custody_death · 2023-Q3
Bureau du coroner (Québec) · Bureau du coroner
Redacted summary
A person died from asphyxiation by obstruction of the upper airways in a temporary transitional resource center in Montreal. The person had a known medical condition and risk. The circumstances surrounding the death, including the lack of adequate surveillance and delays in emergency intervention, raise questions about the evaluation of user needs, collaboration, and information sharing between teams, as well as the management of emergency situations to ensure user safety.
Officer
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