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RISK ASSESSMENT

SUMMARY REPO

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of Risk.

(Sea handwritten AisK ~~t

cnent: T~ Saddleback 008: April H, 1985

Fonn: Identifyin" Potential

June 23, 2008)

CaU8tJ8

Report etm1P,ted by: Bob Olmstead

Date of review: August 25, 2009

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Tamsm Armilage. Pmgflll\J Ckector Christine HoIu~iitOkJoJl. ConnectJoq

Greg Ofsan,.RaaldentJaf Program Manager JeanneUlt Johraon. 1um l..Mdor

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Day PfQgf'am anager

Sob OImst88d. Psychology AssIstant, POD

Idona,. Pate.dlal Riake

1n a best .. ~J Te~ fin. the Impad.. of hie ~ion
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wiD beliving In a~iw enYi'omnent which ~ sexuallY inapproiriafe behavioura. ,.,.

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Include:
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. A \JfNotu1tlJly,8BCUra' group ~le&idence

area iIr T. and apnBctive.1oc:.ked

with a calm downl time out &ataffto ndre8t to In the

EnhInced staf(fng J1umbe~.. . CoIlBlat8ncJ tn day-to-day servJcee as provfded ~ 8 f8.c:iIity such. CentenPIaI CenbB .' AoeeeI to ~ acftViUeI~TemlflCll~ b,lng kept busy. Helikea pbysicaJ actMly. and he also 1Ike1social confaCl on a somewhat

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superficIiJ level such 1hat he can watch tie t:amlngl.and golng8 around
him and grest 1h8 staff who ~In agitation/anxiety continue to pface this ~ ~aIly opaatIons. scenario at nak.
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Aggression. sexuallY inappmp'" b~fulVl~! threatenlrWi~

and
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Analyzing th. Rlab ' . ' The "moat IeCOJ)tepJaode invoJvelill)lI alIac:k an a femafa alConneotIoJ1$. It NqQIred 1WeaCMP oftlcers and a male Conneclfcna atarf10 Udutt him using hand cutfe and pappUI' spray. He was tmnspomd to Fmer,geney at tho ' Wetaskiwln H~ta' and Care Centre. and from there to Centennial Centre In POnoka. He IJJ heavDy sedated} but nonetheJeaa ho had an IV IocJtto guarantee thpt It PRN injectlon would be oKecIIve Immadtely If this became ft8C8Uasy. and hIa RCMP "(:Ort canie,d 8 taser.

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Accor~ing to the RJsk.Analysls Guide (pubBahed Mar 8 by POD AJberta),the potential consequences for Terrenee', aggressive ,urstl are aa follows: . Thecon~ couldbe exten&Ive anc;f Irreversibfe - ;ncJUding de,th . or permanent disability to the 5taff or support workers invo1ved. DuriJlg the last fncident'RCMP OffiCC!AJ queriedthe 1eg~'"Y of a~uJt charges . agafn~ him, even g~en hi, level of dis;Ulillty. I" ' - For the Service Pro,lIiderihls equates na la.pit that threatens the olgiU1izatlon'a vIabiIV both financially and poftllcaUy. For TemmC8, the COI1$8qU8f1cea could include serious but not permanent injury! disability; loBs of hi& hame; arrest Or conftid with the law; and lose of olber vafued actMtJB8. He indicated later that he had a sore stJouJder, there.wp' prulsinsvisibleon'his body, and he~played both phy8icaJ and ~otionaJ effects from~e incident Because h8is $0 UripredJc1:abIe, ~c::ees to community actiYIfJea ~ QJrta1tecf'.,a he is seldOm taken out In public. " For aupport Itaff,theJ8 could bo extended I ..fime injuries and/or whofteal. ~ reaJgpaUoruJ.TheJ8 wet8 tt""~B claim. filed by Injured ataIf frJm 111.Jat incklent. His atJ$If888Jon ~ atafIlead8 them to suspfdon and lImitaUoneIn their.wiJJIr91- to ~ract closelywith him . - The ~p8cI of n 0UIbUrvt8 on ps8I1Ile ~ to aaliW8~ but 8tarf h~ ,repoi1ed a nW)1ber of observances - bahavfouri or comments by those ~ 1hat1hey~erad to benotable.
CUrrent measures to'manage the fisk posed by'his Jresaive behaVJ~.cau ror a Behayfor &upport Plan JncIt,afIng pasittYo J8df1udfcm a~~~.for appropriate behavlor, structuJ'8 ami contJOlln h'sday.tboday actMtJ8lJ. withdrawal ci attention for InappropriIIt8 behaVior. redfreotkJn wHh PhYatcalguldanGe, time out,andpharm~

