Inquest into woman's death in Kingfisher Lake First Nation hears from doctor who treated her

The inquest into the 2017 death of a woman in Kingfisher Lake First Nation heard on Thursday from the doctor who treated her in the period leading up to her death – though Dr. Steve Coupland said he was on holiday during the events that immediately preceded Ruthann Quequish's passing.

Quequish, 31, died of ketoacidosis, a complication of diabetes, after visiting the nursing station in Kingfisher several times between March 22 and April 1, 2017. 

During testimony that lasted nearly an entire day, inquest counsel Carolyn Leach led Coupland through a detailed analysis of Quequish's medical records from encounters with the healthcare system during which Coupland was involved in her care – several of which saw Quequish presenting to healthcare facilities reporting severe abdominal pain. 

Leach questioned Coupland's focus on identifying a psychological, rather than physical, cause for Quequish's pain and asked how her diabetes diagnosis "got lost" in the analysis. 

Coupland denied ignoring her diabetes, saying he was trying to take a multidisciplinary approach to managing Quequish's symptoms, and diabetes was simply dwarfed by other concerns.

Doctor questioned about seeking psychological explanation for pain

He said he focused on psychogenic causes for her pain because extensive testing had failed to produce any other explanation and because Quequish's symptoms appeared to improve when her stress levels and mental health improved. 

One test subsequently suggested that Quequish had gastroparesis, a condition in which food fails to move through the stomach at a normal rate which can appear as a complication of prolonged high blood sugar associated with diabetes, Coupland explained.

Coupland was not copied on the result, which he said would've been a red flag for advanced diabetes.

Had he known, he said, he would have spoken to Quequish about aggressive sugar control and referred her to a dietitian.

Instead, on more than one occasion, Coupland started, and then stopped, treating Quequish with metformin – a drug used to control type 2 diabetes; he said Quequish was resistant to taking the drug, and his openness to discontinuing it at times was part of a bargaining process aimed at getting her to "buy in" to treatment.

Lack of documentation questioned

Leach asked Coupland more than once why he did not document this resistance or his reasoning in her file. 

Coupland conceded that the information could have been helpful to other healthcare professionals treating Quequish but said that time spent writing notes was time not spent on direct patient care.

Emily Hill, the lawyer for Quequish's family, quizzed Coupland about a note he made in her file after Quequish visited the nursing station complaining of extreme pain. Coupland had written that a plan was needed so she wasn't "keeping nursing staff up all night."

Hill suggested Coupland was more concerned with the nursing staff's ability to sleep than with Quequish's pain.

Coupland acknowledged his comment was brash but said that, as the community doctor, he also had a responsibility to ensure nurses were available to serve others.

Lawyer Shawn Bell, representing Kingfisher Lake First Nation, asked Coupland about potential solutions to the challenges he faced providing care to diabetic patients in the community.

Coupland said that having a glucometer in the nursing station would have made it easier for him to test patients' blood glucose levels on the spot. 

He also voiced his support for boosting the nursing complement in Kingfisher to five and providing more training to community health representatives, people who liaise between community members and healthcare providers.

In addition, Coupland told Bell that funding for a second week of work each month in Kingfisher would've allowed him to provide the level of care he wanted to provide.

The inquest opened on Monday with testimony from Quequish's mother, Edna, brother Jordan, and sister Samaria.

Kingfisher Lake Deputy Chief Lott Sainnawap testified that the community doesn't have a resident doctor and said it's not uncommon for someone experiencing an emergency to go to a nursing station and be sent home with Tylenol.