Indigenous man's death after being left unattended in hospital spurs call for 'culture change' in nursing
Story of Keegan Combes's neglect at B.C. hospital fuels nursing college's anti-racism work
This story is part of a series examining systemic discrimination against Indigenous patients within the nursing profession in B.C.
It's been eight years since Keegan Combes died of accidental methanol poisoning after being neglected by staff at a B.C. hospital.
But it's only recently that hard truths about the bias and stereotypes that contributed to his death have been publicly acknowledged, and his story is now a crucial piece in the fight to dismantle anti-Indigenous racism in the nursing profession, according to B.C.'s regulator for nurses.
Lab tests performed shortly after the 29-year-old developmentally disabled Skwah First Nation man arrived at Chilliwack General Hospital showed clear signs of what was causing his vomiting, slumped posture and incoherent speech, according to a report from the First Nations Health Authority (FNHA).
But instead of taking action that could have saved his life, the nurses and other professionals who saw Combes in September 2015 left him unattended and restrained to his bed for much of the night, and failed to check his vital signs for at least 6.5 hours, the report says.
"The lack of urgency and neglect that Keegan experienced at the hospital suggested that he was being left to 'sleep it off' and echoes common experiences of stereotypes about Indigenous people (racist beliefs) shown to lead to discriminatory behaviour in emergency health-care settings," the report reads.
Methanol poisoning is treatable if it's caught in time, but it would take more than 12 hours before Combes's condition was correctly diagnosed, according to the report. By then, he had stopped breathing. He spent the final 10 days of his life in intensive care before dying on Sept. 26, 2015.
The health authority's report on his death, titled Remembering Keegan, was offered as a gift to B.C. health-care leaders — a chance for those with power to learn from past wrongs and make systemic changes to keep Indigenous patients safe, the FNHA says.
It's "intrinsically important" to the anti-racism work currently underway at the B.C. College of Nurses and Midwives, according to registrar Cynthia Johansen, on par with the 2020 In Plain Sight report on anti-Indigenous racism in B.C. health care.
The nursing college is B.C's largest regulator of health professionals, setting professional standards and deciding discipline for 67,000 registrants.
"It's become a huge learning tool for us and something against which we can measure the work we're doing," Johansen said of the report.
'He is exactly who this system intends to hurt'
To that end, Combes's caregiver, Rhianna Millman, has been hired as the college's first Indigenous cultural safety and humility consultant. She told CBC that while she couldn't discuss her role, "there absolutely has to be a culture change" within nursing to prevent ongoing harm to Indigenous patients.
"The system is designed to harm somebody like Keegan, somebody who presents as visibly Indigenous, presents with a physical disability and a mental health diagnosis," Millman said.
"He is exactly who this system intends to hurt. When it comes to the privilege side of the coin, he's at the very bottom of it."
Combes had been living with Millman and her family for two years when he died. He was an avid chess player and a talented pianist, and was enrolled in a trades school.
"He was the coolest," Millman said.
After his death, she discovered he was likely poisoned by accidentally drinking windshield wiper fluid. A clerk at the convenience store where Combes liked to buy snacks told Millman he'd bought a bottle of the bright yellow liquid, after seeing another customer purchase the same thing.
Millman believes Combes may have mistaken it for an energy drink of a similar colour her husband often had around the house.
"I just truly hope that he wasn't in too much pain," she said.
Remembering Keegan lays out in detail the ways systemic bias against Indigenous patients affected Combes's care, and makes it clear that his death was not the result of one or two "bad apples."
It outlines several "culturally unsafe encounters" both Combes and Millman experienced at Chilliwack Hospital beginning on Sept. 15, 2015, including the long delays in diagnosis and treatment, the decision to restrain him, the lack of communication and the overall neglect of a grievously ill patient.
Those encounters began right after Millman called 911, when emergency responders and then hospital staff assured her they "knew Keegan," which the report says suggests they held negative preconceived ideas about him.
Then, after Combes arrived — and long before doctors realized what was wrong with him — a resident doctor suggested Millman place a "do not resuscitate" (DNR) order on his file. The doctor said this recommendation was based on his "quality of life," according to the report.
"This suggestion … echoes a racist stereotype that has been a part of Canadian society for hundreds of years. Since first contact, one of the ways that settler Canadians have justified colonization is a faulty belief that Indigenous people were physically inferior and destined to 'die out,'" the report says.
Fraser Health 'committed to Indigenous anti-racism work'
Initially, a patient safety review conducted by Fraser Health concluded that racism and bias did not play a role in what happened to Combes, according to the FNHA report, but in the eight years since, the health authority has shifted its stance and apologized.
Fraser Health spokesperson Dixon Tam told CBC in an email that the health authority has fully accepted the findings in Remembering Keegan with "humility and respect in order to help us move forward on our journey toward cultural safety."
Tam added that Fraser Health is implementing all recommendations from the In Plain Sight report.
"As an organization, we are committed to Indigenous anti-racism work and work collectively to set goals, measure progress, and stay accountable on our progress," he wrote.
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