from national headquarters following an incident in which a supervising officer was charged with assaulting Smith.
After Smith, of Moncton, N.B., left RPC, no one ever consulted Adelugba about dealing with her, jurors heard.
Despite Adelugba's recommendation she be kept in a treatment centre, she soon rejected help at Pinel and ended up back in prison.
After a dozen further transfers, Smith choked herself to death at Grand Valley Institution in Kitchener, Ont., in October 2007. She was 19.
Adelugba continues testifying Wednesday.