First do no harm pp presentation for general use

“First do no harm…”An Indictment of the

Burntwood Regional Health Authority

The Hippocratic Oath

Physicians take an oath to care for their patients to their full ability, to treat them with respect and dignity, and treat them as whole persons

Although the words “First do no harm” are not actually in the oath, this is the well-known phrase that summarizes their promise

Universal healthcare in Canada We are fortunate in Canada to have universal healthcare Here, it is considered a right to have access to quality

healthcare The healthcare system promises "comprehensiveness,

universality, portability, public administration and accessibility”

There is also a promise in Treaty 6about provision of a “medicine chest”

Most First Nations consider this clause to be included as part of the verbal in Treaty 5

Healthcare in northern Manitoba Healthcare in northern Manitoba, particularly in the

BRHA region, does not reflect these Canadian medical ethics

The result has been terrible suffering and death for many First Nation peoples

In addition, over the past few years the region has not only abused patients, but employees and public funds

This presentation will summarize some personal stories of tragedy

It will also provide information on gross mismanagement by administration and top physicians in the region, leaving in their wake a trail of financial and human devastation

Wendy Saric Nisichawayasihk Cree Nation

Wendy is a 33-year-old single mother For three years, she went to the hospital and clinic

complaining of worsening breathing problems and pain

There were countless visits over that period, involving at least half a dozen BRHA physicians

She was repeatedly told that she had asthma, and given inhalers and antibiotics

No tests or x-rays were ordered over any of these visits

Wendy Saric (cont’d) She should have had x-ray and a “pulmonary function

test” (measuring the air passage to the lungs) to confirm asthma

When her problems continued to get worse, she should have had a “percussion” test (striking the tissues of the area being examined with the fingers or an instrument, listening for resulting sounds, and observing the response of the patient) – this would likely have shown the tumors.

Her breathing problems and general health continued to deteriorate

After three years of frustration, she asked for additional pain medication and a chest x-ray

The doctor accused her of being a “drug-seeker”

Wendy Saric (cont’d) She returned home in tears Her roommate was furious – she called the hospital -

they hung up on her three times When she finally got through, she threatened a lawsuit if

they did not perform some tests on Wendy Only then did they perform a chest x-ray She was diagnosed with advanced Non-Hodgkin's

Lymphoma, Type B Over the years of misdiagnosis, the cancer had already

spread to her pancreas, left ovary, and her eventually to her brain

She was given 6 months to live She is currently in litigation with the BRHA et al

Wendy Saric (cont’d)

The case generated a lot of publicity in the media as well as and Internet sites

Wendy’s cancer treatments, determination to live, and the support of her family and friends have helped her to overcome tremendous odds so far

However, the last year has been like a nightmare,

It was avoidable had she been given the most basic medical treatment when her symptoms started Wendy Saric with her mother, Sylvia,

caregiver and biggest supporter

Darryl Constant Opaskwayak Cree Nation

Darryl is 44 years old and has been HIV+ since 1991 He has been living in Vancouver, where there are

supports and resources for those living with HIV/AIDS In 2007, he became critically ill and ended up in a

coma for several days After he came out of the coma, he wanted to come

home to Thompson to be with family if he died Upon arrival, he was immediately admitted to

Thompson General Hospital

Darryl Constant (cont’d)

Instead of treating him at the Thompson hospital, he was placed in the isolation room on the pretext that he had TB

He waited there for three days, terminally sick and in terrible pain

Not one doctor came to see him in that time


His desperate family gave him body massage, and brought in traditional medicine men to help control his pain

In frustration, Darryl went intothe hallway looking for a doctor

He approached one physician, who looked at him with disgust and said “I am not your doctor…you shouldn’t have come here…we have nothing for you here”


Finally, one doctor came to talk to him and when Darryl asked for pain control, the doctor accused him of being a “drug seeker”

He would not order any tests to see what was making Darryl so ill

He left Darryl there in the isolation room, suffering and untreated except for basic (and ineffective) pain medication

In disgust, Darryl ripped out the IV and went to his sister’s home in Thompson

Darryl Constant (cont’d) In disbelief, his sister called the hospital and said

“something needs to be done here – he’s very sick” Only then, the hospital agreed to send him to

Winnipeg for tests The Health Sciences Centre

immediately gave him an echo-cardiogram (“echo”)

This showed that he had a heart infection, curable byantibiotics

Darryl could have died waiting in the isolation room at Thompson General Hospital, untreated

“Echocardiogram”


At the time, Gloria King was VP at the BRHA Ann Kaciulis, Darryl’s sister, called her and thanked

her for sending her brother to Winnipeg Her response was, “We do that for all patients” If that were true, why did we have to fight so hard to

get him the help he needed? And why are there so many other people starting to

voice their own stories of being improperly treated at the BRHA?

