On Sept. 19, 2008, Brian Sinclair went to a community health centre in Winnipeg. He was in pain and needed help with his catheter bag. A doctor examined him and decided he needed to visit the Health Sciences Centre emergency department. Sinclair, a 45-year-old double amputee, was in the early stages of a bladder infection that might lead to sepsis if untreated, the doctor said, and the centre did not have the capabilities to care for him.
She wrote a letter for the emergency room explaining the situation, folded it into an envelope, and handed it to Sinclair, who tucked it into his pocket. She told him she would arrange a ride for him because he seemed stable and cognizant, and that he would need to give the letter to whoever was at the front desk of the ER that day so he could be seen efficiently.
“Okay, doc,” Sinclair said. He put the note in his pocket.
The next 34 hours unfold in security footage and witness testimony.
There was the man at hour 10 who chatted with Sinclair: “I asked him how long he had been sitting there and he said, ‘Quite a while.’” The man testified he told a nurse Sinclair had been waiting a long time only to be told that sicker patients were being seen first.
There was the health care aide who saw Sinclair that first night, and then the second, and “had a feeling something wasn’t right.” She testified that she told a nurse that Sinclair had waited more than 24 hours, only to have the nurse shrug it off. And then, she testified, when she told a security guard outside on his break, she said “his response was, ‘I think he’s here to watch TV.’”
Another couple, there with their son, also raised concerns with security after Sinclair started to throw up. Sinclair was given a bowl but no medical staff came to treat him.
WATCH: Ten years after Brian Sinclair’s death
And then there was the nurse, working a weekend shift, who was asked to check on Sinclair the morning he died but who said it didn’t seem urgent so he did paperwork first. When he finally did check, he testified, “there wasn’t any commotion.” By the time Sinclair was discovered minutes later, rigor mortis had begun to set in. His eyes were black and his face was white.
“Honestly, they thought he was just a street person sleeping it off, they thought he was just another drunken Indian coming in to pass out,” Sinclair’s cousin says.
“It’s always hidden racism.”
Sinclair — an Indigenous man — was pronounced dead on 12:51 a.m. on Sept. 21, 2008.
Brian Sinclair was one of nine children. His mother was Veronique Goosehead, a residential school survivor, and his father was Alfred Sinclair, a fisher and logger of mixed First Nations and European descent. He grew up northeast of Winnipeg near Sagkeeng First Nation and then, when he was a little older, in Winnipeg.
His older sister remembers him as a kind and helpful little boy, a smart student. But his cousin, Robert Sinclair, remembers him as a fellow middle child, one he never fought with, even though childhood battles were common among so many mischievous boys. It was Sinclair’s doggedness that stood out, Robert says.
In fact, Robert’s circle of childhood friends, which didn’t include his younger siblings, very occasionally included Sinclair because he dedicated himself to finding ways to hang out with the older crowd.
It’s a persistence he seemed to carry until he died.
Sinclair and some of his siblings, who started to sniff solvents with some of the local kids, were put in foster care for about a year when he was 12, the year his parents broke up. Robert and his siblings were also placed in foster care, Robert says, an official decision that would change — but not break — their family connections.
When the siblings were put back in their father’s custody a year later, Sinclair’s sister remembers him becoming devoted to their father. And so it was devastating when Alfred Sinclair died when Sinclair was still only in his early 20s.
Here is how his family, as told to their lawyer Vilko Zbogar, would have you remember Sinclair in adulthood: helpful and courageous. Sinclair once ran into a burning building to rescue elderly people from a fire.
And in the year before his death, after having both of his legs amputated due to frostbite, Sinclair volunteered at the Siloam Mission to help those in his community.
The chaplain at the shelter he volunteered at remembered him as someone struggling with a solvent abuse issue but who was, nevertheless, quiet, humble and kind. But kind didn’t mean a pushover. His support workers said he didn’t shy away from telling someone to move out of his way when he was in a wheelchair and that he took pride in being able to take care of himself on his own as much as he could.
His cousin Robert remembers watching the hospital security videos with family, reporters and lawyers at the inquest. He tracked Sinclair on the grainy footage as he pushed his way around the ER, as he was fatally ignored. Robert waited for the exact moment his cousin died but he couldn’t pinpoint it.
