The Brian Sinclair Inquiry (Racism in Canadian Health Care)

Canada's courts are rather dull affairs with a much greater chance of there being no dramatic high points like one has come to expect from the court cases down south. But this particular inquiry had a rather surprising turn of events.

The premise for the initiation of this inquiry: Brian Sinclair is a resident of Winnipeg, an aboriginal man, a survivor of the Residential Schools, and a person who has went through most of his life trying to destroy himself through self-medication with drugs and alcohol. He was still homeless at the time of his death, when he was carted to an emergency ward and waited for treatment for a bladder infection (he simply required his catheter be changed.) However, he had been sober the entire time. After no treatment for 34 hours, he died and it took a couple more hours for the hospital staff to discover he died.

The aboriginal community protested this death because this was a stark example of mistreatment of a whole community within the health care system. Thus an inquiry was called and now he have this.

The first several weeks, the inquiry has been the obligatory questions and testimony by the security staff, the hospital administration. Questions as to why there was no record of him being there in the emergency ward until after his death, save for the security video,, and such.

Now we come to yesterday where it was the time to ask the nurses on staff.

http://www.cbc.ca/news/canada/manit...nclair-was-intoxicated-inquest-told-1.1959358

Wendy Krongold, who was working as a triage nurse at the Health Sciences Centre's emergency ward on Sept. 20, 2008, was the first to acknowledge she was aware of Sinclair waiting there, but she admitted that she did not help him.

Krongold told the inquest on Thursday that she first thought the 45-year-old aboriginal double-amputee was an IPDA patient, referring to the Intoxicated Persons Detention Act.

Patients deemed to be IPDA patients would be so intoxicated, they would need to be detained by police.

However, only doctors can determine if a patient is intoxicated under the IPDA, and the patient has to be triaged before being seen by a doctor, the inquest was told.

Krongold testified that she thought Sinclair was IPDA because he was in a wheelchair, as staff would often put intoxicated people in wheelchairs.

When asked if she thought he was IPDA because he was aboriginal or male, she said no.

Click to expand...

Penner said while she doesn't remember the 1½-minute conversation with the security guard, she said she must have thought Latour was talking about a different patient in a wheelchair, who had been triaged earlier and was in the same waiting room as Sinclair.

"That would make the most sense," she told the inquest.

She added that hypothetically speaking, if anyone warned her that a patient was in the ER all night, "You should go over and investigate."

Thursday's testimony appeared to be emotionally difficult for both nurses. Penner cried after finishing her testimony and Krongold was sobbing during and after her testimony.

Click to expand...

It would look like there is about to be some uncomfortable truth is about to be uncovered.

An update.

The family of Brian Sinclair have walked out on the inquiry, saying that they have lost faith in the inquiry will result in meaningful change and prevention of further cases.

http://www.cbc.ca/news/canada/manit...ses-confidence-pulls-out-of-inquest-1.2541167

YEah, right now the nurses union et al wants to make this about wait times and so on and so forth, leading us further away from the question of whether or not racism plays a significant role in inhibiting equivalent care. The wait-times spiel now sounds a bit too hollow and if this really does go down this road, will hurt the health professions badly - especially when it wants to use that line in negotiating pay and budgets. The union really needs to take this head on and not be shy.

Reading more updates. The judge is completely shying away from the issue, allowing the whole second part of the inquiry to be dominated by talking points that have nothing to do with Sinclair's death. An absolute shame. I dread to think when a pregnant women is left to deliver, miscarry or die in an ER because the nurses suspect her she is drunk because she is aboriginal.

The inquiry has ruled the death of Brian Sinclair as preventable but not homicide.

http://www.cbc.ca/news/canada/manit...ut-not-homicide-says-inquest-report-1.2871025

The inquiry is still creating echoes here.

Some people are deciding to step up and bring forward their accounts of racial profiling in medical care.

http://www.cbc.ca/news/canada/montr...ent-untreated-due-to-discrimination-1.2886566

In this case, an Inuk woman with cancer went to the doctors complaining about stomach pains. The doctors immediately started asking questions about whether or not she was an alcoholic and how much alcohol she drank on a regular basis. They diagnosed it as a stomach problem as a result of her drinkingand sent her on her way.