Ann Kaciulis Opaskwayak Cree Nation

Ann had several negative experiences with the BRHA healthcare system

She first went to the clinic to see a BRHA physician complaining of intense groin pain

The doctor acted as though he didn’t believe her and minimized the problem

He said it was probably a pulled muscle She did her own research, returned to the doctor,

and requested an ultrasound to diagnose her problem

Ann Kaciulis (cont’d)

She was diagnosed with a hernia, but he still did not believe she was in pain

Frustrated at being in pain, and this pain not being acknowledged, she needed to find someone who would listen

With her own money, she went to Winnipeg and Toronto to find out why she was in pain

Her Winnipeg doctor referred her to a surgeon, explained what the hernia was, and what might be causing the pain

Her excellent Winnipeg doctor has continued to work on the problem, keeping Ann informed and treating her with respect


Ann then started getting lesions on her legs It was difficult to diagnose, and again she took

herself to Winnipeg to get diagnosed The lesions were getting

larger and turning black Finally, a Winnipeg doctor

diagnosed her with an auto-immune disorder, “vasculitis”, which happens when the immune system attacks the blood vessels by mistake.

Ann Kaciulis’ leg lesions that could have led to amputation


Thompson then referred her to a dermatologist, but the wait would be 6 months or more

Ann knew that the problem could not wait that long Again, with her own money, she went to see a

dermatologist in Winnipeg and was finally treated The dermatologist told her that

if she had waited for the original appointment scheduled by the BRHA, she would “probably have lost both her legs to gangrene” Illustration of legs with

advanced gangrene

Ann Kaciulis (cont’d) On another occasion, Ann went to the ER at

Thompson General Hospital due to a cough that caused a lot of pain in her chest

Without tests or x-ray, she was diagnosed with bronchitis

She got cough medicine and an inhaler She went to seek a second opinion with another

doctor He ordered bloodwork and x-ray She did NOT have bronchitis, she had an infection

and required antibiotics If she had not sought a second opinion, the

infection could have led to pneumonia

Bertha Massan Shamattawa First Nation

Bertha complained of anemia and fatigue, which kept getting worse

The Thompson doctors should have ordered a stool analysis and a GI endoscopy (a tiny scope and camera that is inserted into the throat and goes down into the gastrointestinal system, like the stomach, to find the problem)

Several BRHA physicians examined Bertha, three of whom were specialists, who could have ordered some basic tests

Thompson also had a full-time surgeon at the time, who routinely performed endoscopies

This alone could have saved her life

Bertha Massan (cont’d)

In all her visits, and in her worsening condition, none of these obvious tests were ever ordered

They suspected (but did not know) that she had a bacterial infection, and gave her massive doses of antibiotics

One major effect of prolonged exposure to antibiotics is yeast infection – this is basic medical knowledge and something all doctors are taught in medical school

At no time did they conduct this simple test Bertha died on September 28, 2009 of a yeast

infection in her oesophagus


The Thompson doctors assumed that Bertha was an alcoholic and that the root of her problem was cirrhosis of the liver (no tests were performed to confirm this either)

At another point they thought she had TB, while missing the obvious symptoms and tests

Whether these assumptions were racially motivated is difficult to prove

We can only know that repeated lack of basic care caused her death

After she died, her husband Paddy was shocked and upset


He went to MKO and KTC for help in answering questions

KTC interviewed him, and then dropped the matter MKO didn’t even return his phone call By the time he got some attention from his

advocates, the statute of limitations for a lawsuit had expired

Mr. Massan plans a complaint to the College of Physicians and Surgeons, and will continue to draw attention to his wife’s unnecessary death in the media

“John Doe” Opaskwayak Cree Nation

In 2007, “John” went to the ER at Thompson General Hospital

He was very ill, and could barely walk into the examining room

No tests were performed He was given Tylenol 3’s and told to go home He returned several more times, each time

increasingly weaker and sicker Each time, he was sent home with T3’s even though

there was no attempt made at a diagnosis Shortly afterward, he died at home of sepsis

(poisoning of the blood from untreated infection)

“John Doe” (cont’d)

This could have been easily prevented with antibiotics If the hospital had done even a urine test, it would

have indicated infection and he could have been treated – his life would have been saved

“John” was an aboriginal man who lived in poverty, sometimes on the streets of Thompson

He wore shabby clothes Is it possible that medical staff just wrote him off as a

“drunk Indian” and tried to get him out of the ER as soon as possible?

