An inquest that begins Monday into the death of an Indigenous woman seven years ago in northwestern Ontario is expected to explore the challenges of providing health care in remote communities.
Luthan Quikish, 31, who was suffering from complications from diabetes and had been attending a community nursing station from a few hours to a few days before her death, died at her home in Kingfisher Lake First Nation on April 1, 2017.
The remote Oji Cree community, about 350 kilometres northeast of Sioux Lookout, which is part of Treaty 9, is home to fewer than 600 people.
“Ruthan was a beautiful person and a beloved daughter, sister and mother. Our family is desperately fighting for her to receive treatment and we miss her every day,” Ruthan's brother, Jordan Quiquish, said in a written statement to CBC News.
The inquest, which will be held in Thunder Bay, was first postponed to April 2023 and then scheduled to take place in November of that year, before being postponed again to 2024.
Julia Noonan, a spokesperson for the Ministry of the Attorney General, said in an email to CBC News that reasons for the delay include the COVID-19 pandemic and the time needed to engage experts to review investigative materials and identify potential issues related to Quiquesh's death.
“The inquest was recently postponed following requests from the family and the community,” Mr Noonan said.
Dr Michael Wilson will preside over the inquest.
The jury Five-question assignment: It identifies who died, when and where they died, the medical cause of death, and how they died (classified as natural, accidental, homicide, suicide, or unknown).
The jury can also make recommendations to prevent similar deaths.
“This was a voluntary inquest and from that standpoint I think it shows there is a significant public interest in this inquest,” said Kate Forget, a member of the Matachewan First Nation.
Forget and her colleague Carolyn Leach are inquest lawyers for the Indigenous Justice Division of Ontario's Ministry of the Attorney General.
“The inquest is incredibly important both in terms of preventing deaths and in terms of seeking the truth and we hope it will provide answers to questions that families and the community have had for many years,” Mr Forget said.
The process also serves to educate the public about systemic problems and “how the system can be improved to provide equitable health care to Indigenous communities,” she added.
Emily Hill and Caitlin Kasper of Aboriginal Legal Services are representing the Queequesh family during the proceedings, while Edwards Bell Jewitt law firm is representing Kingfisher Lake First Nations and the Sibogama First Nations Council.
“Tylenol Nursing Stations” aren't filling a need
Quikish died of diabetic ketoacidosis, Forget said.
This life-threatening disease develops when the body doesn't produce enough insulin, which helps turn sugar into energy. Without enough insulin, the body breaks down fat for fuel, causing acids (ketones) to build up in the bloodstream. For people with diabetes, monitoring blood sugar levels is important. Symptoms of ketoacidosis include excessive thirst, frequent urination, fatigue, weakness, shortness of breath, and confusion.
The inquest will hear from witnesses including Ms Quikish's family, local residents and the doctors and nurses involved in her care, and the jury will be extensively educated about healthcare in the North.
Forget said he expects several key themes to emerge, including:
- Interactions within the nursing station, including physician supervision of nurses.
- They provide medical services at nursing stations and remote Indigenous settlements, focusing on patients with diabetes and a range of health problems.
- Provide training to nursing station staff.
- Medical testing site.
- How state and federal agencies, such as nursing stations and hospitals, communicate with each other.
Kiwetinong member of parliament Sol Mamakwa, from Kingfisher Lake First Nation, said he knows the Qu'ekish family and knows the coming weeks will be difficult for them.
Mamakwa describes “Tylenol nursing stations” in northern communities – where staff are equipped with only basic medicines and supplies – as places where nurses don't always have the training or resources to meet patients' needs.
Mamakwa said the doctor only visits Kingfisher Lake five times a month, 60 days a year. He is responsible for calling for medical evacuations for First Nations people, but this is difficult if the doctor is not on-site in the event of an emergency, he added.
Mamakwa wants new nursing stations in smaller First Nations and satellite hospitals in larger northern communities, and an Indigenous-led health system.
“When health care responsibilities cross over between state and federal, people can fall through the cracks,” he said.
“We cannot continue to have these unnecessary deaths and unnecessary suffering, especially among Indigenous people who arrive by plane, which is happening all too often.”
The power of the jury
Mr Forget, who has worked on a number of inquests, said he always praised jurors for rising to the difficult task before them.
“Jurors sit down, sometimes for weeks at a time, learn very difficult facts and then ultimately make a final decision,” she said.
“Through their recommendations, they speak to society and appeal to governments and organisations for ways to improve and prevent further autopsies being carried out.”
Last spring, an inquest into the death of Moses Beaver, an artist from the Oji Cree Woodlands of Nibinamik First Nation, ended with 63 recommendations by the jury focused on improving mental health care for Indigenous people.
While jurors cannot find legal liability or hold someone responsible, Leach said their role should not be underestimated.
“Some of the recommendations that have come out of the inquest have led to really fundamental policy changes,” Leach said, “which may be incremental at times, but it's encouraging to see.”
The Queequish family spoke of their hopes for what the inquest will accomplish, noting the obligations the federal government has to First Nations people.
“Our family has been waiting for this inquest for a long time. [Ruthann’s] “The cause of death is preventable and we are hopeful that we will now have answers to the questions of why this happened,” Jordan said.
“Part of the promises made in the treaty was that First Nations people on this land would have access to quality health care – but they did not. We hope that this inquest will result in recommendations to improve access to health care in our community and prevent tragedies like this in the future.”
The inquest into Quiquish will be held at 189 Red River Rd. It will be streamed online in both English and Ojikkree.