Deadly trend shows patient safety must extend beyond medical centres

Imagine your father needs medical help. You call a non-emergency helpline to get him to the hospital safely and quickly, but instead of reaching the hospital, your father dies of gunshot wounds after the police arrive.

This is the story of Mississauga's Ejaz Choudry, 62, who died June 20 after his family called for help getting him to the hospital to deal with his mental health struggles.

Unfortunately his case is not an anomaly.

The recent cases of Chantel Moore and Rodney Levi, two Indigenous citizens in New Brunswick killed during separate police-led investigations, illustrate a deadly trend. Moreover, the viral video showing B.C. nursing student Mona Wang being dragged and stepped on by an officer during a wellness check has raised essential questions about citizen safety during the increasing number of police interactions with members of the public experiencing mental health issues.

As the CBC's Deadly Force database outlines, 2020 has already been a particularly deadly year.

The database focuses on fatal encounters where police used force and clearly shows Black and Indigenous people are disproportionately represented among the victims compared to their share of the overall population.

As the database outlines, there were 30 people killed following police use of force in Canada in the first half of 2020, which is the full-year average for such deaths over the past 10 years.

In the Peel region, where Ejaz Choudry lived, police have been responding to a rising number of calls for assistance during mental-health crises.

In 2019, officers responded to 6,360 such calls, compared with 5,090 in 2016, a 25 per cent increase, the Globe and Mail reported.

Police are the backstop whenever social services aren't available due to a lack of funding.

However, a simple lack of funding isn't the only problem.

In Rodney Levi's case, he and his family tried to get mental health care at the hospital multiple times but he didn't get the help he needed, his sister told APTN.

The absence of quality care is also more common for Black, Indigenous and people of colour than non-racialized Canadians.

Systemic racism compromises patient safety and dignity in all areas of health care. According to a 2015 Wellesley Institute report on the role of racism in the health of Indigenous people, experiences and anticipation of racist treatment by health-care providers act as barriers to accessing needed health services for Indigenous peoples.

Furthermore, in examining the experiences of Indigenous and non-Indigenous persons accessing an inner-city emergency department, research led by University of B.C. Prof. Annette Browne found that Indigenous participants anticipated that being identified as Aboriginal and poor might result in a lack of credibility and/or negatively influence their chances of receiving help.

This was such a common experience that participants actively strategized around how to manage negative responses from health-care providers before accessing care.

Black patients have also reported that they have been treated differently from other patients on the basis of race and feel they have to present themselves in a specific way to be treated properly.

In some cases, these experiences keep people from accessing health care completely.

Our research on patient safety in Manitoba and British Columbia is consistent with these findings. As one participant in our study discussed, Indigenous patients often feel caught in situations where health-care workers assume "[they]'re there for addiction or mental health issues," and would therefore decide to prioritize their care less.

Even in British Columbia, one of the few provinces to approve and use the United Nations Declaration on the Rights of Indigenous Peoples as a guiding policy for Indigenous relations, allegations have emerged recently regarding ER staff playing a "game" to guess the blood-alcohol level of Indigenous patients.

But racism does not only manifest in games: harmful behaviours by health-care staff can include misdiagnosis, delay or denial of service, "improper procedure," and withholding of pain medication for Indigenous patients.

Patients have died after receiving inadequate care.

The patient safety movement seeks to recognize these inequalities and advance the rights of all people seeking care. As defined by the Canadian Patient Safety Dictionary, patient safety is "the reduction and mitigation of unsafe acts within the health-care system, as well as through the use of best practices shown to lead to optimal patient outcomes."

Similarly, the World Health Organization's International Classification for Patient Safety defines patient safety as, "the reduction of risk of unnecessary harm associated with health-care to an acceptable minimum. An acceptable minimum refers to the collective notions of given current knowledge, resources available and the context in which care was delivered weighed against the risk of non-treatment or other treatment."

The deaths of Choudry, Moore and Levi and the harm caused to Wang have shown that there is an unacceptable level of risk in having police respond to mental health situations. The Centre for Addiction and Mental Health, one of the leading mental-health-care institutions in the country, recently denounced the role police play as first responders and the racism that can occur during wellness checks.

As we move forward in a national conversation about making meaningful change, patient safety must be a fundamental guiding principle. We already have the knowledge and research on best practices. We can create the resources and context in which no one else dies because they or a loved one asked for help during a time of vulnerability.

This column is part of CBC's Opinion section. For more information about this section, please read this editor's blog and our FAQ.

• Read more opinion pieces published by CBC Manitoba.