Ontario inquest for First Nation woman who sought help for diabetes to examine health-care inequities

The inquest that begins Monday into the death seven years ago of a First Nations woman in northwestern Ontario is expected to examine the challenges of providing health care in remote communities.

Ruthann Quequish, 31, who was dealing with complications from diabetes, passed away on April 1, 2017, at her home in Kingfisher Lake First Nation after attending her community's nursing station in the hours and days preceding her death.

Fewer than 600 people live in the remote Oji-Cree community, about 350 kilometres northeast of Sioux Lookout, which is part of Treaty 9.

"Ruthann was a very beautiful person and a much-loved daughter, sister and mother. Her family desperately advocated for her to receive medical care, and miss her every day," Jordan Quequish, Ruthann's brother, said in a written statement to CBC News.

The inquest, being held in Thunder Bay, was first delayed in April 2023 and then anticipated to be held that November before being pushed again to 2024. 

Julia Noonan, a spokesperson for the Ministry of the Solicitor General, said in an email to CBC News reasons for the delays include the COVID-19 pandemic, and time needed to retain an expert to review investigative materials and identify potential issues relating to Quequish's death.

"The inquest was most recently delayed in response to a request from family and community," Noonan said.

Sometimes, when you cross over between the provincial and the federal responsibility of health care, people fall through the cracks.- Sol Mamakwa, Kiiwetinoong MPP  

Dr. Michael Wilson will be the presiding officer at the inquest.

The jury will be tasked with answering five questions: identifying who died, when and where they died, their medical cause of death, and by what means they died — which is classified as either natural causes, accident, homicide, suicide or undetermined.

Jurors can also make recommendations to prevent similar deaths.

"This is a discretionary inquest that was called and I think from that perspective, it demonstrates that there is an important public interest in this inquest," said Kate Forget, a member of Matachewan First Nation.

Forget and colleague Carolyn Leach are serving as inquest counsel with the Indigenous justice division of Ontario's Ministry of the Attorney General.

"Inquests are really important from a death prevention perspective and also from a truth-seeking perspective, so that hopefully the family and community gets answers to questions that they may have had for years," Forget said.

The process also serves to educate the public about systemic issues and "how we can make improvements to the system so that there's equitable health care provided to First Nations communities," she added.

Emily Hill and Caitlyn Kasper of Aboriginal Legal Services are representing the Quequish family during the proceedings; Edwards Bell Jewitt LLP is representing Kingfisher Lake First Nation and Shibogama First Nations Council.

'Tylenol nursing stations' not meeting needs

Quequish died of diabetic ketoacidosis, said Forget.

The life-threatening condition develops when the body can't produce enough insulin, which helps turn sugar into energy. Insufficient insulin results in the body breaking down fat as fuel, causing a buildup of acids (ketones) in the bloodstream. Monitoring blood sugar levels is important for people with diabetes. Symptoms of ketoacidosis can include excessive thirst, frequent urination, tiredness, feeling weak, shortness of breath and being confused.

The inquest is expected to hear from witnesses including family, community members, and doctors and nurses involved in Quequish's care. The jury will also be educated about northern health care more broadly. 

A number of key themes are expected to emerge, Forget said, including:

• Interactions within nursing stations, including physicians supervising nurses.
• The provision of medical services in nursing stations and remote First Nations, with a focus on patients who have diabetes and multiple medical concerns.
• Training provided to staff at nursing stations.
• Medical testing sites.
• How provincial and federal entities, like nursing stations and hospitals, communicate with each other.

Kiiwetinoong MPP Sol Mamakwa, who's from Kingfisher Lake First Nation, knows the Quequish family and said he recognizes the next few weeks will be difficult for them.

Mamakwa describes the "Tylenol nursing stations" in northern communities — meaning staff there are only equipped with basic medicine and supplies — as places where nurses don't always have the training or resources to meet patients' needs.

Physicians travel to Kingfisher Lake only five times a month, or 60 days a year, Mamakwa said. They responsible for requesting medical evacuations in First Nations, which is difficult if they're not in the community at the time of an emergency, he added.

Mamakwa wants new nursing stations in smaller First Nations, satellite hospitals in larger northern communities and health-care systems led by First Nations themselves. 

"Sometimes, when you cross over between the provincial and the federal responsibility of health care, people fall through the cracks," he said.

"We cannot continue to have these needless deaths and unnecessary suffering, and we see it all the time in the fly-in First Nations especially."

The power of the jury

Forget, who has been involved in a number of inquests, said she always commends jurors for navigating the difficult task ahead of them.

"The jury is sitting there volunteering their time, sometimes for weeks on end, to also learn these really difficult facts, and at the end, they're the ones that make the ultimate decisions," she said.

"They, through their recommendations, speak to society and they speak to governments and entities about how they can make improvements so that we don't end up having more inquests."

Last spring, an inquest into the death of Oji-Cree Woodlands artist Moses Beaver of Nibinamik First Nation ended with 63 recommendations from the jury that focused on improving mental health care for Indigenous people.

Although jurors can't make any findings of legal responsibility or assign blame to anyone, their role shouldn't be understated, said Leach.

"There are recommendations that have emanated from inquests that have led to really profound policy change," Leach said. "That is heartening to see — incremental, although, it may be at times."

The Quequish family shared their hopes for what the inquest achieves, referencing the duties owed to First Nations by the federal government.

"As a family, we have waited a long time for this inquest. We firmly believe that [Ruthann's] cause of death was preventable and we hope that we get answers to our questions on why this happened," Jordan said.

"Promises that were made in the treaties included that the first peoples of this land would receive good health care. They have not. We would like the inquest to result in recommendations to improve access to health care in our community and to prevent tragedies like this in the future."

Quequish's inquest will be held at 189 Red River Rd. The proceedings will also be streamed online in both English and in Oji-Cree.