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faa crisis protocol to clear 1tta area if he eacaIatea, andto In~

emeJD8I1CY medloaJ eervtces.

madlcatfon8ln bothdaBy andPRNprescrfptions. There poUoe EfndIot

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,.~8o~:eq~~ conJequerKl8t 1to Terrance'8BgJ1'e8slve ouIJUrata 5were ScAle " r.ded from S with 1 insigniftcant~d being catastmphJc. The for
rated from MaJor~J.avBl4 to ~phJc. Level$. . '
Th8 LikeUhood Seals Is .rated from 1 to? with 1 meanin rare an:J 5 meaning almost c;ertain.The likelihood that he wdl continue thIs behavior t$ rated as level

5, and Is almost certain and sxpected to occur agQjn. T~renc:e~1 guardlan and past rfacortis Indicate that Incitents have 0CCUJed ~ evervBI~ monthI to a year In the past, and h,ehat been adntIIsd to ~nial Cantre, Ponoka ~ur

t1mea In tIve yen .

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The Rl$k Ra1Ing Table .k.fmeit . /evala fram LoW Risk, Risk, and High Risk. to Extremu Risk. There" determiJed:to be an ~. Ri;k that this betJsvior wi continue to eccurwitl1CJUt-iJdequate $tIpportl'" pJaQe. Immediate lIctJoc1 involving senior manag~ is indicated, I .
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As Indicated above. it is important that hB. have a comfortable safe home enviro~ with enhfillced 24hDur~ng. The ron~ng $ho~ be considered;
1. An ImP~ 8~ of~unl~
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shauId.lid bf' dewfoped that

rec:agnrr.es Terrence's behavipur SJgnS". In debitefIng from the fast

Inckfent It became apparent that different staff had noticed subtle chang., but thereweren'tsufficient jndica~ns~ put th~ 819M together in order to warn anvono of the impendlflg o&ealation. It should also be l10tert that his escaIaIIOna .., usuaRy explosive. PerhaPJ a . pmfDCoI or Checkllstot Ind ,. GOuld be~. Currently such pnJdJotiom ilr1t"ditftGuft to make and CiI1 be aubJ~ to. aifferent

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hit WlbslJzationa and IlCtkma appear more or loP ~ ~ ~I'J predictlan ls a hard 081 to make. and QJ ~by1lul 5.I1.etWeBn m.ntaining his rights VI. maintaining IIsafe snvinJRment for everyone else. 2. "HIe menu of poaftIye euppor18 GJI) aIvRIya ba ~, He may need a ~ bafatIctt '" actlYly VIJ. raat ,_ time. V~L communIcatians probably be modified eapedaOywhan h.ail~. Tho . diMdopment of COI'IGJ'eIe_rigu9 wap by hill home euppoftstaff may bel1'l8nClattNy given his aPeciffc dJaabUlUee("I. fYou have 10 ., "Come tI8ftf becIMO ".-0 you Jater!"18too ab~ far hfm 10 pracesa). In t?Jisi8 a~ ItdV/Jtalse English II&i ascand IaAguap may need ~ to niduce1hoir~Female IIaff anr It \1realtljdak -bacauee they ~ his p""d"-'An~c~WbUId_todeviae. bdw behavtoUrai sIrategIeI. An ongoing reIaUonahfp with a psydliafrtst Js alBO rvquhd to malntaln and IJf1IJance 1111medfcaIIon 1r8aInient. 3. An fmpottuntcornplliJrnGnl to T~mmce's hcu. se.tftng would be a In P,8~ psychiatric nlnCt whO$J avaiabilfty~Uld facilitate fmmedf_ PRNfnlBlV8Iltlon. A line out mom with locka would be useful ifTerrenca 0QIftP1Ied with rvquesIIs to GO butllll outtJundI exceed IfIe GlPllbIlHy infatpJetations ~
approprfate in
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and theleGhnJquea taught In cammon GIi8i& intervention traIM1g. A

