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Stories of the MMIW: Joyce Echaquan - Wrongful Death

Imagine being in the most vulnerable position one can be in. You're terribly sick and in excruciating pain. You've been struggling with cardiomyopathy for six years and have already been implanted with a pacemaker. Not knowing a word of French, you're forced to frequently check yourself into a French Canadian hospital in Quebec and rely on a cousin to translate through Facebook Live streams. This situation is scary enough on its own. Now add the element of extreme prejudice on the part of the hospital staff. Complete indifference to your suffering as you're being either ignored or taunted by those meant to help you. Unfortunately for the First Nations people of Canada this is a horrifying reality when visiting a hospital.

This introduction is not only meant to help you put yourself in the shoes of an Indigenous person visiting a Quebec hospital, but also to paint a picture. This was very much the experience of Joyce Echaquan in her final hours. Scared, suffering, sick, and in pain as she was being ignored, taunted, and insulted by a racist staff meant to administer her care.

Joyce Echaquan was a 37-year-old mother of seven children. She was happily married to her husband, Carol Dube, at the time of her death. In 2014 she was diagnosed with cardiomyopathy, which the Mayo Clinic defines as a disease of the heart muscle that makes it more difficult for the heart to pump blood to the rest of the body. She was implanted with a pacemaker and would make frequent trips to a Joliette hospital in Quebec due to her health problems. A member of the Atikamekw First Nations community, Joyce didn't speak French. This posed an issue since the entire Joliette staff exclusively spoke French and had no means of translating for those who do not. A quick solution to her problem, she would simply Facebook Live stream her visits with the staff so a cousin could translate for her. It would be an extremely shocking Live stream that would turn the world's attention directly to Joliette's hospital and their uncaring, prejudice staff.

On September 26, 2020, Joyce was admitted to a Quebec hospital in Joliette for stomach pains. Rather than check her medical history, the staff automatically assumed her to be experiencing withdrawal symptoms simply because she was Indigenous as reported by The New York Times. CBC News lays out Joyce's final hours in excruciating detail. Their timeline comes directly from the coroner's inquest into her death. The names of the nurses and attendants that testified in the inquest were protected from publication, but their testimonies were not. Their words shocked the world and intensified the fear and mistrust felt by First Nations people against the Canadian healthcare system.

An attendant testified that she had witnessed Joyce at 8:00 on the morning of September 28, 2020, the day of her death. At that time she described the patient as being calm as she chatted on the phone. This same attendant returned at around 10:15 to find her kneeling on her hospital bed as she banged her head against the wall, screaming. As she attempted to calm her down, she said that she could not even catch Joyce's eye, claiming that they seemed empty as though she weren't there. It was at this point that she was taken to a private room, sedated, and left alone for 40 minutes. This goes directly against Joliette's protocol. When a patient has been sedated an attendant must stay with them to ensure their safety.

This attendant's testimony shed a shining light on the negligence of this hospital's administration. The young woman told an incredulous crowd that she was the only attendant on the floor at the time Joyce was sedated. Spread too thin with 38 other patients to look after on her own, she claims that she was left with no choice but to leave Joyce alone while she tended to the others on her floor. She described that day as being 'chaotic.'

This young woman stated that she finally returned to look in on Joyce at 11:00 to find that her hands and feet had been restrained. She was asked by one of the two nurses in the room to add a weight belt to properly secure the patient. As the woman testified, these types of restraints are commonly used for patients that have proved to be a threat to themselves or others. She didn't know what had transpired in the 40 minutes she had been gone to lead to the restraints. The most she had been able to gather was that the patient had been found on the bathroom floor.

At this point she was informed by one of the nurses that Joyce had filmed them, but the unnamed nurse claimed to have deleted the video. This video that she had filmed from the bathroom floor turned out to be the now infamous and haunting Facebook Live stream that enraged the world. Upon investigation, her phone records showed that no videos had been deleted from the phone, but a Facebook Live stream had been stopped. One of the nurses heard in the video claimed to have followed the hospital's protocol on being filmed during an interaction with a patient. She informed her superior about the video before returning to the floor to finish out her shift for the day.

This atrocious video was played during the inquest for all to hear. Though it pained Joyce's mother and husband deeply to see and hear her anguish in her final moments, they stayed in the room. They were determined to see this through to the end and ensure that she received justice for the torment she endured. While CBC News published much of what was said in the video, The Guardian published one additional quote I did not find elsewhere.

