'Measurable progress is not yet where it should be,' the Correctional Investigator of Canada reports. (CBC)

A review of nine deaths in federal custody between April 2008 and April 2010 shows recurring problems in responding to medical emergencies and difficulty with accountability and compliance.

The fourth and final assessment of the Correctional Service of Canada's progress in preventing deaths in custody was released Wednesday in Ottawa.

While the correctional service has taken some concrete steps toward preventing deaths in federal facilities, "measurable progress is not yet where it should be," the review's author, Howard Sapers, who is the Correctional Investigator of Canada, said in a statement.

"The preservation of life is an integral part of the mandate of the correctional service. I expect this principle to be embedded in policy, reflected in the culture of the organization and orient its day-to-day interactions with offenders."

The Correctional Investigator is an independent ombudsman for federal offenders.

The nine cases reviewed in the final assessment found problems in the following areas:

• Slow response to medical emergencies.
• Lack of sharing of information between clinical and front-line staff.
• Lack of monitoring of suicide pre-indicators.
• Quality and frequency of security patrols.
• Management of mentally ill offenders.
• Quality of internal investigative reports and processes.

One of Sapers's key recommendations is that the CSC create a senior management position responsible for promoting and monitoring safe custody practices

Among his other recommendations:

• Prohibit the practice of placing mentally ill offenders, or those at risk of suicide or serious self-injury, in prolonged segregation.
• Provide round-the-clock health-care coverage at all maximum, medium and multi-level institutions.
• Introduce audits to ensure the quality of security patrols.
• Training front-line staff on how to manage offenders at risk of self-injury or to ensure proper monitoring, crisis response and prevention protocols are in place.

Public Safety Minister Vic Toews's office said it was reviewing the Sapers report.

"Our government is committed to ensuring public safety and takes the death of any offender in custody very seriously. To this end, we continue to work closely with provincial governments to address mental health issues in our respective prison systems," Toews's office said in a statement.

The office said it has provided additional mental health resources in prisons, including requiring that all inmates receive clinical assessments in the first 90 days of their incarceration, as well as mental health awareness training for corrections staff across Canada.

Sapers's quarterly assessment process was sparked by the case of Ashley Smith, who had history of harming herself and died in her Kitchener, Ont., prison cell In October 2007 after a prolonged period of segregation.

Smith had spent five years in the youth justice system in New Brunswick before being transferred to the federal institution in October 2006 at age 18.

Since Smith's death, more than 130 offenders have died in federal custody.