Inquest for First Nation woman yields 42 recommendations to improve remote health care

Jordan Quequish says he's always protected his sisters.

As he closed the inquest into the death of his youngest sister, Ruthann, with a traditional song and drum, he expressed hope that others are protected from the same pain his family has gone through.

Ruthann's family advocated for a discretionary inquest into her death. More than seven years after the 31-year-old's passing, three weeks of proceedings wrapped up on Friday in Thunder Bay, Ont.

A jury of five heard testimony from 22 witnesses before delivering its verdict: that Ruthann died on April 1, 2017 in her home community of Kingfisher Lake First Nation, of undiagnosed and untreated diabetic ketoacidosis. They ruled that the means of death in her case was "undetermined," as opposed to homicide, suicide, accident, or natural causes.

According to Nishnawbe Aski Nation (NAN), the family wanted her death classified as a homicide, "because their daughter died from an untreated disease in an under-serviced community," says a news release from NAN issued Friday.

NAN represents 49 First Nations across Treaties 9 and 5, including Kingfisher Lake.

Jurors provided 42 recommendations, with the goal of preventing future, similar deaths by improving the health-care system, with specific focuses on diabetes care and patient advocacy.

"We really need people to listen to our people, to First Nations people. They're forgetting about the agreement that they made to our people, and we see that there [are] more and more broken promises today," Jordan Quequish said after the jury delivered its verdict.

The verdict and recommendations will be posted online.

'Neglect, racism, and chronic underfunding'

Kingfisher Lake First Nation is part of Treaty 9. Fewer than 600 people live in the remote Oji-Cree community, which is about 350 kilometres northeast of Sioux Lookout.

NAN Grand Chief Alvin Fiddler expressed disappointment with the verdict that Ruthann's means of death was undetermined, instead saying in Friday's news release that "it was neglect, racism, and chronic underfunding that killed Ruthann."

The jury heard that Ruthann visited her community's nursing station multiple times in the days leading up to her death, but a number of challenges, including access to medical information, communication breakdowns, and the lack of regular physicians in Kingfisher Lake impacted her care. Physicians only come to Kingfisher Lake 60 days a year.

"That speaks to just how racist this health-care system that we're still subject to is, [which] is still rooted in the colonial and the racist policies that flow from the Indian Act, that still is very much a part of our lives," Fiddler told members of the media on Friday.

NAN first declared a health state of emergency in 2016 before making another emergency declaration earlier this year.

Jordan Quequish's other sister, Samaria, suffered a brain aneurysm during the first week of Ruthann's inquest. She was hospitalized in Hamilton.

"Our thoughts and our prayers remain with the family," Fiddler said.

Empowerment through health-care autonomy

The jury's recommendations were received by:

• Ministry of Health.
• Ontario Health.
• Sioux Lookout Regional Physicians' Services Inc.
• Shibogama First Nations Council.
• Kingfisher Lake First Nation.
• Sioux Lookout Meno Ya Win Health Centre.
• Indigenous Services Canada.
• Sioux Lookout First Nations Health Authority.

There was a large focus on empowering Kingfisher Lake with more autonomy over its health-care services. For example, while Kingfisher Lake operates its own nursing station, the jury recommended the community and its tribal council, Shibogama First Nations Council, be provided with the same resources as those that receive nursing services from Indigenous Services Canada.

As for staffing, jurors suggested there always be four nurses and a charge nurse present in Kingfisher Lake. They also supported the concept of "doctor pods," meaning groups — or pods — of physicians assigned to serve the same cluster of communities. This is aimed at improving physician coverage and continuity of care.

Kiiwetinoong MPP Sol Mamakwa, who is from Kingfisher Lake and is Chief Eddie Mamakwa's cousin, says this is what health transformation means to him.

"Bringing back services closer to home, but also again, bringing back the power, the authority back to the First Nations," Mamakwa said. "Give us those provincial resources, give us those federal resources and let us run it on our own."

That includes more funding for initiatives like Shibogama First Nations Council's diabetes prevention strategy, land-based programs and education, and training for youth who wish to enter the health-care sector, as recommended by the jury.

In terms of improving communications, the creation of a single electronic medical record for patients in remote First Nations was also put forward, along with ensuring cumulative patient profiles are included on all paper charts and digital records.

Plans for a new nursing station

Kingfisher Lake Chief Eddie Mamakwa was the final witness to provide testimony during the inquest. He spoke of a feasibility study underway to replace the community's current nursing station, which opened in 1995.

"We have outgrown it," Mamakwa told the jury. "We need more services because I think it affects everybody, like not [being] given a chance for what they need."

A draft blueprint shown to the jury included spaces for specialized services, ranging from dental care, dialysis, physiotherapy, and mental health and addictions support — plus accommodations for health-care providers.

Jurors recommended Kingfisher Lake and Indigenous Services Canada engage in regular discussions about the new nursing station's construction.

Another challenge Mamakwa spoke about was community members having to move elsewhere for better access to health care.

Beyond bringing more services to Kingfisher Lake, the jury recommended a patient advocate be hired to liaise between patients and health-care workers, and to help people access second medical opinions — both inside and outside the community.

Protecting future generations

While those that received recommendations aren't legally obligated to fulfil them, they must report back to the Office of the Chief Coroner in six months' time with an update. 

Jordan Quequish presented two eagle feathers to the family's counsel, Emily Hill and Caitlyn Kasper of Aboriginal Legal Services.

"That's a sign from our people to keep helping First Nations people, to stand strong for the people," he said.

He also shared what he wants to see the inquest achieve going forward.

"I hope that you take this as a teaching and use these recommendations, too, that these go forward, that they don't get pushed, shoved behind somewhere," he said to those involved in the proceedings.

"We have to make things better for the future generations of our people."