In French one of the nurses can be heard saying, "You're stupid as hell." As quoted from The Guardian, she is also heard asking, "Are you done acting stupid? Are you done?" The New York Post also published many of the awful statements made by these cruel, insensitive nurses. The second woman coldly comments, "You made some bad choices, my dear," before asking, "What are your children going to think, seeing you like this?" To this, the first woman responds, "She's good at having sex, more than anything else." Before the Live stream is terminated Joyce is asked, "Who do you think is paying for this?" while also being told that she would be "better off dead." All of this is happening while Joyce is lying on the ground, crying out in pain, while also on sedatives.

Several people had to leave the room during the coroner's inquest as the Facebook Live stream replayed this poor woman's misery. The agonized cries that echoed through the room were more than many could handle. As difficult and devastating as it was, Joyce's mother and husband endured a psychological torment all their own as they relived their loss and her pain.

One of the nurses on that video testified that there had been no malice on her part. The hospital was short-staffed and simply doing the best that they could under their circumstances. She claimed to have been told by another staff member that Joyce was experiencing withdrawals and thus handled the situation as such. She thought the mention of her children would "bring her back to reality," claiming that her intent had only been to motivate her patient. Her hollow words meant little to a grieving family and community still in shock over the traumatic and preventable loss of a loved one.

A student nurse that stepped forward to testify gave the most candid description of Joyce's treatment by the rest of the staff. The student had never dealt with a restrained patient before and was unsure of how to handle the situation. She said that a doctor had approved her request to have Joyce looked after once she was sedated, but when it was found that no one was available, she was told to "figure it out." Having several patients of her own to look in on, the student was not able to stay with Joyce, either. It would be another 40 minutes before she was able to look in on her again. Then she was approached by a resident gastroenterologist that had attempted to speak with the patient about her treatment. He described her as "acting out," a term used by medical staff when a patient pretends to be asleep to avoid answering questions.

When the student returned to Joyce's private room, she could see immediately that she was not doing well. Upon finding that her pulse was quite weak the young student requested that she be taken to a resuscitation room. She was told that all of the rooms were full and she would have to wait. The young woman didn't feel as though she was being taken seriously, so she decided to look into it herself. She found that there was one open, but there was still another 10 minute wait before Joyce could be transferred. Before she could even be moved a patient attendant had entered her room to find Joyce's daughter present. The attendant discovered that she wasn't breathing and took her to a resuscitation room. From there two attendants attempted to revive her for 45 minutes.

One of the attendants that had tried to revive Joyce cried while delivering her testimony. She apologized to the family and expressed her hope for reconciliation between the hospital and the Atikamekw community. Stating that the language barrier had always been an obstacle when treating First Nations patients, she said that she hoped to see it eliminated with more resources for translation and more ER training in the future. In her statement she pointed out the fear that First Nations people seem to have for the hospital and their staff since the senseless death of one of their own. A perfectly reasonable response considering that Joyce was far from the first Indigenous person to face this kind of discrimination in a Quebec hospital.

Making their negligence all the more jarring is the realization that her death was 100% preventable. The coroner's findings in this case were all the more damning for the hospital's staff. Though it was assumed by everyone that had contact with her that she was experiencing withdrawals, her autopsy showed absolutely no signs that she had been a drug user. Her cause of death was revealed as a pulmonary edema, which is an excess of fluid in the lungs. The coroner, Gehane Kamel, maintains the opinion that her death could've been prevented by a caring and attentive staff administering proper care. In short, she declared that racism played a huge role in this helpless woman's death. She stated that systemic racism was a serious issue in their province as well as their healthcare system, and it needs to be recognized. Very bluntly the coroner stated to the press that had Joyce been a white woman, she would still be alive today.

Dr. Alain Vadeboncoeur, an emergency physician at the Montreal Heart Institute, examined Joyce's medical background, autopsy report, and hospital records. In his testimony he revealed that she had been suffering from additional health problems aside from cardiomyopathy. With so much going against her and the staff clearly unaware of her medical history, he stated that leaving her unattended after giving her powerful sedatives was pure negligence.

Though Carol Dube is still grieving the loss of his beloved wife, he said after the inquest that the coroner's report "was a vindication that his wife had been the victim of prejudice." The New York Times quoted him as saying, "The system today still allows people with prejudice to commit horrors." It's the hope of the Atikamekw community as well as other First Nation communities of Canada that Joyce's death will open an honest dialogue about the treatment of Indigenous patients and effect change in the healthcare system.

After the inquest, the Grand Chief of the Atikamekw First Nation, Constant Awashish, was caught outside of the courthouse. He commented to reporters that the vitriol heard from the nurses on the Live stream was "hard to swallow." When asked about the testimony of one of the nurses from the video he replied, "I'm going to give her the benefit of the doubt, but it's kind of hard to believe given the way it was said."