“He was dying,” Robert says, “He was dying and I was watching it like a video on YouTube.”
Friday marks a full decade since Sinclair’s death. There has been an investigation, an inquest, a lawsuit, a working group, and a book. The Sinclair’s family lawsuit is still winding its way through the courts; already the health authority has apologized publicly, paying the family $110,000 in damages.
Much has been made of Brian Sinclair’s life. At the inquest, people spoke of how he was and of the care he had been receiving.
They also spoke of his vulnerability.
WATCH: Brian Sinclair video revealed
One home care attendant said Sinclair would “literally give his shirt or jacket to someone in greater need than he.” She thought he was doing better, although in its final report the inquest cited witnesses saying Sinclair “did not fully appreciate his own vulnerability.”
He wasn’t vulnerable, counters Dr. Barry Lavallee, an Indigenous family doctor — no Indigenous person is.
The inquest — a fraught affair that saw Robert, Sinclair’s other family members, and Indigenous advocacy groups walk out — made 63 recommendations. Many called for a review of policies and procedures, while five alluded to the fact that Sinclair was Indigenous.
In the last few years, Manitoba Health has carried out 55 of the inquest’s recommendations, has partially completed another five, and three remain “open” — a classification that, a spokeswoman says, means work is “underway or pending.”
The inquest rejected a request from the Sinclair family lawyer, Vilko Zbogar, to call a separate inquiry into the role stereotyping and racism played not just in Sinclair’s death but also more broadly in preventing and deterring Indigenous people from accessing health care.
But by refusing to grapple with racism, experts say, we are avoiding the uncomfortable conversation that is necessary to ensure nobody else dies like Sinclair.
Even now, Dr. Lavallee, who specializes in Indigenous health, says the problem of how racism hampers Indigenous people’s access to health care is only just “emerging.”
“We don’t fully understand it,” says Lavallee, “how it occurs from person to person, how it occurs structurally, how it occurs in terms of policy, or by action and inaction.”
Lavallee is a member of the Brian Sinclair Working Group, which came together to address racism in a way the inquest did not.
He is blunt and unapologetic, likely the result of years spent trying to make the Canadian health care system act on what he and many other experts see: it is failing Indigenous people.
“Brian Sinclair died because he was Indigenous,” Lavallee says, “full stop.”
Brian Sinclair is not the only Indigenous person to die in the care of an arguably indifferent health-care system. Katie Ross died 20 years before him, in July 1988, needing care for a gunshot wound that health care workers misdiagnosed as anxiety. Ross, 56, had been camping with her husband and son in British Columbia when her husband was shot and killed. She was shot at. The specifics of the shooting are not quite clear, in part, because several names have been redacted in official documents. What is clear is that Ross sought care.
When the Mounties were called, she told them she had been shot and was hurt, but a constable checked her and “could not see any blood or a wound.” He asked, are you sure you’ve been shot? She said she wasn’t sure. The RCMP constable cancelled the ambulance.
Later, when Ross was still in pain, her children persuaded her to go for care, first at a Red Cross Outpost and then later at the nearest hospital. In both instances she was diagnosed with “emotional shock” and when she vomited, the response was to increase her sedatives.
There is a note at the bottom of the inquest report: the nurses saw what they thought was a mole on her back. In reality, it likely wasn’t. Ross died from abdominal inflammation caused by a gunshot wound to her back.
Sherene Razack, a professor in gender studies at the University of California in Los Angeles, writes of the inquest’s attempts to direct change:
“The Ross inquest was not concerned, as we might expect, with the violent outcome of clinical negligence and thus with the death of a human being, but rather with improving communications between Indigenous and non-Indigenous people. The focus on communications provides a euphemism for medical professional’s near complete lack of interest in Ross’s injuries.”
The official recommendation was for a cultural liaison program as well as cross-cultural training. The latter never materialized.
