Ontario NDP leader Andrea Horwath is calling for a coroner's inquest into suicide deaths by patients at St. Joseph's Healthcare Hamilton since the beginning of 2016.

Horwath, who is Hamilton Centre MPP, called Friday morning for the coroner's office to undertake a public review of the deaths. The appeal comes after the hospital released a review it commissioned earlier this summer. Horwath held a press conference outside the hospital with the family of Daniel Reale alongside her. 

Reale died by suicide while an inpatient at St. Joe's West 5th campus, the region's mental health specialty hospital, in June. The family supports the call for an inquest.

Andrea Horwath and Denise Skowronnek

Ontario NDP leader Andrea Horwath is calling for a coroner's inquest into suicide deaths by patients at St. Joseph's Healthcare Hamilton since the beginning of 2016. Horwath made the call in front of St. Joe's West 5th hospital where 11 suicides involving in-patients and out-patients have taken place in the last 18 months. Horwath was joined by Denise Skowronnek, who lost her brother to suicide in June. (Laura Clementson/CBC)

"Dan was a very humble, kind man who loved his family dearly," said his sister, Denise Skowronnek. "We miss him terribly, every day."

He died just a few months before his first granddaughter was born, just last Friday. One of her middle names: Danielle.

Denise Skowronnek

Denise Skowronnek stands outside of St. Joseph's Healthcare Hamilton Friday, holding a photo of her brother, Daniel Reale who died by suicide while an inpatient at St. Joe's West 5th campus, the region's mental health specialty hospital, in June. (Laura Clementson/CBC)

One glimmer in the middle of the darkness was Reale's decision to be an organ donor, which the family says brought help to five people. And another is the change they hope will come from going public with his story and joining the push for a coroner's inquest.

"How can we make sure this never happens again?" Skowronnek said.

Horwath tied the deaths to the province's budget squeeze on hospitals and health care.

"These deaths are troubling," said Horwath. "Patient care has already been seriously impacted by the Wynne government's cuts to health care, and the hospital itself has called the high number of suicides in its facility unusual. Hamiltonians need to know – are there more cuts coming?"

In a statement to CBC St. Joseph's Healthcare Hamilton president David Higgins says the facility is committed to preventing suicide by all possible means and has already made information available to the coroner's office. 

"We have an action committee for the prevention of suicide, and are devoting additional resources to ensure St. Joe's is the safest place possible for our patients in times of crisis and despair," said Higgins. 

"We have investigated each tragic death and also have sought outside review of the events, our care approach, our policies and procedures. The recommendations from this external report were made public and have been submitted to the Coroner's office," said Higgins.

"The coroner receives all reviews of deaths by suicide in our facility, and we ensure all information is available to the coroner's officer. We have and will help with any review, investigation or inquest."

Hospital commits to make suicide a 'never event'

Reale died about three weeks before St. Joe's administrators announced their goal of making suicide a "never event."

In July, the hospital released recommendations from an external review they'd commissioned by a psychiatrist specializing in suicide studies and a former regional supervising coroner.

Not all of the suicides happened within the hospital's walls. Some took place while patients were out on day passes, and others were individuals who'd been seen as outpatients.

st joes west 5th 1

Administrators of St. Joe's, whose West 5th campus is the mental health specialty hospital for the region, announced in July the hospital plans to make suicide a "never event" for patients of the hospital. (Dave Beatty/CBC)

They commissioned the review after there were nine suicides by patients in 2016. There have been two more this year, Reale included. Many of those changes have implementation deadlines for this fall.

"This is what they said – 'One suicide is too many,'" Skowronnek said. "Then what could they possibly be thinking at number 11?"

'Peaks and valleys'

Reale was 58 when he died. He was a fixture of the French Catholic community in Welland. He was committed to his church, l'Église du Sacré-Coeur, and coordinated its winter homeless program for many years.

Dan Reale

Dan Reale seen in a family photograph with his wife, Lori Ann and his daughters, Meghan Realesmith and Courtney Reale Hingston. (Reale family photo)

He was the oldest of four kids, and the extended family frequently gathered for holidays at his home. He was married and had two daughter, age 32 and 29.

Reale was diagnosed with bipolar disorder in 1988. In the 29 years he struggled with the disease, there were years when he found joyful time with his family and good times and treatments that worked, Skowronnek said.

"It's peaks and valleys when you deal with mental illness," Skowronnek said.

Reale was admitted voluntarily as an inpatient at West 5th on May 31 after months of being in one of those valleys.

"We were extremely relieved when there was a bed available," Skowronnek said. "We encouraged him, explained that this would keep him safe from harm. He was very ill. He was clearly in crisis."

'How wrong could we have been?'

His care team decided to transition him off of one family of medications onto another, which requires weaning off of medication before starting the new course, his sister said.

One evening about three weeks after Reale had been admitted, staff told the family they checked on him around 10 p.m. and he was in bed, Skowronnek said. But when the staff checked on him again at 10:55 p.m., he was without vital signs.

He took his own life using means his family doesn't believe he should've been available to him in his room.

The hospital has said that as part of its changes, it will update practices around searching and seizing contraband and means for suicide.

But once the immediate "shock and grief" began to subside, the family searched online and came across CBC Hamilton articles about some of the other suicide deaths that have happened at West 5th in the last year and a half.

Dan Reale

Denise Reale Skowronnek, centre, and her brothers Dan Reale, Marc Reale (behind) and Patrick Reale. (Reale family photo)

"We started considering the hospital's role because … we convinced [Reale] that all the proper care, close monitoring, constant supervision, it would keep him safe," she said. "How wrong could we have been?"

'The right questions to ask'

Now, they have retained a lawyer and say they plan to sue. And they join Horwath in the call for a coroner's inquest, where they would hope to have standing. And they say they may soon be ready to talk with the hospital, representatives of which have called a couple of times.

"To me it clearly demonstrates a need for a completely independent review," Skowronnek said. "And that's why I think a coroner's inquest would assist in providing that sort of transparency."

"I'm not speaking out publicly in essence, to avenge my brothers death or anything like that," she said.

"I think that a coroner's inquest, if it brings greater public awareness for other families, perhaps to know the right questions to ask when their loved ones are being admitted to a facility, then I will feel like I've done something to affect change."

kelly.bennett@cbc.ca