The chief of Joyce's community of Manawan, Paul-Emile Ottawa, said that the testimony heard that day proved that not one particular attendant was at fault, but rather the entire administration. Thinking that they could handle such a large hospital during a pandemic with a reduced workforce was absolutely ludicrous as well as negligent. The fault definitely lies squarely at the feet of the hospital that allowed such a tragedy to take place without intervention.

Federal Indigenous services minister, Marc Miller, told reporters, "This is the worst face of racism." He also points out that this is far from the first time this kind of discrimination has been seen within the Canadian healthcare system. Miller pointed directly to the case of a British Columbia hospital where the staff was betting on the blood alcohol levels of Indigenous patients as they were coming in the door. For Indigenous Canadians suffering with serious health problems, Joyce's case and the heart-wrenching video that started it all serves as a terrifying reminder of the kind of treatment they have received in the past.

Quebec's premier, Francois Legault, condemned the actions of the venomous nurses, stating that at least one of them had already been fired. In the same breath he also rejected the notion of Joyce's death being representative of a much broader issue in Quebec's healthcare system. In a statement that sounded much like he hadn't wandered into one of those hospitals in quite some time, he said that he didn't think that they dealt with First Nations people in this way. Regardless of his opinions the coroner launched her own investigation into the death as well as the local health board. When announcing the start of their investigation the board said, "We will not tolerate any remarks of that type from our personnel."

According to Wikipedia, it was not only Joyce's inability to understand the staff that prompted her to stream her visits with them while staying at the hospital. She also felt a deep mistrust of Quebec's healthcare system and the attendants meant to administer her care. A statement given by a witness to the care Joyce received at the same hospital just a month prior to her death gives her concerns a considerable amount of weight. A cousin of her's was quoted as saying that she regularly mentioned the staff being "fed up" with her and that they never really treated her, only ensured she was not in pain.

In August, just a month before her death, Joyce was mistreated at the very same hospital when a woman named Jennifer Mac Donald attempted to help. Mac Donald was a 33-year-old attendant at a local Alzheimer's centre. She was at the hospital in Joliette to support her father as he received care. While she was there, she could clearly hear a woman screaming from a nearby cubicle as she tried to voice concerns about her treatment. This woman was Joyce Echaquan. When Mac Donald approached she witnessed the staff's behavior towards her and described it as "indifferent and verbally aggressive." As the staff ignored her pleas for help the witness overheard a nurse asking "Will she ever shut up?" She finally decided to step in and see if she could help in any way, but was told by the staff to "mind her own business."

When the news broke a month later that a patient had died after filming the staff verbally abusing her, Mac Donald didn't realize it was the same woman she had tried to help. When she saw the video for herself, she knew immediately who the woman was. She recognized her from the hospital bed she had seen her screaming and crying from.

Just over two years later, the fight is still not over. In September of this year Joyce's family filed a nearly $2.7 million lawsuit. According to CTV Montreal the suit was filed in Joliette and includes the names of the attending doctor, Dr. Jasmine Thanh, and one of the attending nurses, Paule Rocray. Their suit, which contains allegations not previously tested in court, seeks a total of $2,675,000 in damages. It claims negligence on the part of the hospital, stating that Dr. Thanh never properly assessed Joyce's situation. It goes on to say that Rocray didn't bother to help her when she fell out of bed, choosing instead to make "racist" comments towards her. Her mother and husband have called on Premier Francois Legault to recognize the racism that runs rampant in the Canadian healthcare system and do something about it, but her refuses. In his eyes there is no problem to correct.

As tragic and senseless as her death was it has not been entirely in vain. Her video opened the eyes of the world to a problem that many of us had no idea even existed. In the aftermath of her passing the Atikamekw community drafted Joyce's Principles. This is a series of measures aimed at ensuring that Indigenous patients have access to equitable healthcare and that systemic racism within is recognized. While Legault's incumbent Coalition Avenir Quebec government has adopted many of its policies, they have not accepted the reference to systemic racism. Leaders of the Atikamekw community denounced their refusal at a news conference this past September. Grand Chief Constant Awashish told reporters that things need to change at the political level. He feels that his people and their concerns are not being heard at all, let alone taken seriously.

During a televised leaders debate in the same month Legault apologized publicly to Joyce's husband, saying that the issue of racism in the Joliette hospital had been "settled." His words meant nothing and were likely only a political ploy. Yet another politician that will say anything to get on top and stay there.

The case of Joyce Echaquan is truly eye-opening. When Americans think of the Canadian healthcare system we typically only think of it as being free. Before the release of this shocking Facebook Live stream it would seem that no one outside of the Canadian Indigenous communities knew anything of the abhorrent treatment inflicted upon them. It's a sad commentary on their system that it took the death of an innocent woman to turn the world's attention to this atrocity. But now that they have our attention, why can't we as a society of living human beings hold these racist pricks responsible?

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