It’s easy to react in horror and then dismiss deaths like Sinclair’s as a “one-off,” says Mary Jane Logan McCallum, a history professor at the University of Winnipeg who recently co-authored the book Structures of Indifference: An Indigenous life and death in a Canadian City with Adele Perry. It’s about Sinclair and they wrote it because they wanted a book that would tell Sinclair’s story in a succinct manner, one easily digestible by students, health care workers, and the general public.
They raise issues that one of Canada’s top Indigenous health experts addressed during the inquest.
Dr. Janet Smylie, a Métis doctor working in Toronto who has conducted extensive research on racism in Canadian health care, said surveys have made it quite clear that Indigenous people cannot expect equal treatment when they go to ERs.
“Our health care services were set up with the best intentions in mind,” she testified, but “they weren’t set up with Indigenous people in mind.”
As soon as the inquest shrunk racism’s role in Sinclair’s death, his family and many important Indigenous organizations recused themselves — they walked out. The focus, they felt, had shifted too much toward ways in which the emergency room and Health Sciences Centre, in particular, could have organized themselves better and too far from deadly stereotyping of Indigenous people. There were 63 recommendations, just five of which hint overtly at race.
WATCH FROM 2014: Family blames racism for Brian Sinclair death
“Sinclair was not ill but simply sleeping or intoxicated,” McCallum and Perry write in their book. “This assumption, made and remade over and over in the thirty-four hours while Sinclair sickened and died in a hospital ER, is a striking and painful example of one of the structures of indifference that cost Brian Sinclair his life, as it has cost the lives of other Indigenous people in Canadian cities.”
It’s a direct result of the fact that racism is “never acknowledged,” Sherene Razack says.
“When we talk about racism, people sort of go into overdrive to explain how race was not a factor.”
Razack, the UCLA professor, is also the author of Dying from Improvement, a book that illuminates the lengths to which courts, inquests and coroners have gone to avoid blaming racism for someone’s death in Canada.
“There’s no official condemnation when anything happens,” she says. “There is, instead, a really determined effort to turn this into, ‘Look, we’re always caring, we even have an inquest, … but these people are very hard to care for.’”
For more than a decade now, there has been an understanding that Indigenous people are not receiving equitable health care, says Cheryl Ward, provincial lead for the San’yas Indigenous Cultural Safety Program in B.C.
But up until the time Sinclair died, the solution was mostly to bring people in for a talk about Indian Residential Schools and to share with them a snapshot of Indigenous life before colonization.
WATCH: The government is considering a national holiday for legacy of residential schools but does it risk becoming “just a holiday?”
“It was not a very effective approach. It didn’t seem to be leading to the kinds of outcomes that were needed,” Ward says. In other words, it wasn’t changing behaviours or practices.
In 2008, the B.C. government tasked Ward with developing online cultural competency training. The idea was to shift away from history — “it’s important but it is not everything” — and tackle thornier questions. How do you help people see and then counter their own biases, their own moments, inadvertent or advertent, of stereotyping and discrimination?
“That’s been the most difficult work,” Ward says. “The backlash is so high that people don’t want to do it.”
The backlash is that people don’t want to hear the truth, she says. So much of the history Canadians are taught is wrapped up in this idea that the engagement between Indigenous people and settlers was “benevolent,” Ward says, “that there was no violence.”
“We’ve been teaching about history for a while now,” Ward says.
“It doesn’t seem to be changing behaviours at the speed that it needs to change or to the depth that needs to be changed.”
That’s part of the reason some people, Lavallee included, are critical of positioning cultural safety training as a solution to racism. And yet, Ward says, she does feel like there has been progress. San’yas has spread east from B.C. She’s done work in Manitoba and now in Ontario, too.
“There’s a tsunami of resistance,” she says, “But it’s cracking open these doors. They talk about the glass ceiling but that’s got nothing on the red ceiling.”
Many Indigenous people worry about accessing health care, says Carrie Bourassa, scientific director of the Institute of Indigenous Peoples’ Health in Regina.
“For many … there is that fear that when you go into a hospital or clinical setting that you’re going to experience racism or stigma or bias,” she says.
For some, Bourassa says, that fear is enough for them to avoid seeking help.
