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A woman kneels during a vigil in front of the hospital where Joyce Echaquan died in Joliette, Que. on Sept. 29, 2020.Paul Chiasson/The Canadian Press

The senior executive in charge of the Joliette, Que., hospital knew it was a toxic workplace, but says he had no idea racism against Indigenous patients was among the symptoms until Joyce Echaquan died in 2020.

The nurse co-ordinator also says she didn’t know. Same with the head emergency room nurse and her assistant. Nobody in charge the day Ms. Echaquan was bombarded with racist abuse, slipped into a coma under the watch of a nurse trainee and died, seemed to know racism was a problem at the hospital.

And yet in 2018, about 20 members of Ms. Echaquan’s Atikamekw nation made the five-hour trek southeast to Quebec City to testify at the Viens Commission, which was investigating the mistreatment of Quebec’s Indigenous people by the province’s public institutions.

On their list of complaints: Neglect, disrespect and racism at the hands of medical staff at the Joliette hospital.

“When the report came out, I read it. But I didn’t receive the additional information about the Joliette hospital,” Daniel Castonguay, the former chief executive of the Lanaudières health district in charge of the hospital, testified at the inquest into Ms. Echaquan’s death. “I didn’t go listen to the testimony. My agenda didn’t allow it. In retrospect, I should have.”

‘The video doesn’t lie’: Echaquan Inquiry turns to medical mysteries around Atikamekw woman’s death

Health care staff mocked, chastised Joyce Echaquan all morning, hospital roommate testifies

Ms. Echaquan, a 37-year-old mother of seven with a heart condition and chronic pain, went to the Joliette hospital emergency room early in the morning on Sept. 27, 2020. She was stable and alternated between periods of calm good humour and agitated pain.

At about 10:30 a.m. on Sept. 28, while Ms. Echaquan was having a bout of writhing pain, two hospital staffers showered her with racist verbal abuse, which she recorded on her telephone. An hour later, she had slipped into a coma, which her daughter recorded. The names of the hospital staff are under a publication ban.

After at least 17 minutes, medical staff tried to revive her. She was pronounced dead during the noon hour. Experts have testified earlier intervention could have saved her.

The inquest presided over by coroner Géhane Kamel has concentrated on two main issues with Ms. Echaquan’s death: The racist treatment by senior staff captured in the first video, and inadequate treatment when she was left with a nurse trainee captured in the second video.

Mr. Castonguay took charge of the health district in 2015, and he said that in 2017 he became aware of a long-standing issue of harassment and verbal abuse at the hospital – but mainly among staff. A campaign to tackle workplace culture was about to launch in 2020 when the pandemic hit, he said.

“To illustrate how it was, we sent three nurses to work at the hospital during the pandemic and they returned crying, saying they didn’t want to go back,” Mr. Castonguay said.

Nancy Pellerin, the nursing co-ordinator at the hospital, testified she had never heard about racist treatment, despite years of complaints from the Atikamekw people and documentation by the Viens commission.

Ms. Pellerin said she had heard about incivility among hospital staff, but the recording of the racist language floored her. She had never heard complaints about the senior nurse who delivered most of the abuse toward Ms. Echquan until after the death.

“I hadn’t heard she was a super nurse, nor a no-good nurse,” Ms. Pellerin said. “Afterward, I learned she swore regularly, that she was a hard person, that ambulance crews avoided her. I pulled her personnel file and there was nothing in there. Zero. Nothing.”

Ms. Pellerin also expressed surprise a nurse trainee was left in charge of Ms. Echaquan and 15 other patients while more senior nurses went on breaks, contrary to hospital rules. “I certainly never approved that practice,” she said. Twenty nurses were working in the emergency room for 38 patients that morning, she said. “There was not a lack of staff.”

Ms. Pellerin apologized to Ms. Echaquan’s family for the quality of care she received, but Ms. Kamel sent her away with a different message: “The biggest issue here that I hope you will retain is that the hospital needs to rebuild bridges with the Atikamekw people so they don’t feel ostracized while getting care at the hospital.”

On Thursday, head nurse Josée Roch and a deputy whose name is covered by a publication ban each said they were unaware of racist treatment at the hospital. “Nobody told me there was a problem and I have never heard about it or seen it myself,” Ms. Roch said. “If I had ever heard anything like that, I would have intervened.”

Viviane Michel, president of the Quebec Native Women advocacy group, ended the week’s inquest testimony with recommendations that the coroner step back from casting individual blame for racist acts and words, and poor, disorganized treatment. A wider problem, she said, permeates the hospital, the health system and Quebec and Canadian society.

She pointed out the insults the hospital staff made toward Ms. Echaquan, suggesting she was good only for sex, was living off public charity, was incapable of caring for herself, are the same hypersexualized, dehumanizing and infantilizing tropes that have marked the views of the European settler majority about Indigenous women for centuries.

“Joyce Echaquan faced racism and discrimination that is systemic,” Ms. Michel said. “There was nothing surprising about these attitudes.”

Intensive staff training on bias and Indigenous reality, partnership with Indigenous communities and improved complaint mechanisms are among the blocks for building a new relationship, she said.

Others, including the Echaquan family, will make recommendations as the inquest ends next week.

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