"The first diagnosis was very good. It was about my intestines contracting, and I believed that," she said. For years, whenever her stomach hurt, she’d ask for a glass of cold water to help with her "contracting intestines."

But years of unrelenting stomach pain led her back to the clinic again and again.

"It was unbearable," Tayara said.

When the doctors' questioning changed from whether she drank, to how much she drank, she understood it to mean she was being profiled as yet another aboriginal person in Canada being accused of drinking herself sick.

"I have so many assumptions. My first assumption was that they thought I was drinking and that I was probably spoiling my stomach, because that was the last diagnosis I got," Tayara said.

Click to expand...

A study put out by Wellesley Institute is finding broad racism issues in Canadian health care. A much more clearer example:

Michelle Labrecque pushes herself gingerly in a wheelchair down the hallway of a hotel. The Oneida woman was recently found to have a fractured pelvis, but she says it took three trips to the hospital and increasing pain before she received that diagnosis.

"The third time, I was just left in the ER room, not being able to walk anywhere. Nobody around to help me, not even to a wheelchair," says Labrecque.

She felt abandoned, she says, because she’s native.

It wasn't her first bad experience at Victoria’s Royal Jubilee Hospital. In 2008, she sought medication for what she describes as severe stomach pain. She discussed the pain with a doctor, as well as her struggles with alcohol and finding a home.

The doctor wrote her a prescription, and told her she was good to go. When she got home, she discovered all the doctor had scribbled on the prescription form was a crude drawing of a beer bottle, circled with a slash through it.

Click to expand...

CBC News

Some observations from the study:

For example, during the global H1N1 pandemic, Indigenous populations across a range of geographies including Canada, Australia and New Zealand, experienced disproportionate rates of hospitalization and experienced greater severity of symptoms in comparison to nonIndigenous populations (Mousseau, 2013). A theory of genetic susceptibility surfaced even though these Indigenous populations share no common ancestry (Zarychanski et al., 2010). What these populations do share is a common experience of colonization that has resulted in and sustained disparities in health status and the social determinants of health (Mousseau, 2013; Zarychanski et al., 2010) including substandard housing, overcrowding and a lack of running water, all of which serve to increase risk of transmission for respiratory viruses.

Click to expand...

Finally, in a study examining experiences of racism among Aboriginal university students in Edmonton, Alberta, 80 percent of participants reported experiencing racism in their lifetime, with two-thirds experiencing high levels of racism (Currie et al., 2012a). This study utilized an in-person survey with a small convenience sample (n=60) of Aboriginal university students. The survey included the Experiences of Discrimination scale (Krieger et al., 2005) and compared its findings to those from the United for Health study in the US which used the same tool with a sample of Latino and African American people. The researchers found that the lifetime experiences of discrimination for Aboriginal university students were 2-3 times that of African Americans and Latinos in the US. Further, the researchers suggest that the students’ reactions to racism were indicative of racial battle fatigue (Smith, Allen & Danley, 2007), described as the depletion of mental and physical resources due to the constant engagement of stress response systems to cope with ongoing discrimination (Currie et al., 2012a; Smith, Allen & Danley, 2007).

Click to expand...

FN and Metis rely on the provincial health care systems a lot and I can't say for certain that there is a federal level of care or whether the federal government simply reimburses the provinces. In the case of Brian Sinclair, I would assume that this was on the province's bill.

Some of the recommendations are being implemented and the ER doctors are throwing a fit:

But Dr. Jill McEwen, president of the Canadian Association of Emergency Physicians, says the report was flawed in its recommendations.

"Yeah, we're disappointed with the results. In summary, I believe they're flawed," she told CBC News on Friday.

"I want to know why. Like, there is a miscommunication somewhere. Someone is advising these recommendations that does not know, does not understand."

McEwen said her organization's input at the inquest was ignored, and she's disturbed to learn some of the recommendations may take years to be implemented.

As well, she said the report misses one point — that the major cause of emergency room overcrowding is a shortage of beds.