What else could possibly explain why an obviously sick man would not receive the simplest tests to save his life?

Sharon McIvor Pimicikamak Cree Nation

On March 14, 2008, Sharon went to Thompson General Hospital with dizziness, vomiting, and rapid eye movements

She was unable to walk These symptoms normally indicate a brain disease No tests were ordered or performed She was diagnosed with an inner ear infection and

given anti-allergy medication, Gravol, and an inhaler for asthma

She went back a week later because she had not gotten any better

Sharon McIvor (cont’d) Her bouts of dizziness and her other symptoms got

worse She developed a feeling of being unbalanced, with

tingling on the left side of her body She kept returning to the hospital, even though her

symptoms were getting very serious they continued to tell her it was an inner ear infection (with no tests to confirm this)

Since the physicians at the hospital couldn’t diagnose her properly, she went to the local clinic

She was given the same diagnosis

Sharon McIvor (cont’d)

On August 8, 2008, she went deaf in her left ear She was finally referred to an Ear Nose and Throat

(ENT) specialist at the BRHA She waited 3 weeks to hear from the ENT She called the clinic, and found out they had not

even faxed out the referral yet She made the arrangements herself to have the

referral sent to the ENT The ENT performed a CT scan, which he said

“showed nothing” and guessed it might be the “nerves in her cheeks”


The ENT was very disrespectful to her, and rudely told her “she had boogers in her nose”

She answered “never mind my boogers, I can’t even wipe my own arse”

When her symptoms started, they would last 3-5 hours at a time

By the end of 2008, they would last 3-5 days She made another appointment on her own to see

the ENT because she was missing work and could barely walk

In February 2009, the ENT finally did bloodwork and sent her to see a specialist in Winnipeg


He suspected she might have Ménière's disease, a disorder of the inner ear that causes vertigo (lack of balance)

She was given medication for vertigo In the meantime, with her worsening symptoms, she

repeatedly sought the help of Thompson doctors They continued to prescribe anti-histamine, Gravol,

and inhalers The Winnipeg specialist ordered an MRI scheduled

for August 8, 2009 While she was waiting, in May 2009 she collapsed

at a local restaurant


She was brought by ambulance to the hospital, where she was again wrongly diagnosed as having “a bad bout of gallbladder”

By this time, she nearly lost her bowel function and was practically in a vegetative state

She and her family knew that this had nothing to do with her gallbladder, and were frustrated with the constant misdiagnoses

She left a message for Gloria King, CEO of the BRHA, to report what was going on and to request an emergency MRI

Ms. King never returned her call


Sharon was frightened and frustrated and becoming desperate

She spoke to a reporter and her story was publicized She received an angry phone call from a senior

physician/administrator at the BRHA, who tried to intimidate her and make her feel guilty for going public

He did not sympathize with her at all and only seemed concerned with the reputation of the BRHA

She tried to explain that because of her symptoms, she was having trouble understanding what he was saying


She went back to the clinic (again) to see a doctor visiting from Winnipeg

She tearfully begged him to listen to her She reported that she had been going to doctors for

a year, she couldn’t hear, had double vision, was numb on one side of her body, and kept collapsing

She requested that she be sent for an emergency MRI

The visiting doctor recognized the seriousness of her condition

He ordered an immediate MRI She finally went to St. Boniface Hospital in Winnipeg

for an MRI on June 10th, 2009

Sharon McIvor (cont’d) She was correctly diagnosed with Chiari I

Malformation (a brain disorder that leads to obstruction of brain fluid and paralysis)

She underwent several surgeries on her brain and spine, and had to have a shunt in her head to clear the way for the brain fluid

Her surgeon told her that if she had been diagnosed earlier, especially in the first 3 months, she would have had few complications

He also told her that at any point while she was being misdiagnosed repeatedly, she could have asphyxiated, had a heart attack, stroke, or gone into a coma because of the increasing pressure on her brain

Sharon McIvor (cont’d) When she returned home, the BRHA never provided

home care Because of the ongoing misdiagnosis and negligence

in Thompson, she is permanently disabled and continues to suffer pain, dizziness, double vision, tinnitus in her ear, and partial paralysis.