loCked-panicrocm'Ymere staff can to far refuge ~Id also be neceaaary. But 1hIs leaves aIher cBentt at risk. m1d besplhe question of haW to intervene'betWeen Terrence arid the greater uoHyduring an ememency. .

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NewRI~ Rating

According to thtJ Rl$k Analysis Guide, the

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behaviour if the abQ1m,deaCJibed measures were all in placa would nkelV still be rated at feast as Moderate (~, 3) to Major (~ 4), They coukt tI'IIlmten continued effective pnw;siDrt of $t)IVJces and req~if9 topwlevel managerpei'tt review and intervention. For Terrence, they could still result in serious but not permanent injury; arrest or coi1fttct wi1b the laW; a~ lose of his cwrent home. For, spwort ltaff. there could 9tiH be exleJKfed rost. ~ injuries, increased staff turnover and/or wholesafG staff resIgnation_ FO': ~~ Service Provider this could Include lawsuits and property and/or monetary IOI[ wlth very high consequeilces . '. fo..1he oJganlmtion both ffnanciallv and polftfCaJJy. ' .
On th.lb'fi~ood Scalethisbeh~r is rated as event Will occur again in most oircumstances.

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. . ~ ~ There is determined to be a High Risk that thts eYENl wiIb adequate'suppO$ in plaQ8.
Maldng a DecIsion

4. and LikelY thal an '

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avlor will CQI'ltinue to ~

He '$hot.dd not return ID a propJfetoqhfp. The~ res&ing concernIs to mamtain-safety. Staff and other have to be to recognizethe warning , 319118 and ,8V8dt;t TemtnQIJ prior to an',aI1ack. Cu' , the only option fa to ~ . for RCMP asaiatanc:4. &Saff.W,hokrwW femmes have wftneaaed hIe outbUnsIIn ffrm in their corMctJon U1at. lilt wiD ha en again. a

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, Report ~Jefed

by;

Bobormatead.
t PEnOn8I DwefopmerJt Team

Psydlology ",

PDO Centlal Region Augu$l28. 2009. '

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FAX #- 1BO 429 5.500

Attention Karen KleiSs

From; Granam Jone~ 1S0-432-7t;2~

5 'Pages

Edmonton, AB, April 28, 2011 Honourable M. J. Jablonski #227 Legislature Building 10800 97 Avenue Edmonton, AB, T5K 2B6

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Dear Ms. Jablonski:

