Coroner to investigate death of Atikamekw baby who waited 3 hours for ambulance

The death of a 7-month-old baby from the Atikamekw community of Manawan has prompted a coroner's investigation, after it took hours for an ambulance to arrive from outside the community.

The baby girl died April 4 at the Centre Hospitalier Universitaire Sainte-Justine in Montreal, from complications of meningitis and COVID-19, after first being diagnosed at the community's health centre as having a fever from teething, a spokesperson for the family told Radio-Canada. 

Community members say the child's death is another heartbreaking example of unequal access to health care for the 2,000 residents of Manawan, located 250 kilometres north of Montreal, in the province's Lanaudière region.

The infant developed a fever on March 31, and her parents gave her acetaminophen, believing it was related to her teeth coming in, according to the family friend, who Radio-Canada agreed not to name to protect the child's identity.

When the fever did not break the next day, the parents, by then seriously concerned, called the Centre de Santé Masko-Siwin de Manawan. A nurse evaluated the baby and recommended to continue giving her acetaminophen and to remain vigilant.

"She said the little girl had six teeth that were coming in at the same time and that the fever would break with Tylenol. That's typical of the nurses here, to give us Tylenol," said the family spokesperson.

The child's condition did not improve, and by the night of  April 2 she went into convulsions, she said. Police arrived as first responders, and the child was transported to the health centre around 8:40 p.m.

But it was only three hours later, at around 11:45 p.m., that the baby and her mother left the community aboard an ambulance en route to the Joliette hospital. The girl was transferred to Montreal, where she died on Monday, April 4.

The health board for the region, the Centre intégré de santé et de services sociaux de Lanaudière, has launched an internal investigation, as has the Centre de Santé Masko-Siwin de Manawan.

Local ambulance was unavailable

The family friend said the parents question the quality of care at the health centre and the fact that patients must be triaged by a nurse before an ambulance is called. 

"We're stuck with that," she said. "It has to change — we have no 911."

But they also question why it took three hours for an ambulance to arrive, she said. The ambulance that transported the girl came from Saint-Michel-des-Saints, Que., about a two-hour drive from Manawan, the bulk of it on a gravel road.

Manawan has had an ambulance in the community since November 2018, but it was not available, because the crew had already worked more than the maximum number of hours allowed.

"In principle, we always have ambulance services on site, but at that moment, the team of paramedics were already 'over.' That meant they couldn't be assigned to the call," said Francine Moar, director of health services for the Centre de Santé Masko-Siwin de Manawan.

"With the state of the road, it took them two hours … and then you're still not even in Joliette. It was a long delay," said Moar.

The family also lamented the state of the road, which the friend said is in "horrible" condition, due to the spring freeze and thaw.

Vice-chief calls for helicopter medevac service 

The family, along with community leadership, are questioning why a medevac was not called for such a seriously ill child. 

"When it concerns the health of a child, they could have chosen to transfer the child by helicopter. That would have been possible. I still don't understand why it wasn't done," said Sipi Flamand, vice-chief of the Atikamekw Council of Manawan.

While private medical helicopter services exist, ​Quebec is one of the only provinces in Canada without an organized, pre-hospital emergency air ambulance system.

It's not the first time an coroner has investigated the death of a child from Manawan after a transfer by ambulance. 

After a toddler who was also transferred from Saint-Michel-des-Saints to Montreal died of drowning in 2009, a coroner recommended finding ways to reduce wait times for ambulances, including the possibility of establishing medevac services for patients in critical condition in remote regions. 

The parents of another child in Manawan who drowned in 2017 had also sounded the alarm about the long wait times for ambulances. 

Flamand points out that he testified at the Viens Commission, a public inquiry into relations between Indigenous peoples and certain public services in Quebec, about the need for Manawan to have more than one ambulance. At the time, the community had none. 

"For decades, we've been asking for two or three ambulances for emergencies, but the government only gave us one," Flamand said.

He hopes the government will act on any recommendations that come out of this new coroner's investigation, but he remains skeptical.

"It's all well and good to have investigations, but when there are recommendations, no one acts on them. It's a waste of time," he said.