An Atikamekw woman who died after livestreaming the abusive remarks of hospital staff could have been saved if she'd been more closely monitored, an expert witness told a coroner's inquiry in Trois-Rivières, Que., on Thursday.
Joyce Echaquan died of pulmonary edema, an excess of fluid in the lungs, according to the testimony of Dr. Alain Vadeboncoeur, an emergency physician at the Montreal Heart Institute.
Vadeboncoeur examined Echaquan's medical background, autopsy report and hospital records, to give recommendations to coroner Géhane Kamel.
He said the 37-year-old mother of seven had serious health problems, including severe cardiomyopathy, which had been treated since 2014.
Vadeboncoeur said Echaquan wasn't properly supervised on the morning of Sept. 28, 2020 — the day of her livestream — after she was given powerful sedatives. She went into cardiac arrest later that day and died.
Her case made international headlines after her Facebook video showed hospital staff verbally abusing her. The coroner's inquiry is looking into her death and how the health-care system treats Indigenous people.
Vadeboncoeur said he was troubled by another video, one that Echaquan's daughter captured that morning, that started at 11:39 a.m.
He says the video, which has not been released, shows Echaquan barely breathing, very pale and probably in a coma.
Vadeboncoeur said he doesn't understand why a resident gastroenterologist who, according to records took her vital signs at 11:35 a.m., reported she was "calm."
"There is a difference between calm and a coma," he said.
The lawyer representing Echaquan's family, Patrick Martin-Ménard, asked Vadebocoeur if it would have made a difference if she had been more closely monitored.
With proper monitoring, Vadeboncoeur said the answer was likely yes.
The nursing candidate who was in the emergency room that day had only a few months of experience, and had yet to obtain her nursing permit. She had nine patients under her care that morning at one point, including several who were in unstable condition, testimony revealed this week.
The hospital's head nurse, Josée Roch, said Thursday nursing candidates with a college education weren't allowed to work in the ER prior to the end of 2019, when the policy changed.
Vadeboncoeur said experienced staff would have recognized right away that Echaquan was not doing well.
He said he hopes the inquiry will address the chronic staffing shortages in Quebec's health-care system.
"This needs to be fixed, because this have consequences on real lives, on patients — there is something to learn about this," he said.
Rare heart condition
The pathologist who conducted her autopsy also testified today about Echaquan's heart.
Dr. Richard Fraser, from the McGill University Health Centre, said Echaquan had a very rare condition, rheumatic heart disease, which is sometimes brought on by an earlier infection such as strep throat
He said this was the first time he'd seen it in the 3,500 autopsies he's performed.
Fraser said he did not, however, detect any acute cardiac problems that would explain why Echaquan went into cardiac arrest.
A chemist and judicial toxicologist who testified earlier in the day said Echaquan may have been, in general, "strongly medicated," but was not, as some health-care workers have implied during the inquiry, addicted to opioids.
The coroner's inquiry also heard more about employee attitudes at the Centre hospitalier régional de Lanaudière in Joliette.
Only five of its 200 employees signed up for a training program on Atikamekw culture that was offered in 2018, according to the nurse who offered it.
Alexandre Deslauriers St-Jean, a nurse from Manawan who was completing his master's degree, says he wanted to address communication failures between the Joliette hospital and the health clinic in Manawan.
Employees were paid to follow the training.