The cause of death of a 28-year-old Saint John inmate was consistent with COVID-19, a coroner's inquest heard Tuesday.

Skyler Sappier, who was double vaccinated, died at the Saint John Regional Hospital on Jan. 31, 2022, two days after being transferred from the Saint John Regional Correctional Centre.

There was a COVID-19 outbreak at the provincial jail at the time, which resulted in staff shortages, and no mask mandate for inmates, although masks were available, several witnesses testified.

Sappier's cellmate had COVID-19 and he too later tested positive, the jury heard.

"My opinion as to the cause of death was it was probably due to complications of COVID-19 infection," pathologist Dr. Kenneth Obenson told the crowded courtroom.

A man with a greying beard and glasses, wearing a grey blazer and mult-colour collared shirt, smiles at the camera.
Pathologist Dr. Kenneth Obenson told the court he could not say how quick the onset of Sappier's symptoms would have been. 'Based on my experience with other diseases, people can appear to do well right up until they don’t do well,' he said. (Roger Cosman/CBC)

Sappier was admitted to the intensive care unit with "deteriorating pulmonary function with bilateral hemorrhagic pneumonia and substantially heavy lungs," about 3,410 grams combined — roughly four times the normal weight, Obenson noted.

Crown prosecutor Chris Titus questioned whether "probably due to" was as definitive as Obenson could offer.

Obenson replied he "wanted to hedge" because about a dozen drugs were found in Sappier's system. Although they were all consistent with medical treatment he would have received at the hospital, Obenson didn't know with certainty whether any were obtained illegally.

"I don't have any objection to saying it's consistent with COVID-19," he added, as several members of Sappier's family and other supporters from Neqotkuk First Nation looked on.

Jury hears from 13 witnesses

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

The inquest began with a ceremony by members of Sappier's community, formerly known as Tobique First Nation. Two men stood at the front of the courtroom and performed a drumming song to honour him and his family. They also offered a prayer, requesting guidance and wisdom.

The jury heard from 13 witnesses, including correctional officers and medical staff from the jail, and hospital staff who were working the day Sappier was admitted.

Crown prosecutor Patrick Wilbur asked Dr. Jeffrey Marr, who served as the doctor for inmates at the jail at the time, about Sappier being bunked with someone COVID-positive.

A portrait of a smiling man, wearing a blue blazer, white collared shirt and red tie.
Dr. Jeffrey Marr testified there wasn't enough room at the Saint John Regional Correctional Centre to maintain an isolation area during the COVID outbreak in January, when one in three inmates were testing positive. (Roger Cosman/CBC)

Marr said there was initially an isolation area for those who were infected to limit exposure, but by late January, one in three inmates were testing positive.

The jail, which is about 50 years old, has "limited capacity" for segregation, and is "not designed to handle acute medical illness," he said. In addition, "there was such a high prevalence that people already had these exposures."

'I don't feel like my lungs are OK'

Inmates were tested regularly for the virus with rapid tests and Sappier had tested negative until Jan. 28, when he first reported feeling unwell. He told jail staff, "I don't feel like my lungs are OK," presiding regional coroner Michael Johnston told the Saint John courtroom.

Sappier was given Tylenol and Advil, some correctional officers testified.

By around 8 a.m. the next day, after correctional officer Jillian Morse had conducted her morning rounds, a few of the other inmates in the common room drew her attention to Sappier, who was sitting in his cell.

She went to check on him and, "He just looked at me and said, 'Do I look OK?' I said, 'No, you don't look OK,' and I immediately called the nurse." He looked pale, she said.

Morse testified she checked back on Sappier every 15 minutes until she left at 11 a.m., after a 12-hour shift and five hours of overtime.

'He didn't appears to be in respiratory distress'

Registered nurse Ashley Brouwer, who responded to Morse's call within about five minutes, said Sappier reported shortness of breath, general malaise and "a bit of pain in his chest."

She, like other medical staff during the outbreak, wore full personal protective equipment, as she took his vitals.

