Brian Sinclair, Joyce Echaquan died years apart in hospitals. Only one of their inquests points to change

This column is an opinion from Mary Jane Logan McCallum, Jose Lavoie, Christa Big Canoe and Annette Browne, members of the Brian Sinclair Working Group, which works to understand how systemic racism impacts Indigenous people in health care institutions and beyond. For more information aboutCBC's Opinion section, please see theFAQ.

"If Snow White had gone there, she would have got the same treatment under the same circumstances," testified Dr. Thambiraja Balachandra, chief medical examiner of Manitoba, during the 2014 inquest into the death of Brian Sinclair. "Brian Sinclair or Snow White it's the same."

"Would Joyce Echaquan still be alive if she were white?" asked a reporter at a 2021 press conference following the release of Quebec Coroner Ghane Kamel's investigation report concerning the death of Joyce Echaquan. "I think so," Kamel replied.

These two statements about the role of racism in untimely deaths of Indigenous patients in Canadian hospitals were made seven years apart.

The first ridicules the notion that racism played a role in the death of Brian Sinclair, who died of a treatable infection after having been ignored in Winnipeg's Health Sciences Centre emergency waiting room for 34 hours in September 2008.

• Ignored to death: Brian Sinclair's death caused by racism, inquest inadequate, group says

The original scope of the inquest included Brian Sinclair's treatment as an Indigenous person and testimony during the first phase of the inquest showed that incorrect assumptions about Brian Sinclair were made by a number of front-line staff that ultimately impacted decision-making to refuse him care.

However, on Jan. 10, 2010, Judge Timothy Preston ruled racism out of the scope of the inquest and instead focused on delays that occur once a person presents to an emergency department and measures to reduce those delays.

Many of the inquest's recommendations, which are intended to prevent a similar death from happening in the future, were therefore banal and had little to do with the circumstances relating to Sinclair's death. Not surprisingly, hospitals in Manitoba remain systemically racist.

Understanding the context

In her recently-released report concerning the death of Joyce Echaquan, Quebec Coroner Ghane Kamel insists that understanding the context in which the death occurred and the impact of that context on the quality of care provided is of vital importance to the inquest process.

Unlike Judge Preston, Kamel chose an anti-racist approach to understanding the cause of death one that seeks to clarify, not obscure, how systemic racism influences the assumptions and treatment provided by staff in relation to Echaquan's health needs.

This approach helped Kamel understand not just the circumstances of her death, but also the patterns of staff behaviour towards Indigenous people and the mistaken assumptions about Indigenous people in general and Echaquan in particular. She then connected this context to the flawed responses by physicians and nurses, and the lack of appropriate care that led to Echaquan's death.

Kamel's report genuinely addresses Echaquan's family and the community and takes into consideration a longstanding pattern of anti-Indigenous racism shaping poor health outcomes for Indigenous people.

• Racism, prejudice contributed to Joyce Echaquan's death in hospital, Quebec coroner's inquiry concludes

She inquired about Indigenous liaison work and discovered a lack of engagement of staff with education, training and the personnel best suited for care of patients.

Her recommendations include widespread recognition of the existence of systemic racism in health care and a commitment to eliminate it. She also recommends reviews by the Order of Quebec Nurses and the College of Quebec Physicians into the quality of care, procedures and services provided by the nurses and physicians who were responsible for Echaquan.

There are many factors accounting for the differing outcomes of these two similar inquests.

Changes give hope

Since 2014, Canadians have read the final report of the Truth and Reconciliation Commission and considered its many recommendations. As well, there have been several well-publicized reports and provincial inquiries into racism in Canadian health care

Universities like the University of Winnipeg have undertaken enormous efforts to make education about Indigenous history and inequity mandatory for Canadian post-secondary students.

These changes give us hope as members of a working group that initially came together to continue a discussion of the role of racism in Brian Sinclair's death at a time when the inquest refused to even consider it.

At the same time, however, Indigenous people remain a long way from being able to walk into a hospital confident that we will receive the standard of care acceptable in Canadian medical and nursing practices.

There is no way for us to achieve equitable health outcomes until there is a full recognition and a tidal change in the way health professionals and hospital staff treat Indigenous people.

Until that time, the struggle for health equity will continue.

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