I am writing in my capacity as the guardian of Terrence Wade Saddleback who was recently tried for the manslaughter of an employee of the Canadian Mental Health Association in Camrose. Terrence has been committed to Alberta Hospital, Edmonton because of his limited rental capacity and his inability to stand trial due to mental defect. I concur with the judge's ruling. I am also writing to enquire if there are any investigations being carried out, other than the Occupational Health and Safety investigation, on the decisions t~at were made prior to this death occurring and the reasons why this tragic event happened. Based on my experience, I believe that the death of Valerie Diane Wolski could have been prevented if cert~in policies and procedures were adhered to. Both individuals in this situation were set-up for failur' I am aware of a Public Fatal Inquiry held in Lethbridge in 2008 in 'fhich the death of Sharla Marie Collier occurred. A young man, with documented aberrant behaviours sImilar to Terrence, murdered a staff member who was working with him. Specific Recommendations were made in the Judicial Review ofthis case. If these recommendations had been followed in the Placem~nt of Terrence, the death of the lady in Camrose could have probably been prevented. In my opinion, gross errors in judgment were made in the placement of Terrence with the Canadian Mental Health Ass9ciation by the Persons with Development Disabilities Department (PDD) of your Ministry. The essence of the Adult Guardianship Act were also not embraced which I made apparent prior to and dU~ing the judicial proceedings, and this has been confirmed even moreso since receiving information appertaining to Terrence's Disposition Hearing on March 23, 2011. As this issue has caused myself and others a great deal of grief I Hope that you will respond to my letter and am advising you that I am not prepared to see this issue 'swkpt under the carpet'. Terrence, other persons with disabilities, and the general public of Alberta deserJe more than that. We need first class programs and accountability forward to your response. under the legislation to retain our sanding asia first class province. I look

Graham Jones c.c. Honourable Dave Hancock, Q.c.

WD~CS
Wmskiwin Br iDistrict Assodation for (oimunity Service
November 19,2009 Tim Lowe Community Resource Manager PDD Central Region Community Board Dear Tim, After much deliberation with our Board of Directors, insurance carriers, agency lawyer and staff, we have come to the difficult decision of having to tebninate services for Terrence Saddleback. As you well know, Terrence's high-risk behavior, which has been described as psychotic in nature, is a real threat to himself, staff, clients and community. We do not have the resources to adequately address his needs. During the last critical incident, 5 RCMP officers, pepper spray and handcuffs were required to diffuse the situation. Despite having an effective response time with our RCMP, we do not have the manpower or skills necessary to mitigate risk prior to their arrival. Further, to adapt a home within the community to ensure staff and client safety would be to disregard CET standards. As well,! supporting Terrence in a restricted environment does not fit within our mandate. Please understand that this was a very difficult decision to make. However, in the end, we realize our limitations as it relates to his needs beyond his developmental disability, and can therefore, not place Terrence, staff or clients in a position of known risk. WDACS will extend an offer to participate in training and Jransition planning should that be an option.

Sincerely,

Marilyn Conner Executive Director WDACS

Cc:

Graham Jones

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SefYk;as - Edmonton Zo

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Re: SADDLEBACK, Ten~e'W~de . . .---,.. . '-. ,DOS: 11~April"1~ . " " . .. . .'. ., ..' .. ~':.>._.:.:~. Court ~ed.ntN~y, March 2~,.2Dll G9-..30adl in-~ui:b'~ 4H)Q1.,_" : Docket'. 110198264P1.cn.-om l _". . . _ ... ..

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repeet, Mr. moderate mental impaiiment (I~ing disability). Due' f{):~j~.:~unp~t he js completely ~b1e to gi'O'e any reasonable account ~f ~f.Jn preparing this report I ~m. te ~ quite he8vify 4e~c-nt on ba.~g:r~ mto~tion .reeeived on Mr. Saddtehat-k. UnlortunatelYI to d~te,the:1No~on received haS . . . .._.\:"... been limited ~ .t)4l.ture. I have however ha:cJopportu~tY t~ ~ew .the f(jl1owing documents, .. .

"234'~of,February ~11 ~irr5Uant an ~~m~ order ftd\m.:!h.~indal G9urt, .. Camrcse. The court directed that Mr. Saddle-back be a~Sse(tfor'his fitness.to. ...

