Quebec must recognize systemic racism, coroner in Echaquan inquest says

The Quebec government should recognize the existence of systemic racism and make a commitment to root it out of institutions, says the coroner who investigated the 2020 death of Joyce Echaquan.

Released Friday, the report by coroner Géhane Kamel concluded that while Echaquan’s death was accidental, the racism and prejudice the Atikamekw woman was subjected to contributed to her demise.

The report includes several recommendations to various bodies, but the first one is for the government to acknowledge systemic racism, something Quebec Premier François Legault’s government has repeatedly refused to do.

On Friday afternoon about six hours after details of the report had been made public, Legault’s office issued a statement saying that “out of respect for the family and people close to Joyce Echaquan as well as the work of coroner in chief, we will wait for her to present her report Tuesday before commenting.”

Echaquan, a 37-year-old mother of seven, filmed herself on Facebook Live as a nurse and an orderly were heard making derogatory comments toward her shortly before her death Sept. 28, 2020, at a hospital in Joliette, northeast of Montreal.

The video of her treatment went viral and drew outrage and condemnation across the province and the country.

“In Ms. Echaquan’s case, if there hadn’t been a video, it’s a safe bet that this event would never have been brought to public attention,” Kamel wrote. “When the system withdraws defensively on itself, this is the very definition of systemic racism.”

Kamel said the existence of systemic racism was raised numerous times by the public after Echaquan’s death, particularly with regard to the Atikamekw community’s experiences receiving medical care.

She noted the report of the Viens Commission, a Quebec inquiry that reported in 2019 on Indigenous communities’ interactions with government services, stated the Atikamekw had long-standing complaints about the Joliette hospital well before Echaquan’s death.

“It is therefore my duty, as coroner, to do everything in my power to avoid that a member of the Indigenous community or of any other origin receives care such as that offered to Ms. Echaquan,” Kamel wrote.

She appreciated that the government has taken steps to address the situation, including removing the head of the regional health authority and mandating cultural sensitivity training. But, she added, “the recognition of a disparity in treatment is fundamental, if not vital,” to restoring trust.

“Efforts are all the more necessary as the findings of this investigation indicate that Ms. Echaquan was indeed ostracized, that her death is directly related to the care received during her hospitalization in September 2020 and that her death could have been avoided,” Kamel wrote.

Echaquan was rushed to hospital on Sept. 26, 2020, by ambulance, complaining of severe stomach pains. The inquiry heard she was initially misdiagnosed as going through withdrawal from opioids or narcotics.

“Based on this prejudice, it followed that her pleas for help will not be taken seriously,” Kamel wrote. “This label will follow her throughout her stay and will guide the actions of the nursing staff until her death.”

The inquiry heard a nurse in training was assigned to Echaquan, who wasn’t properly monitored after being restrained twice, including just before her death. Better surveillance would have got her to intensive care more quickly when she needed it most, Kamel concluded. Echaquan died of a pulmonary edema that was linked to a rare heart condition.

In the aftermath of her death, the Atikamekw community drafted Joyce’s Principle, a series of measures aimed at ensuring equitable access to health care for Indigenous patients and recognizing systemic racism. The province has agreed to adopt much of what is in the document, but it does not accept the reference to systemic racism.

Several senior cabinet ministers were questioned about the coroner’s recommendations on Friday, including deputy premier Geneviève Guilbault, who told reporters the government’s position is to focus on tangible actions aimed at fighting racism.

A Léger survey for the Association for Canadian Studies released this week indicated two-thirds of Quebec respondents agreed the term “systemic racism” is an accurate way of describing the level of prejudice and discrimination faced by certain groups in the province.

Kamel made several other recommendations involving the regional health authority. She said it should improve patient-staff ratios, impose periodic training sessions on proper restraint measures and create a code of ethics.

The coroner also recommended that the province’s college of physicians as well as the nurses order review the quality of care provided to Echaquan by their members.

Kamel said she will not comment further until a news conference Tuesday in Trois-Rivières, where hearings were held on Echaquan’s death this year. Echaquan’s family is also expected to comment after that event.