Fatality inquiry into disabled woman's death makes 13 recommendations

A fatality inquiry into the death of a mentally handicapped woman who was neglected by her family has made 13 recommendations, including better funding and programs for people with disabilities.

Before her death, Betty Anne Gagnon had been confined in a basement, a dog run and a converted school bus

Before her death in 2009, Betty Anne Gagnon had been confined in a basement, a dog run and a converted school bus with no heat on a rural property east of Edmonton. (Supplied)

 A fatality inquiry into the death of a mentally handicapped woman neglected by her family has made 13 recommendations, including better funding and programs for people with disabilities.

Before her death in 2009, Betty Anne Gagnon had been confined in a basement, a dog run and a converted school bus with no heat on a rural property east of Edmonton.

Gagnon's younger sister, Denise Scriven, and brother-in-law, Michael Scriven, were sentenced to 20 months each in jail after pleading guilty to failing to provide the necessaries of life.

"There were also many missed opportunities for authorities to intervene, which if fully and proactively acted upon may have prevented this very tragic and unnecessary death," Alberta Provincial Court Judge Michèle Collinson said in her report, released Thursday.

Report makes 13 recommendations

The 13 recommendations in the report include: making sure there is adequate funding for programs; taking immediate steps to address emergencies; reviewing programs for people with disabilities who live in rural areas; and conducting a review to consider legislation that would provide authority for emergency interventions.

In her report, Collinson said the Scrivens reached out for help from the government, several social services agencies and the RCMP, though their requests for assistance were not consistent.

"Sometimes, Michael reached out for help; sometimes Denise reached out for help; and sometimes, neither reached out for help," Collinson said. "They did not follow up in their requests for help nor were they persistent in seeking assistance."

Betty Anne Gagnon died in 2009 from a head injury. (Supplied)

A medical examiner determined that Gagnon, 48, died of a head injury that was caused by either a blow to the face or an accidental fall.

Gagnon was found dead at a rural gas station outside Edmonton on Nov. 20, 2009. At the time of her death, she weighed 65 pounds, had bruises on her body, two black eyes and blood in her nose.

She had been living with her sister and brother-in-law since 2005.

When Gagnon and the Scrivens initially moved to an acreage near Androssan, about 30 kilometres east of Edmonton, the arrangement seemed to work.

But family members later said Gagnon's behavior changed and the Scrivens began to struggle to provide the care she needed.

Couple initially charged with manslaughter

The couple's relationship suffered and they became abusive toward Gagnon. The two were initially charged with manslaughter but later pleaded guilty to failing to provide the necessaries of life.

Alberta launched a review of the Persons with Development Disabilities program in January. The program includes services that help people live at home, get job training and take part in community activities. The government said at the time it would seek input from people receiving assistance, their families and staff.

Community and Social Services Minister Irfan Sabir said Thursday that changes have already being made.

"The death of Betty Anne Gagnon is a heartbreaking tragedy," Sabir said in a statement. "Albertans deserve to see real action to stop tragedies like this from happening again. That is why we have made significant changes to improve the safety and well-being of Albertans who receive supports through the Persons with Developmental Disabilities program."

Sabir said the changes include implementing new training for staff, prioritizing individuals with urgent needs for supports, creating new accountability mechanisms and launching a provincial help line to report suspected abuse or neglect.

He said the province has also increased funding for the PDD program by $150 million to ensure that more Albertans have access to supports.

with files from The Canadian Press