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2. A h~tory horn ~

from the A1be;<ta HoSpital rtci~:JatedlcJtb AJ>ril

Alberta H06pitat Ponoka taken ~1~9.~ M.t~ '. .'.. Saddlebrl's admission to the Alberta Hospital POI~oKa the. 14th of on FebtuAry 2011 .. ' .' . . ., ::. :'. .
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. 3. A number of dOcuments received from Camr~

a) The Prosecutor Information sheet

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individllaUy i4entif)'i"l'cJiIllftO$ric, 1fc:Cmert1. ~

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Hca1rh Au1t>otit)' un4t:t Scx:ncm1" 1)(P) 1M ~ )f(a)C1f!tlc //,Qlth IIff~IftIJItiO#t ~mpfjam.tw1tb .ad tot the . 1'CqU~ by die r.rilffiltlli cOdii tr:'Q~. "_. - .' .
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b} A letter from the Office of the Public Guardian, dated 120\ January

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c) A report (rom Michael Machuk, suppbrt intensity scale specialist. TDD, Central Region Community Board (my copy undated) d) A risk assessment by Bob Olmstead, ~yChotogistassi.stan~ ~~n.J Development Team. Central region/ dated 23rd of June \

Ipresent m.y report in summary format:

1. As already stated, Mr. Saddlcbaek suffers from severe to moderate mental impairment. He was born in Calgary. At this time we do not have any -information as to etiological factors behind his mental impainnent, apart fiom noting that at an early age he was diagn~ with mffering rom a "Perversive Developmental Disorder and I1'\txlerate to severe mental impairment". T I ", Ii aUi 1i8 Itt:s
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3. With respect to his psychiatric history, info4alion in the records refers to five admissions to the Alberta Hospital Ponofa. I do not have details on sll of these admissions. 1note however, that there was a ten month admission in 2008/2009 (discharge lilt of Ap~ :20(9),

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6. A further 2009 and Pervasive Moderate

admission to Alberta Hospital Ponoka OC' rred between July. December, 2010. The dia~ on this ad . -on were Developmental Disorder, Disruptive Be vieur Disorder and to Severe Mental Retardation .

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WoIs~ the alleged offence have occurred on or 2011. of Valerie Diane t the 12th of February

8. Mr. Saddleback is charged with the marwlaugh

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10. On the 13d' of F~bruary 2011 following his in~\iew with the police, Mr. Saddleback wu admitted to the Alberta Hospital\ Ponoka. It is stated
follOWing admission to the Alberta Hospital Pon9~ he was observed to "L. be somewhat different than his usual praentati~ :1 .., and was subsequm\tJy seen to be pAeing, tense and ap~arI uncomfortable in his surroundings. A labile _ ransms from happiness to sadneas to .anger wae also noted. Por. period Mr. Saddleback was managed in t~ seclusion room. is ~fcrence to him stating the}~11_o~g in ~~IuHiotuoom. "'I come outilcome out . -now"~..Cf.K.r. followins which he ke ton re "" heard to say, don't ullt about voices."
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11.On tM 23td of February. 201t Mr. Saddleback was raNlerred from th~ Alberta Hoepital Ponob to the Alberta Hospital monton. SitM:~he has
been at the Alberta H.ospital Edmonton he has been\ calm and settled on pt .) II P '5 i ' & E 7 I It h.u been apparent throughout Mr. Saddlebadt's period at the AlbertaiHospitaJ that he is ex~ly low functiOning. Hc\can give no adequate acCount of

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himself. He requires supervision and promp' activities and basic care.

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12. l have interviewed Mr. Saddleback on three ~C.asiOnssince admission to the Alberta Hospital Edmonton. Most of the c nversation J have had from Mr. Saddleback (including responses to quest OIlS put to him), consists of,
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1have attempted to do some simple cognitive 1esting with Mr. Saddleback. He has been able to correctly tell re the ~y..?-(~e w~, ~~._ ".-appears to have-no sdea wMfWion"lh or fearwe arein'Examples given when asked for the month W~,. "ten" at\d _ked what the year was II he responded, "one O.K. t could not establis,,\,\fl\ether'Mr. Saddleback understood that he was now at"the Alberta H~ital Edmonton, although ,it is clear that he r~alius that he is not in Camr~ and wants to return there. Mr. Saddleback is illiterate. He can rec~~ the odd simple word such as lithe". When asked to read the word "~" however, he responded "star" and when asked to read the word "or he responded Nfar". Mr. Saddl~back$'arithmetic abiliti~ are extremely Jfor. He cannot even , correctly answer simple addition or $Ubstrit,tio~sums. For example, when asked what 2 -+ 2 was he responded, "'10OJ<." Ntr. Saddleback's attention span (immediate memory recall) measured a~3 normal- 6 to 7). I could not get him to perform tests for longer term ory. M,..Saddleback was able to say the days of the week correctly fOIW with encouragement He was not able to say months 01 the year. He able to follow simple instructions such as stand up, sit down, put his up, etc. He was also able to sign his name with a poorly legible

