The former director of the regional health authority that oversees the hospital where Joyce Echaquan died Sept. 28, 2020, says he was unaware of any issues between hospital staff and members of the Atikamekw community of Manawan.
Daniel Castonguay, who was removed from his position as director of the CISSS Lanaudière last December, testified at the coroner's inquest into Echaquan's death Friday that while he was aware of a "toxic" work environment at the Joliette hospital, he did not know of any incidents of racism or discrimination prior to Echaquan's death.
"I did not notice any barriers," said Castonguay.
Echaquan, a 37-year-old mother of seven, died shortly after live streaming hospital staff hurling racist insults at her. Expert testimony heard at the inquiry earlier this week revealed she died of a pulmonary edema.
Castonguay testified he was made aware of some behavioural issues within his staff, both toward other staff members and toward the patients.
He said he had started to meet with staff members individually so that he could better understand these problematic attitudes at the Centre hospital régional de Lanaudière.
He described one incident in which an intoxicated patient spat in an employee's face, and where the employee reacted by offering to "settle things in the parking lot."
But, he said, incidents like that were properly dealt with and that he began to implement an action plan for a more respectful worth ethic.
At least 11 complaints have been made by Indigenous patients since 2015, regarding the Joliette hospital alone. Several of them alleged racist or discriminatory behaviour. Others claimed there were issues with the medical treatment they received.
Castonguay said though that out of the "thousands" of complaints he received as a director, the complaints of racism did not stand out to him.
Changes were put in place, Castonguay says
Castonguay took on his role at the board in 2015. He said he first met with Atikamekw Chief Jean-Roch Ottawa about a year into his job to discuss some of the issues the community was dealing with.
The most pressing issue at that point, he said, was that there was no ambulance service for the community. Castonguay said the regional health authority set plans in motion for the ambulance in 2018, and eventually got the vehicle on the ground a year later.
Castonguay said he read the recommendations put forward in the Viens Commision report in 2019, and insisted he had begun implementing all those that targeted the CISSS before Echaquan's death.
More specifically, he said, he made sure the board hired an Atikamekw liaison officer for the hospital, put a call-out for groups willing to hold cultural safety training for the staff, and signed an agreement with the Atikamekw community that gave them more independence within the youth protection system.
The inquest heard earlier this week though that the liaison officer hired, Barbara Flamand, never felt welcome at the hospital, was never given an office and was often barred from seeing the patients.
"It seems as though you solved a problem that was strictly cosmetic," Quebec Coroner Géhane Kamel, who is presiding over the inquiry, interjected.
Castonguay denied that.
"I never heard there were any issues," he said, "and the door was open."
The cultural safety training was also delayed until earlier this year, because of the pandemic, he said.
During the Viens Commission, 20 members of the Atikamekw community described issues of mistreatment and racism at the Joliette hospital specifically.
In his testimony Friday, Castonguay testified that he was unaware of that testimony prior to Echaquan's death.
He said he was aware of a few "isolated" incidents, but that the issue was not "systemic."
'These are not isolated incidents,' coroner hears
Kamel began hearing recommendations Friday afternoon.
Viviane Michel, president of Quebec Native Women, says major changes are needed to prevent the deaths of more Indigenous women like Echaquan.
"Racism and discrimination kills," said Michel. "She did not receive the attention and the dignity that she deserved, as a person, because she was an Indigenous woman."
Michel recommended that all health-care institutions be made to hold sensitivity training specifically educating workers on the issues Indigenous women face, and that this training be led in conjunction with Indigenous community groups.
She recommends this training be held twice a year and that employers make sure to follow up with their staff.
Annette Browne, a professor at the University of British Columbia who specializes in nursing practices, also made some recommendations Friday.
She recommends "higher level changes to prevent anti-Indigenous sentiment," including cultural training for all health-care staff, and an open dialogue on issues of racism in health-care facilities.
Most importantly, she said, it is important that establishments acknowledge systemic racism is an issue and acknowledge that it directly affects the medical care Indigenous people receive.
More recommendations will be presented to the coroner when the inquiry resumes Monday.