The family of a Lac Brochet woman who died in the community in May following an earlier medical procedure in Winnipeg is calling for an inquiry into her death with the support of the Northlands Denesuline First Nation, Manitoba Keewatinowi Okimakanak (MKO) and the Assembly of Manitoba Chiefs (AMC).
"I do not want to see another family go through this," said Laura Tssessaze in a June 11 press release. Her daughter, Lisa Tssessaze, died May 27 after having breathing troubles over a period of five days following the removal of a tracheal tube by her doctor in Winnipeg. The tube had put in place as a result of injuries Lisa Tssessaze suffered in a house fire eight years ago. "If there is anything I can do to prevent this from happening again," said Lisa's mother.
The chief and council of Northlands Denesuline First Nation at Lac Brochet as well as MKO called in the same press release for "an inquiry, investigation and inquest into the death of Ms. Tssessaze with terms of reference to include a broad examination of the inadequate health service system in northern Manitoba which has claimed numerous lives in northern communities." They blamed Lisa Tssessaze's death on the negligence of her Winnipeg doctor and the Northern Regional Health Authority (NRHA) emergency unit, which they say refused the recommendation of Lac Brochet nursing station nurses to medevac Lisa Tssessaze.
"This is yet another case of systemic medical negligence in an emergency case involving NRHA and First Nation Inuit Health Branch," said Northlands Denesuline First Nation Chief Leo Dettanikeaze. "A significant failure in communication and medical consultation systems as well as remote medical assessment by a contract physician has resulted in yet another death of a First Nation individual. Northlands in also calling on government to immediately change the medevac policy to place the protection of life and proper health care in emergencies over the saving of costs."
"Action must immediately be taken to change the medevac policy and to hold physicians accountable for decisions not to use medevac flights," said Northlands Densuline First Nation Coun. Joe Hyslop. The medevac policy places a priority on saving costs over saving lives."
AMC Grand Chief Derek Nepinak sais in a June 13 press release that Lisa Tssessaze's "untimely, and preventable" death was the result of a lack of co-ordination between federal and provincial governments that creates a fragmented health care system for First Nations citizens.
"This system is rooted in outdated policies that have created jurisdictional gaps and a long-standing debate between federal, provincial and First Nations governments as to who is ultimately responsible for First Nations health care," said Nepinak. "A comprehensive review of how health care services are delivered in Manitoba is urgently needed and I call upon the federal and provincial Ministers of Health to agree to a full provincial wide public inquiry.If we can save one life this review will be worth the effort, but to investigate on a case-by-case basis is not what is needed.What is needed is an independent inquiry that will make recommendations to fill the gaps in services and work towards legislative frameworks that willimprove health care delivery in our First Nation communities.This requires a commitment and action by both levels of government to fill those gaps."
The AMC press release also noted that the organization called on federal Health Minister Leona Aglukkaq to appoint an independent inquiry on health care delivery service in Northern Manitoba after the 2011 death of two-month-old Drianna Ross of Gods Lake Narrows, who died of pneumonia after her parents, Erna Hastings and Paul Ross took her to the local nursing because she was crying, coughing and having trouble breathing. The first three times they went there, nurses sent them home with Tylenol for the baby. The fourth time, on Nov. 26, 2011 they called for a medevac transfer to Thompson General Hospital. By the time the medevac arrived at the destination, Drianna Ross had stopped breathing and had to be revived. She died the next day.
An inquest into Drianna Ross's death was ordered in June 2012 by Manitoba's chief medical examiner Dr. Thambirajah Balachandra under the Fatality Inquiries Act. Such inquests are intended to determine the circumstances of the death and identify steps that can be taken to prevent such deaths in the future.
"It is time the governments step up to the plate and realize that there have been too many preventable deaths and it is time for action on a provincial wide basis," concluded Grand Chief Nepinak.