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1 W8$ not able to egtablish if Mr. Saddleback suff trom any psychotic symptoms, such as auditory ha11udnations at . time. However I do reference to him Teferring to vokes whilst at the lberta Hospital Ponoka prior to Met transfer to Alberta Hospital Edtn.onto 13. It was impossible to have any mea.rUnglul discuss'on with Mr. Saddleback regarding the alleged offence. On being asked wh he was in hospital he responded, Idon't know". On being asked if he d been charged with any offence he responded, "ten. O.K.?" It is elear f. Saddleback did not understand what was meant by the word off~nce. I asked him if he had done something bad". '
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A range of inv(.~tigations have been ordered for Mr. $addleback (brain scan and EEG). The results of t~ investigations are not available at the time of completion oftJ:ds. report. . . .. .-_ . __ __"". ::::-_-:....--:.-.::-:.... " PSYCHOLOGICAL ASSESSMeNT: A psychologic:al assessment has been requested in res , t to Mr. Saddleback. It is likely to be a couple of weeks before psychological ~stin8 has been completed and reported upon.
CONCLOSIONS:

My conclusions and comments on this case are as tolloi'S;1_ Mr. Saddlcbeck suffers from severe to moderate ~ntal impairment (learning uisability). There is no doubt about thij diagnosis. His presentation at Alberta Hospital Edmonton has been consistent with someone who suffers from a severe to moderate earning disability.

3. lv!r. S.addl~bad, is co~pletely unable to give any .&\easonableaccOUtl~of hinu;eli, It IS not possible to have any reasonable tn-depth conversanon with hiIil about any subject. His verbal in~raction are S.,ncrally limited to greding people and saying, "yes, O.K." He req ires 24 hour supervision and support in day-to-day activities. 4. Mr. Saddleback appears to have little, if any, unde tanding of the mattel' 01 whi<.:h he is charged: He does not the ability to nderstand the meanings of the pleas guilty or not guilty. He is co pletely incapable of i.n.snucting hi5 legal advisors, He would not be Db) to follow court proceedings.

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5. Pollowtng from the above. it is my opinion ttJt Mr. Saddleback is unfit to plead and .tmd trial. 6. 'this report is coming completed after a relative! y brief period of psychiatric assessment. We are stilt awaiting the completion of the psychological assessment on Mr. Saddleback. fe may alw be receiving further documentation in respect to Mr. Saddlcback's background history. Va.riou~ inv~tigations (including blood work, EBG and brain scan) ~1l5o remain to be completed. 7. Once the above investigations have been completed, and possiblyfurther .., .. '----iiUonnation received, it may be possible to pro,ide a more detailed account on Mr. Saddleback This wilt not how~v~r, lter the position in a respect to his unfitness to plead and stand trial. 8. Mr. Saddleback continues to require secure psy hiatric in-patient treatment and ma.nag~ent. Abed conttnues to be available tor him with Forensic Psychiatric: Services at the Alberta Hosp,ital Edmonton.

Respectfully submitted,

Christopher Green M.B., Ch.B., LM.CC., D.P,M., P.R.C.Psych (UK), F.R.C.P. (~,da) Forensic Psychiatrist Alberta Hospital Edmonton
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