A Toronto man with mental health issues died while being held in restraints inside a locked room at St. Joseph's Health Centre, a jury heard at the start of a coroner's inquest into his death.

Nokolaos Mpelos, 65, died on May 26, 2013 inside the emergency department's crisis unit, since the facility did not have a bed available in its psychiatric department.

More than a day earlier, Mpelos had called Toronto Police and told them he was hearing voices in his head telling him to end his life.

He had been diagnosed with schizophrenia, and his family says he called police because St. Joseph's had refused him entry into the hospital on an earlier occasion.

On the opening day of the inquest, the jury heard that Mpelos was held for up to 34 hours, much of it inside a locked room that may have exacerbated his condition.

The coroner's lawyer Michael Blain said video evidence to be shown later in the inquest captured Mpelos fiddling with the locked door; losing his balance and falling; and relieving himself inside the room, where he did not have access to a washroom.

He was later put in restraints and strapped to the bed, where he eventually died of heart failure. The jury has been asked to determine if the restraints or the hospital's treatment contributed to Mpelos's death.

Family not notified

During his opening remarks, Blain read a letter addressed to the court by Mpelos's nephew Peter Paparizos, who said his family was not told that Mpelos was admitted to the hospital until after his death.

"To this day, we still feel that if we were notified by the hospital that he was there, he'd still be alive," Paparizos wrote.

Dr. Andrew Sue-A-Quan, the emergency department doctor who first evaluated Mpelos, said a patient's family is not typically notified before a psychiatric assessment is performed due to patient privacy concerns.

Dr. Sue-A-Quan

Dr. Andrew Sue-A-Quan examined Mpelos not long before he died of heart failure. (Jean-Philippe Nadeau/CBC News)

"My main concern was, 'Is he a danger to himself or others?'" he told the jury.

A family may be notified under a patient's request, he said, but Mpelos did not.ask for it to be done.

In his assessment, Dr. Sue-A-Quan wrote that Mpelos was at risk of harming himself, but that he was generally cooperative in the triage process. His assessment also did not reveal any heart issues.

In a written statement, St. Joseph's Health Centre said Monday it "sincerely regrets that Mr. Mpelos failed to receive the care he deserved while at our hospital. We extend our apologies and deepest condolences to Mr. Mpelos' family and loved ones. The hospital will be an active participant in the coroner's inquest and will do everything possible to help the coroner, the jury and all other parties complete their work."

St. Joseph's also says it has already implemented changes in response to Mpelos's death.

 In 2014, St. Joseph's conducted its own extensive review, the results of which will be discussed during the inquest," the statement reads.

"That review led us to implement more than a dozen individual recommendations for change and, separately, to address personnel and performance issues. Still, we recognize that more may need to be done. It is our hope that the Coroner's Inquest will help to identify such measures."

The inquest is expected to last 10 days, after which the jury may provide recommendations for possible changes to prevent similar deaths in the future.