Systemic racism against Indigenous people contributed to care woman got before death, Ontario inquest told

goodness morn. I'm alice paul Forsyth, and I've been natural covering this inquest since it began on process 30. 

The coroner’s jury has taken in a lot of emotional testimony on what may have led up to the death of Heather Winterstein on Dec. 10, 2021. The 24-year-old collapsed in the St. Catharines, Ont., hospital’s emergency department waiting room on the second day she tried to seek care for pain from a fall.

We’ve already heard from a number of the about 22 witnesses set to speak during the 13 days of hearings.

They include Winterstein’s mother, father, brother and stepmother, who spoke about the grief the family has endured since she died of sepsis. The life-threatening medical emergency amounts to a severe reaction to a bacterial infection, causing the immune system to harm healthy tissues and organs.

Winterstein was a member of the Cayuga Nation, with ties to Six Nations of the Grand River. Her family and community organizations have raised concerns about whether addiction discrimination and anti-Indigenous racism may have played a role in how she was treated. 

Yesterday, testimony addressed whether there were any medical “biases” in the Winterstein case, in part due to her being Indigenous. 

Among medical professionals who’ve testified was an emergency room triage nurse who said the COVID-19 pandemic put even more strain on staff in the busy emergency room, so she barely had time with Winterstein. 

A range of doctors and medical specialists have weighed in on the type of assessments and care Winterstein received, including on Dec. 9. The physician who saw her, Dr. Emad Nour, looked for signs of infection, but ruled that out in part because she didn’t have a fever. He diagnosed her as having “social issues,” and noted in his doctor's notes that she had a substance use disorder and generalized anxiety disorder. She was sent home with a Tylenol and given instructions to come back to the hospital if her condition worsened. 

The next day, Winterstein died despite frantic attempts by medical staff to save her. A woman who was seeking care and spoke briefly to Winterstein told the inquest she “just looked terrified.… She clearly wanted help" before she collapsed.

Sheryl Hutton, a patient who sought care in the St. Catharines hospital’s ER, is now testifying.

The inquest lawyer, Julian Roy, says her evidence is "very important." 

Hutton saw Winterstein in the ER waiting room on the day she died.

Hutton says she was in the ER seeking care after she cut her finger cutting a pit out of an avocado and needed stitches, so she drove herself there between 1 p.m. And 1:30 p.m. 

The inquest heard earlier that Winterstein was triaged just after noon that day and sent to the hospital emergency waiting room.

The inquest is on a short break to sort out technical equipment as jurors were having a hard time hearing the testimony.

We're now on a brief break as we get ready for the next witness.

Shoush says we have "centuries of understanding of how the human body works," but agrees when questioned by Eden that some treatments don't work. 

Shoush acknowledges the grief Winterstein's family is dealing with and hopes important recommendations will come out of the inquest.

Her testimony is now over. 

There was a short break so inquest jurors could ponder questions to ask Shoush. 

Juror questions are always the last part of questioning of witnesses.

The jurors had no questions, but one of them says they wanted to thank Shoush. 

The presiding officer, Dr. David Eden, asks Shoush about systemic racism. 

“We still have a system that still harms Indigenous people," she says. 

Shoush agrees with a question by Eden that identifying individual bigots doesn't stop systemic racism.

Shoush says systemic racism against Indigenous people and other groups is "inescapable.”

Systemic racism and biases "were contributing factors in how care was delivered" for Winterstein, she says.

Shoush says there’s "a mountain of evidence" of poorer health outcomes for Indigenous people.

Crawford asks the doctor why those poor outcomes are so predictable.

"Heather was a very young girl and she was alone in the [emergency department], and she was critically ill and she was repeatedly seeking care," responds Shoush. "Were people listening when Heather was saying what was wrong with her? Something was lost in translation."

"Systemic racism does not mean Intent to harm," says Shoush. She noted cumulative decisions by people contributed to what happened to Winterstein. 

"We couldn't hear what she was trying to tell us." 

Crawford says the hospital has had 100 per cent buy-in among top administration in a 12-hour cultural safety training program. 

She agrees that "anti-Indigenous bias" in health care does happen.

Shoush says the fact administration is on board for the cultural safety training program is “fantastic."

Crawford is citing other steps the hospital has undertaken to help improve Indigenous services.

She noted all staff and physicians are undergoing bias- and trauma-informing training. 

Shoush says that type of training can lead to better patient-centred care. 

"These are skills for lifesaving," she says, noting it’s similar to what using CPR on someone can achieve.

Kate Crawford, a lawyer for Niagara Health, which operates the hospital, is asking Shoush about a new Indigenous community room in the hospital that the regional health system has created. 

Shoush says it’s a good step, but other steps in terms of engaging individuals using the ER are also needed to improve health-care services for Indigenous people.

The inquest is now underway, with Dr. Suzanne Shoush continuing testimony she began yesterday. 

Shoush is a family physician with expertise in the Indigenous experience in the health-care system.

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