Atikamekw chiefs were stunned by premier François Legault saying the "problem that happened at the Joliette hospital with Mrs. Joyce is now resolved" during the TVA electoral debate Thursday evening, two years after Joyce Echaquan's death.
"The problem is far from settled," said the Chief of Manawan, Paul-Émile Ottawa, and the Grand Chief of the Atikamekw Nation, Constant Awashish, stressing systemic racism must be acknowledged in Quebec to move forward.
"It is a very big statement that he made," said Awashish. Legault's words, he said, shocked and irritated many people.
The Atikamekw woman from Manawan and mother of seven died at a hospital in Joliette, Que in late September 2020, after posting a Facebook livestream showing staff insulting and swearing at her.
A Quebec coroner later ruled her death was not from natural causes but "accidental" because she failed to receive the care she was entitled to.
In the wake of Echaquan's death, the Atikamekw Council of Manawan and the Atikamekw Nation Council (CNA) submitted a brief to both the provincial and federal governments outlining their demands for Joyce's Principle. Its aim is to guarantee all Indigenous Peoples the right to equitable access to health and social services in the province.
Manawan and the CNA have constantly called for the implementation of the principle and recognition of systemic racism since.
Hounded by the opposition during the debate, Legault hammered that there is no systemic racism in Quebec, emphasizing he has already committed $200 million to improve how health care and other public services are provided to Indigenous people.
He accused the opposition of engaging in a "word fight."
In October 2021, Coroner Géhane Kamel made a series of recommendations in her inquest report into Echaquan's death. The first was that the province recognize the existence of systemic racism within its institutions.
Since then the premier has refused to do so.
Chief Sipi Flamand said as long as the government refuses to recognize the existence of systemic racism communities will struggle to have confidence in the public health care system.
To justify his remarks, François Legault invited his opponents to go to the Joliette hospital.
In June 2021, Guy Niquay, an Atikamekw from Manawan, became assistant to the chief executive officer of the regional health authority that oversees the Joliette hospital that Echaquan died in.
Since then all of the staff working with the CISSS de Lanaudière have been asked to take part in 11 hours of cultural sensitivity training.
But not everyone has followed it yet, according to a statement from the regional health authority. Only 71 per cent of staff have participated in the second phase.
The implementation of the third component began this September.
"Apparently, for [Legault], by putting an Atikamekw in senior management, creating cultural safety courses, the matter is settled. I think we live in two different worlds," Awashish said.
The grand chief said members of his nation are still reporting incidents of racism.
Between April 2021 and June 2022, nine complaints were filed to the complaints commissioner of the CISSS de Lanaudière – four of which were based on discrimination and racism.
This is a considerable increase; between April 2015 and May 2021 it received 11 complaints. The health authority believes the increase can be explained by greater confidence in the complaint office thanks to training and Niquay's presence.
Echaquan's family shocked
Echaquan's family was surprised to hear the premier imply he had spoken with them to discuss her death.
"In Joliette, [the problem] is solved. I just spoke to her husband. It is settled," said Legault during the debate.
Patrick Martin-Ménard, the family's lawyer, has since said this isn't true.
Carol Dubé, Echaquan's spouse, did meet the premier, but only by chance during the Pope's visit to the Sainte-Anne-de-Beaupré sanctuary. The family had been wanting to meet Legault for two years, said Martin-Ménard.
The premier washing his hands of Echequan's death through magical thinking reflects an old mentality and reproduces the dynamic that led to her death in the first place, the lawyer said.
Coroner Géhane Kamel made eight recommendations to the regional health authority.
According to its spokesperson Pascale Lamy, most of these recommendations have already been implemented.
An agreement with the Masko-Siwin health centre in Manawan is currently being revised, which will further collaboration between the two communities, Lamy said.
Chief Sipi Flamand recognized steps have been taken but said more recommendations, like adopting Joyce's Principle, must be implemented.
The coroner's recommendations for the Lanaudière health authority include:
Ensuring the Manawan liaison officer is effectively integrated into the establishment, especially by involving them with the care teams;
Collaboration between the Manawan dispensary and the emergency department of the Lanaudière Hospital Center to ensure medical information is transmitted in real time;
Ensuring the notes in medical files reflect the reality of a patient's care;
Reviewing the ratios of nurses and patient attendants based on provincially recognized standards;
Apply an emergency management model based on the guiding principles of the the province's Emergency Management Guide;
Maintain periodic training on the establishment's code of ethics, restraint measures, monitoring of patients following a fall and record keeping;
Quickly set up training and activities for the inclusion of Indigenous culture, in consultation with the community of Manawan;
Refine the model of nursing/nursing assistants and ensure that each clearly understands their role.
The coroner also asked the College of Physicians to review the quality of care provided to Echaquan by the doctor and resident in gastrology at the Joliette hospital.
The College told Radio-Canada's Espaces Autochtones its investigations are confidential, meaning it can neither confirm nor deny the holding of an investigation against a particular doctor.
In addition to recognizing systemic racism in May 2021, the college has "taken several concrete actions to counter systemic racism in health care," spokesperson Leslie Labranche wrote in a statement.
Quebec's nursing order recognized the existence of systemic racism in July 2021.
The Ordre des infirmières et infirmiers du Québec (OIIQ) also suspended the nurse who admitted to making insulting remarks towards Echaquan for one year.
It also wouldn't say whether investigations have been carried out on other nurses who provided care to Joyce Echaquan, as they would be confidential.
Awashish applauded the approach taken so far by the college and nursing order.
"They embraced Joyce's Principle, recognized the systemic racism that Indigenous peoples have experienced for decades," he said. "I think that, already, it demonstrates a greater openness than the government."