While Brian Sinclair sat dying for 34 hours, the emergency room medical staff at Health Sciences Centre only saw an aboriginal man looking for a place to get out of the cold or a safe place to sleep, an inquest heard Tuesday.
That assumption is implicit racism, concludes Dr. Janet Smylie, an expert in aboriginal health care in hospital emergency departments who is based at St. Michael's Hospital in Toronto.
Smylie, who said she is Métis, was testifying at the inquest examining the death of Sinclair, 45, at HSC in September 2008.
"Stereotyping or discrimination are more dangerous than explicit racism," she told provincial court Judge Tim Preston on Tuesday. "It would have been people having unintentional implicit stereotypes of Mr. Sinclair, for example, the assumption why he was there. He was homeless or cold or needed shelter.
"There was an assumption he didn't have an acute or semi-acute medical problem."
Smylie said the wrong assumption by hospital staff wasn't helped by Sinclair's background and the history of aboriginal people in Canada.
"We know Mr. Sinclair attended residential school and he... had a (past) history of being homeless," she said.
"One could say he didn't feel comfortable in asserting himself in the emergency department.
"For me, all of those elements can add up to a bad equation. He was an aboriginal person who has faced judgment in that emergency room or elsewhere and didn't feel comfortable in expressing his needs. I want them to remember every time there is a person there."
Sinclair, 45, died in the waiting room of HSC's emergency department after waiting to have his blocked urinary catheter checked. Security cameras showed a hospital worker appearing to scribble down his name on a piece of paper when he first entered the area, but that form was never found and Sinclair was never called to the triage desk.
A coroner said Sinclair died from a treatable bladder infection and may have died up to seven hours before staff were alerted by other waiting patients.
When emergency room staff started working on Sinclair, they stopped when they realized rigor mortis was already setting in.
Smylie said based on her review of racial and ethnic studies around the world, what happened to Sinclair is not different from what aboriginal people have faced in Australia or what minorities encounter getting health care in the United States.
"First people receive second-class treatment," she said.
While Smylie said there are no studies about racism in Canada's medical system, she said studies in Australia have shown their aboriginal people don't receive the same prompt treatment for heart attacks non-aboriginal people get.
Smylie said one of the best ways of helping aboriginal people get better health care in Winnipeg would be to create a stand-alone aboriginal ambulatory health-care clinic.
She said with aboriginals representing 40 per cent of the patient load at HSC's ER, the clinic would also help with overcrowding at the province's busiest emergency room.
As well, Smylie said it would likely help if medical workers took cultural courses every few years instead of once in a career.
Smylie said providing aboriginal food in a hospital setting is only "the tip of the iceberg" when trying to deal with cultural differences.
Smylie said health-care providers have to recognize there is a power imbalance in their favour when treating aboriginal patients because of past negative aboriginal experiences.
"If somebody already had an abusive experience with somebody in authority, they can bring that when dealing with a health-care provider," she said.