READ MORE: New report highlights racism in health care
In Regina, that’s clear from the work the All Nations Hope Network does with the Indigenous community to tackle HIV and Hepatitis C. Bourassa was part of a team that interviewed more than 160 Indigenous women who had Hepatitis C or were HIV positive, and many were only just then getting care.
“Many of them had never been tested,” Bourassa says.
“They were afraid to go to the doctor, were afraid to be tested, afraid to go to the hospital.”
Fixing those relationships is crucial to addressing the disparity among health outcomes, she says, but it requires a “painstaking amount of time.”
Bourassa’s worry, shared by Lavallee, is that not enough is being done to critically evaluate programs, like cultural safety training, that are supposed to help.
“I don’t want to be critical of it. It’s very important and needed,” she says. “But how do the patients feel? Do Indigenous people feel that there are changes being made? Because I think that is absolutely vital.”
No charges were laid in connection with Sinclair’s death and the Winnipeg Regional Health Authority (WRHA) — under whose care Brian died — argued individual people shouldn’t face repercussions. An internal review concluded that it wouldn’t be fair.
“This was truly an exceptional occurrence,” the review found. “To hold individuals accountable on a disciplinary basis for such gaps in the system would be inappropriate and unfair.”
That emphasis on how “exceptional” Sinclair’s death was, is part of the problem, Indigenous health experts say. Racism doesn’t always present as a headline-grabbing death.
The WRHA acknowledges that now.
Krista Williams is now the authority’s chief health operations officer. At the time of Sinclair’s death, she was working as the First Nations and Inuit Health Branch’s director of nursing. She speaks about the “significant gaps in our system” that contributed to Sinclair’s death, but also about how hard racism can be for people to grasp.
WATCH FROM 2014: WRHA says, “He came to us seeking care and we failed him”
“What I’ve learned, and I believe we’ve all learned, is that a lot of people don’t really understand what racism is,” she says. “They don’t realize that it may be more subtle things like those biases, those perceptions, that they’ve developed over time.”
Dr. Catherine Cook, provincial lead for Indigenous health at the Manitoba’s Shared Health organization, echoes the Truth and Reconciliation Commission’s calls to action.
It’s important to recognize that this is not just an Indigenous issue, she says. “This is a Canadian issue and we all need to work together to address it.”
Achieving equity in care requires putting on an Indigenous lens, Cook says.
“It is critically important going into the future that we always remember Brian Sinclair and that we continue to make every effort that we can to improve equitable access to health care.”
The WRHA offers Manitoba Indigenous Cultural Safety Training and Indigenous Cultural Awareness Workshops.
The goal is to help people become aware of what moments in their past might inadvertently shape their interactions with Indigenous people who come to them seeking care, Williams says. “The focus of that is really to educate and ensure we’re providing the knowledge.”
The program is not mandatory. In response to an access to information request, the WRHA stated it “does not have the capacity or resources to determine how many staff have not completed training within a certain timeframe.”
So what the health authority can say is this: between November 2016, when cultural safety training was first offered, and July 20, 2018, 716 of approximately 28,000 employees took the training. The WRHA also couldn’t say how many complaints concerning racism have been levelled by or at providers this year. In a letter, the interim CEO Réal Cloutier wrote, “we do not compile or collect patient or employee complaints in aggregate form, related to alleged racism or discrimination.”
This is why Lavallee feels very little measurable progress has been made to address the role racism played in Sinclair’s death.
One start, McCallum says, could be to gather data.
If we tracked the time it takes for people of different backgrounds who are complaining of the same issue to be diagnosed and provided with care, she says, “we could compare and demonstrate if, when and how inequity works in the system.”
The Sinclair family is waiting.
Their lawsuit against the WRHA is ongoing. Although lower courts ruled Sinclair’s family couldn’t sue on his behalf because his charter and privacy rights died when he did, Manitoba’s highest court overturned that ruling in 2015.
His family wants now what they wanted when he died: for his death not to be in vain. Robert says he doesn’t remember what changes he thought would happen after Sinclair’s death, just that he thought there would be more of a focus on racism and persistent health inequities.
“I don’t know what I was looking for,” he says. He gets quiet for a moment, thinking.
“I don’t know what we could possibly do to change people’s minds and beliefs.”
— With files from The Canadian Press