She noted his cellmate had COVID, but the results of Sappier's Jan. 28 PCR test had not come back yet. He was negative as of his last rapid test on Jan. 23.

Sappier's blood oxygen saturation levels were between 89 and 93 per cent, said Brouwer. Between 95 and 100 is considered normal range, she said.

A woman with dark hair, wearing a blue rain jacket, exits a building.
Ashley Brouwer, a nurse at the Saint John Regional Correctional Centre, testified she gave Sappier two different puffers on Jan. 29 to help his breathing. (Roger Cosman/CBC)

Brouwer gave him a quick-acting puffer, known as a bronchodilator, and his levels increased to 96 per cent. Sappier told her he could breathe better, she said.

"He didn't appear to be in respiratory distress," just "a little bit lethargic."

"It was consistent with what we were seeing with the other clients with COVID."

When she checked back about 90 minutes later, however, he was still short of breath, so she gave him another puffer with steroids and recommended he be moved to the medical unit, near the nursing station — a more comfortable cell, where she could keep a closer eye on him.

Mother sobs watching video

Around 2 p.m., Sappier didn't report feeling any worse and all his vitals were "fine," but he still hadn't tested positive for COVID, so Brouwer consulted with the jail doctor over the phone. They decided he should be transferred to the Saint John Regional Hospital by jail staff.

Sappier's mother Dora Sappier sobbed as a video of Sappier waiting to be transferred was played for the jury.

Sappier's positive COVID test result came back shortly before he left, so he donned personal protective equipment for the trip, along with handcuffs and shackles.

Five women standing arm-in-arm.
Skyler Sappier's sister Shawna, sister Leah, mother Dora, sister Raeann, and sister Sierra standing in front of the Saint John Law Courts building Tuesday morning, before the coroner's inquest began, wearing T-shirts bearing his image. (Roger Cosman/CBC)

He was triaged as a "level two," ER nurse Rae Tremblay testified, which means he "ideally" should be seen by a doctor within 15 minutes of arrival. Only level one is more serious and is applied when someone isn't breathing or their heart has stopped, she said.

Sappier was showing signs of sepsis, the body's extreme response to an infection, according to Tremblay. He was so short of breath he was having some difficulty speaking and his heart rate was elevated. "He looked uncomfortable," said Tremblay.

Shawn Carter, one of the correctional officers who transported Sappier, testified he noticed "a little bit of a crackle" in his breathing, which he described as "out of the ordinary."

Sappier "seemed relieved" once they got to the hospital, he said. Not long after, he was intubated.

Sappier's condition continued to deteriorate and he died in the intensive care unit on Jan. 31, around 3 a.m. — nine days before he was scheduled to be released from jail.

'Justice for Skyler'

Several members of Sappier's family and other supporters gathered outside the courthouse before the proceedings began, where they performed a smudging ceremony.

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Skyler Sappier’s family and supporters gathered outside an inquest into his death while he was an inmate at a Saint John jail. The family believes the Neqotkuk First Nation man died of COVID-19.

His mother and four sisters all wore white T-shirts bearing his image and the message, Justice for Skyler. On the sleeve is the message, My Life Mattered.

Among the supporters who attended were Tobique Chief Ross Perley and Martha Martin, mother of Chantel Moore, 26, who was shot and killed by Edmundston Police Force Const. Jeremy Son on June 4, 2020.

A group of people look on as a man plays an Indigenous hand drum.
Skyler Sappier's family and supporters gathered outside the Saint John courthouse early Tuesday morning, where they performed a smudging ceremony and Julian Moulton drummed and sang. (Roger Cosman/CBC)

The inquest resumes Wednesday morning. It's scheduled to continue through Friday.

An inquest is a formal proceeding that allows for the public presentation of all evidence relating to a death. The New Brunswick Coroner Service is an independent fact-finding agency that does not make any finding of legal responsibility.

Crown prosecutors Chris Titus, Patrick Wilbur and Rebecca Butler are assisting the presiding coroner.

Sappier was serving a 96-day sentence at the time of his death, the courtroom heard.

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