She has initiated various formal complaints and is considering a lawsuit against the BRHA

Overall, she was misdiagnosed 23 times over a period of 18 months

Diagram illustrating the brain fluid blockage (where

the shunt is inserted)

Marilyn Lagimodiere Pimicikamak Cree Nation

Marilyn was diagnosed with rheumatoid arthritis 29 years ago

She was never told that her hips would degenerate and start “locking up”

She needed help rising from a sitting position because her hips were so stiff and painful

Although she is employed, it is difficult to enjoy family and work life when there is chronic and intense pain

She experienced increasing pain and stiffness in her hips, and in February 2006 started attending the clinic in Thompson

Marilyn Lagimodiere (cont’d)

She had been on Celebrex for years, but it was not helping her pain

Her doctor took her off the Celebrex, saying she had been on it too long, and prescribed extra strength Tylenol

This did not help and the pain and locking up increasingly unbearable

Around this time, her doctor informed her that she also had osteoarthritis

It had been in her file but nobody had informed her Doctors tried various medications but none were

effective


She was consistently told that she was too young for hip surgery, even though was becoming increasingly disabled

She got attacks in her hips that lasted from 2 to 5 hours

When this occurs, she could not walk or stand, and was in tears from the pain

On one occasion, she was stuck sitting in a lawn chair for 5 hours because she could not get up until her hips unlocked

She had to be carried inside, still in the lawn chair, when it started to rain


Marilyn became concerned about the medical treatment she was receiving from the Burntwood Regional Health Authority and felt she had to seek a second opinion

The treatment plans she received were completely ineffective

She did not trust the doctors at the BRHA because they neglected to inform her that she had osteoarthritis for so many years

She requested a referral to the a specialist at the Pan Am Clinic in Winnipeg

The request was refused


Marilyn decided to attend the PanAm Clinic in Winnipeg on her own expense on December 7, 2009

She had an appointment right away and was seen at 11:00 a.m. that morning

They ordered x-rays and was told that her right hip was in very bad shape as there was no cartilage left

All that could be done for her was hip replacement surgery Pan Am Clinic in Winnipeg, Manitoba

Marilyn Lagimodiere (cont’d) She was finally scheduled for surgery on June 14,

2010 in Winnipeg All the medical trips to and from Winnipeg were paid

for out of her own pocket - this included hotel, meals, and mileage for herself and her escort

A letter was written to the BRHA requesting help, and they did agree to pay for one trip for surgery

If Marilyn had been told that she had osteoarthritis, and had received proper information about hip surgery years earlier, the problem would have been far less serious

However, like in so many other cases, negligence, misinformation, and misdiagnosis has claimed yet another victim


Marilyn is fortunate that she finally received treatment (in Winnipeg)

If she had not had the funds to travel, however, she would have continued to suffer at the hands of an incompetent health care system in the north

She would still be disabled and living in agony How many other people are in this position but lack

the funds to take matters into their own hands? This is the job of our medical professionals Too many people are having to travel to other

locations at their own expense to receive appropriate medical treatment

“Jane Doe” * Northern Manitoba First Nation “Jane” is 24 years old, and at the time of this incident had

just given birth to a baby On November 9, 2010 she went to the clinic in Thompson

to get a wart removed from her foot Nobody told her how to treat the wound after surgery, or

to watch for infection That night a painful purple lump formed, but she thought

this might be normal The next night the lump was noticeably bigger and more

painful She went to the ER at Thompson General Hospital at

midnight November 11, 2010* This story is based on hearsay and is our understanding of what occurred

“Jane Doe” (cont’d)

In two days, the infection had spread from her foot all the way up to her knee

She was told she would need intravenous antibiotics, as this was a serious infection

She told them that she was nursing, and wanted to make sure that whatever she was taking would be safe for her baby

She received one IV antibiotic dose that night, and was told to return for two more rounds

“Jane Doe” (cont’d) She returned that evening for her next dose, which went

fine The nurse told her to come back anytime after noon the

next day for her last dose The doctor would examine her foot and then decide if

she needed more doses of antibiotic. When she went in for her final dose on November 12th,

the nurse told her that she had mistakenly given her someone else’s medication!

Even more traumatic was the fact that she was given medication for patients with HIV/AIDS

She had to stop nursing “cold turkey” because of the risk to the baby, and this has negatively affected both mother and baby

“Jane Doe” (cont’d) She had to take powerful medication as a precaution,

and she felt nauseous, fatigued, and had constant diarrhea

Everything she eats goes right through her She works as a lifeguard, and people with flu-like

symptoms are not allowed in the pool She has lost wages because of this, as well as the joy

of life and new motherhood

She is concerned her job might even be in jeopardy because she has to keeptelling her boss that she can’t go in the water

“Jane Doe” (cont’d)

This mistake has cost Jane a great deal, physically, mentally, emotionally and financially

It could so easily have been avoided if she had been given proper instructions after surgery, and if proper checks and balances were used on the ward to ensure that patients receive the proper medication