Click to expand...

Be reminded that the inquiry generally avoided the issue of racism so very little of the recommendations deal with the issue head on.

Hospital in Wetaskiwin is being fingered in another case of neglect. This time, the patient survived but has bed sores and pressure ulcers so deep that his rib bones through the flesh.

http://www.cbc.ca/news/canada/edmon...ealth-claiming-abuse-discrimination-1.3144243

She noticed the smell after a few weeks. It was like poop, unclean. Nursing staff reassured her that he needed a diaper change and would have her leave the room.

Five months later, during an appointment at a different hospital, the doctor noticed it too. And when nurses stripped Francis down in front of his wife - she couldn't believe what she saw.

Huge pressure sores. Eight in total. One stretched up the right side of his body.

Youngchief could see his rib bones through the flesh. Other sores were on his buttocks, his heel, his arm, his thigh. Deep and oozing.

"That's where that smell was coming from. They were just yellow and green. Infections, like," she said.

Click to expand...

Patient was transfered and now AHS and the hospital in question are facing a lawsuit.

Some more comment of the Gerald Francis case and the struggles that folks living on the reserve have trouble getting health care off the reserve:

"There are a lot of holes in the system for First Nations," said Kris Janvier, health policy analyst for the Treaty 8 First Nations of Alberta.

He described the complexities of approaching provincial health care from an aboriginal perspective as "very challenging." And he named current funding models as an example.

In Alberta, aboriginal people are not eligible to apply for many provincial grants that cover uninsured expenses such as wheelchairs. Instead, they must go through a federal fund called the Non-Insured Health Benefits program.

A family will often apply and be turned down the first time, Janvier explained. Sometimes, it takes two or three attempts over many years to secure funding.

"A lot of people give up before they get there," he said.

Click to expand...

A nursing home in Burlington was caught putting a job ad on Kijiji and Craigslist with a specific criterion: "Looking for a Caucasian RN."

http://www.cbc.ca/news/canada/hamil...ought-for-seniors-care-in-online-ad-1.3151160

An online ad to recruit home care workers for seniors in Burlington, Ont., has a catch — you have to be white.

The ad for Retire at Home services for seniors was posted on Craigslist last week, saying that a client is "looking for a Caucasian RN or RPN to work shifts that are between eight and 12 hours in length."

One Hamilton lawyer says an ad like this — if legitimate — could open the company up to a complaint to the Ontario Human Rights Tribunal, and a local anti-racism activist says it exposes a pervasive problem in the nursing and home care industry.

Click to expand...

An update on the Gerald Francis case:

http://www.cbc.ca/news/canada/edmon...iplegic-lawsuit-alberta-health-care-1.3338906

A lawyer representing the province, Health Minister Sarah Hoffman and the director of the Protection for Persons in Care filed a statement of defence Wednesday.

"At all material times, the Crown, through the Ministry of Health, provided global funding to the responsible regional health authority, Alberta Health Services (AHS), who in turn delivers health services to the residents of Alberta," the statement reads.

The statement said that while the Health Ministry provides global funding to the regional health authority and AHS, it noted AHS is an incorporated legal entity, distinct from the ministry.

"The Crown denies that it owed any duty to the plaintiff, or any of them, either statutory or otherwise, and further denies that it breached any duty owed to the plaintiff, or any of them, as alleged or at all," the statement reads.

Click to expand...

This has more to do with the prison system but it also concerns itself with access to healthcare. An inquiry was set up in Saskatchewan to investigate the death of Kinew James and to uncover the reasons why she was not able to access health care in prison. The coroner has ruled that the Elizabeth Fry Society, one of the only advocacy groups for imprisoned women, will not be permitted to participate.

Kinew James' was imprisoned with Ashley Smith in Ontario at the facility where Ashley Smith committed suicide after prolonged stays in solitary confinement and lack of access to health care. Kinew James was also the one who blew the whistle on the guards in that same facility who were smuggling in contraband for sexual favours.

http://www.cbc.ca/news/canada/kinew-james-inquest-aboriginal-prison-death-1.3339087