BACKGROUNDER - 46th Annual Report to Parliament



The 2018-19 Annual Report of the Office of the Correctional Investigator (OCI) was tabled in Parliament on February 18, 2020. A number of issues identified in this year’s report raise significant human rights and/or human dignity concerns:

  • Elevated rate of use of force incidents involving inmate-patients residing at the Regional Treatment Centres (psychiatric hospitals). 

  • Accommodating the needs of transgender prisoners. 

  • Lack of in-cell toilets on one living unit at Pacific Institution. 

  • Provision of the first medically assisted death in a federal penitentiary. 

  • Continued use of security classification and risk assessment tools that are not responsive to the needs or social histories of Indigenous offenders. 

  • Warehousing of aging/elderly, chronically and terminally ill offenders who do not present an undue risk to society. 

  • Unnecessary restrictions on accessing the Prison Needle Exchange Program.

The report includes three case studies highlighting systemic conditions of confinement issues in federal corrections:

  • Culture of impunity at Edmonton Institution. 

  • Substandard and inadequate prison food. 

  • Use of force at Atlantic Institution.


1. Negative Workplace Culture at Edmonton Institution

  • This case study reports on the Office’s investigation into a series of degrading and humiliating inmate-on-inmate assaults that occurred between August and October 2018. The investigation found that correctional staff and management at Edmonton Institution (EI) knew about and tolerated an established history of bullying, harassment and assaultive behaviour directed by groups of inmates against a sub population of protected status offenders. 

  • Evidence shows that protected status inmates were repeatedly subjected to a constant barrage of insults and assaults, which included throwing food, bodily fluids, garbage and other demeaning acts.  These incidents went largely unreported by staff and no disciplinary measures were taken against the inmate aggressors, even though they were known to staff. 

  • OCI and subsequent reporting by the Correctional Service of Canada (CSC) shows that the repetitive nature of these incidents can be traced back to “negative environmental factors” deeply ingrained in the staff culture at EI. One independent human resource consultant’s report described that culture as “dysfunctional and toxic.” It said that EI ran on fear, mistrust, suspicion, harassment, bullying and abuse of power among staff. In such an environment, even the most abhorrent inmate actions and behaviours were “normalized.” 

  • Significantly, Edmonton Institution management failed to act on initial Office concerns brought forward in August 2018.  In fact, senior levels of CSC management only took action after the Correctional Investigator disclosed incontrovertible video evidence to the Commissioner on November 9, 2018. 


2. Quality and Quantity of Prison Food

  • This case study documents the implications of failing to provide sufficient quantity and quality of food in the federal prison system. It reviews the findings of an internal audit of food services conducted by the CSC. 

  • The audit confirms several deficiencies previously reported by the Office:
    • Inadequate per diem (less than $6.00 per day per inmate spent on food). 

    • Inconsistent or substandard meal portion sizes. 

    • Failure to meet Canada Food Guide requirements. 

    • Excessive amount of food wastage. 

    • Failure to consistently follow special diet requirements. 

  • The audit only goes so far however. On the links between food and institutional security, the audit did not examine the food shortages, inadequate portions or poor meal quality that were causally linked to the deadly December 2016 riot at Saskatchewan Penitentiary.  It also did not examine the full range of risks and costs associated with the implementation of the ‘cook-chill’ food production system, an industrial food services model which replaced traditional, on-demand scratch cooking at most institutions in 2015. 

  • The Office concludes that cost savings and other efficiencies in the food services area are prioritized at the expense of inmate well-being.  Office reporting confirms other negative effects of the ‘cook-chill’ initiative: the ascendance of food as a commodity in underground prison economies; extortion, muscling, intimidation for food; rising levels of frustration, tension and protest related to poor quality and quantity of meals; inmate canteens supplementing or even replacing institutional meals. 


3. Use of Force at Atlantic Institution

  • Based on four years of data, this case study identifies recurring compliance problems in use of force incident management at Atlantic Institution (maximum security).  These issues include: deficient accountability, lack of meaningful corrective actions, failure to learn from poor incident management and inability to sustain reforms over time. 

  • The Office’s review indicates that implementation of the new Engagement and Intervention Model (EIM) has not had a measureable impact on reducing the manner, rate, severity or level of force used at Atlantic.  Evidence shows a continuing over-reliance on the use of inflammatory agents (pepper spray), high number of Emergency Response Team deployments and increasing number of inmate allegations of improper or excessive use of force. 

  • Despite a series of OCI interventions and recommendations, the occupational culture at Atlantic Institution appears resistant to change, slowing the pace of expected reform. 

  • The Office recommends that CSC should establish a working group, with external representation, to review all use of force incidents over a two-year period at maximum-security facilities with a view to analyzing the culture that contributes to repeated compliance issues and inappropriate uses of force. 



Safe and Timely Community Reintegration 

  • Insufficient number of community bed spaces, resulting in paroled offenders being held prison instead of released. 

  • Individuals are being returned to the community without health cards and other official identification, resulting in difficulties with accessing essential services. 


Federally Sentenced Women 

  • Maximum-security women residing in Secure Units face arbitrary and discriminatory restrictions in accessing services and programs in other parts of the institution. 

  • Accommodation of gender identity/expression needs to be addressed in a manner that does not compromise the unique features of women’s institutions. 

  • The introduction of a randomized strip search routine/protocol is not trauma-informed or responsive to the principles of women’s corrections. 



The report makes 16 recommendations. CSC’s response is embedded (follows each recommendation) rather than annexed. Key recommendations include:

  1. CSC should commission an independent, third-party expert, to assess and diagnose the potential causes of a culture of impunity that appears to be present at some maximum-security facilities, and prescribe potential strategies that will lead to change. 

  2. An external and independent review of CSC food services is required to inform the development of a revised National Menu inclusive of ingredients, cooking methods, portion sizes, nutritional content and food costs fully compliant with the new Canada Food Guide. This review should include direct and meaningful consultation with the inmate population. 

  3. CSC should reconsider the recommendations of the joints OCI/Canadian Human Rights Commission report Aging and Dying in Prison , with an aim to revising the national policy framework for aging offenders, identifying ongoing and new commitments and specific timelines for implementation. 

  4. The random strip search routine and protocol in women’s institutions should be immediately rescinded and replaced with a more trauma-informed, gender-responsive search policy. 


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