Indigenous Patients Want Action After CMA’s Apology

Victor Summers died in May 2023. A member of Canada’s First Nations’ Oneida Tribe, Summers had been sober for 30 years, according to relatives such as his cousin Joel Abram, grand chief of the Association of Iroquois and Allied Indians and regional chief of the Oneida Nation of the Thames in Ontario. 

Yet, when Summers presented to a local emergency department (ED) in clear physical distress, staff advised that he go home. “Take a Tylenol, drink lots of fluids, and sleep off your hangover, and you will feel better tomorrow,” they allegedly said. Summers was turned away by several additional hospital EDs that evening. Finally, he collapsed, went into a coma, and died. He was later diagnosed with infectious myocarditis.

The ED experience of Summers is an example of the mistreatment that tens of thousands of First Nations, Inuit, and Métis patients have encountered within Canada’s health system for more than a century. “We have not lived up to the ethical standards the medical profession is expected to uphold to ensure the highest standard of care is provided to patients and trust is fostered in physicians…,” said Canadian Medical Association (CMA) president Joss Reimer, MD, in a formal apology to the roughly 1.8 million people who identify as Indigenous Canadians.

The case of Summers did not receive as much national attention as that of Joyce Echaquan, a 37-year-old First Nation Atikamekw patient who, just before her death in 2020, recorded the verbal abuse she received from hospital staff in Joliette, Québec, Canada. But the racism that, according to the coroner, contributed to her death demands the same degree of attention, said Abram. 

Indelible Harms

CMA’s apology came 9 years after the 2015 Truth and Reconciliation Commission of Canada’s Calls to Action, which includes 94 points aimed at redressing intergenerational harms caused by the residential school system. These schools were founded by the Canadian government in the late 19th century and run by churches, with the aim of removing Indigenous children from their families, languages, and culture and assimilating them into White, Euro-Canadian society. 

Concurrent with the apology, the CMA released a 47-page report acknowledging its complicity in the significant disparities in life expectancy, mental health challenges, substance use disorders, and chronic illnesses such as diabetes, asthma, arthritis, and hypertension that Indigenous people face today. Not only are these disparities directly influenced by social determinants of health (which include a range of social, educational, and financial disadvantages), but also they have been exacerbated by enduring trauma in survivors and their relatives as a result of documented injustice within the healthcare system. 

“The medical system has a history of exhibiting and accepting racist, colonial, and paternalistic attitudes toward Indigenous Peoples,” wrote the CMA in its report, listing harms that ranged from medical experimentation on children and adults to forced sterilization, experimental vaccines, and physical and sexual violence.

Racism in the health system persists, according to patients and clinicians. “If I had a dollar for every time one of my patients came to me and shared, at best, a culturally unsafe experience and, at worst, an overtly racist experience in the ED, I could retire,” said Jamaica Cass, MD, PhD, Indigenous Health Lead at Toronto Metropolitan University School of Medicine, Toronto, and director of Indigenous Health at Queen’s University, Kingston, in Ontario, Canada. Cass is a First Nations Mohawk of the Bay of Quinte. 

“This is a systemic issue,” she said. “At the institutional level, providers and staff need cultural safety learning and skill building so they can work safely with Indigenous patients, understand the difference between not being a racist and being an antiracist: Someone who has the skills to combat racism when they see it.” 

Action and Accountability

The CMA’s apology has been well received among Indigenous communities, but the association’s action will ultimately prove its commitment to change. For Indigenous patients, accountability is a key concern.

“It’s good that they apologized and recognized that a lot of what their practitioners are doing is wrong,” said Abram. “But when we talk about health transformation, what we are trying to advocate for is more primary care services in First Nation communities or at least more equitable access to them,” he explained. 

Abram also called for Indigenous representation within hospital EDs, which is where he says Indigenous men seek care when they need it most. He envisions representatives such as the general Indigenous navigators found in other hospital units. 

But most of all, Abram emphasized the need for accountability through data collection. “It’s a major thing that CMA didn’t talk about: How they are going to show that things are getting better and they’ve made progress,” he said.

Cass, who divides her time between education, policy, and practice, said that better resources are needed within academia not only to identify Indigenous students who desire a healthcare career, but also to provide support throughout their journey. “They need to be supported and not seen as token Indigenous students, to be able to talk to other Indigenous students, physicians, and residents and hear about their experiences, to talk through their unique struggles and challenges,” she explained. 

But Cass also emphasized a much larger need, one that Canada (like other countries) might not be ready to address: The multiple indignities that Indigenous patients face to this day. Despite her academic status and degrees, she still carries a card in her wallet that identifies her as an “Indian” under the Indian Act.

“The CMA has done a lot of things really well, but I don’t know how many of the actions that they’ve identified are actually within their sphere of influence,” said Cass. “It’s really important to have everyone on the same page about why these disparities exist and get the government, institutions, hospitals, and health systems, not just physicians, on board to do the work. 

“It’s really important to understand that reconciliation is not the work of Indigenous peoples; it’s the work of the rest of Canada.”

Despite multiple attempts, Medscape Medical News was unable to obtain comments from representatives of the Métis and Inuit communities. Some of their initial reactions to CMA’s apology can be found online. Abram and Cass reported no relevant financial relationships. 

Liz Scherer is an independent health and science journalist.