The implications of such a mistake are enormous –it could have so easily been fatal

She could have been allergic to the medication she as given in error, and this could have caused death

Jane is very angry and no longer trusts the BRHA

“Jane Doe” (cont’d) After this incident, Marion Ellis attempted to contact “Jane”

by phone, but “Jane” would not take her call “Jane” then received an email from Marion’s daughter, a

BRHA nurse, asking her not to contact a certain journalist who had been criticizing the BRHA

Again, the prime concern of the BRHA is not patient care, but damage control to their reputation

This is an example of the lengths they will go to protect themselves

This is not the first patient they have attempted to intimidate into remaining silent

This begs the question – how many more patients ARE remaining silent out of fear that if they speak out they will receive no care at all?

Joan Saunders York Factory First Nation

In December 2008, Joan became ill and was medivac’d to Thompson General Hospital

She was not told she had a heart attack or given any information about her condition

She was put on oxygen She was dizzy, unable to sleep, and very

uncomfortable She was not even provided with a facecloth so she

could give herself a sponge bath She tried asking for attention but the staff said they

were too busy - she felt frightened and ignored

Joan Saunders (cont’d) A day after admission, she told a nurse she had not

passed water for over 10 hours, but the nurse ignored her

She kept getting weaker, and reported that her legs were getting swollen

Again, she was ignored by nurses and doctors, and nobody from Aboriginal Services came to see her

Her family was not told how sick she was Another patient was admitted at the same time as

Joan, and witnessed her shabby treatment by staff Finally, staff realized that she was experiencing

kidney failure, but nobody told her what was going on

Joan Saunders (cont’d)

She was put on a catheter and told she was going to Winnipeg

Nobody offered to pack her bags, and in her condition she had to find some orderlies to help her

It was only before she left for Winnipeg that a doctor finally came to see her and let her know what was happening to her

She left for Winnipeg at 1:00 a.m. with no escort The plane was cold, and the pilot had to restart the

plane several times before the heat came on She waited 2 hours alone at the Winnipeg airport for

the ambulance to take her to HSC


Her family had not even been notified that she was being transferred to Winnipeg – her husband was very upset by this

Once she arrived at HSC, she was immediately put on dialysis as her kidneys had already been shut down for three days

She was treated very well in Winnipeg, and stayed for three weeks (right over Christmas 2009)

She was so ill she was prescribed 9 medications, and the doctor carefully explained the purpose of each one and showed her how to give herself insulin shots

Joan Saunders (cont’d) Joan was scheduled for an angiogram and

angioplasty (heart surgery to prevent heart attack) Her Winnipeg doctor also provided a letter stating

that she needed an escort for all medical travel, and that she needed to travel by air due to her serious health condition

However, she continued to experience problems with her medical travel, and FNIH were sending her to and from Winnipeg by bus rather than by plane


When Joan returned home to York Landing, there was a letter from Thompson General Hospital that she needed to come in for a colonoscopy

She informed the nurse that she had just returned from Winnipeg and was too sick to travel right away

The nurse insisted that she come anyway She was told to fast prior to her appointment, so she

could only have jelly and broth Since Joan had diabetes, this was very damaging to

her blood sugar – she was supposed to eat regularly The plane taking her to Thompson was 5 hours late She could have gone into a diabetic coma while

waiting


She had been told to pick up a prescription and drink 4 litres of water before coming to the hospital in Thompson

She stopped at Wal-Mart pharmacy The pharmacist told her this prescription, that

included very high potassium, could cause a fatal heart attack

She didn’t know what to do, and was very lightheaded and sick – likely her blood sugar was high from lack of food


She tried to reschedule her appointment until she was feeling stronger but the hospital refused

She went to the appointment at the hospital and advised that she had not taken the prescription

The nurse insisted she have the procedure done anyway

She waited an hour for the doctor This doctor seemed unaware that she had a history

of heart attack and renal failure She tried to explain why she had not taken the

medication and was uncomfortable taking the test The reaction of the doctor was shocking

Joan Saunders (cont’d) Instead of sympathizing and listening to her, he

acted angry with her He and a panel of medical staff began to

question her, rudely and loudly, in front of other patients in the room

The doctor told her it was criminal how she wasted money from the system, and how much it cost to bring herfrom York Landing to Thompson

He did not even consider that the fast and potassium he prescribed could have killed her

Joan Saunders (cont’d) The doctor said he was going to write a letter of

complaint to the Charge Nurse in York Landing about her refusal to take the test

She was humiliated – it reminded her of her treatment at residential school

After many traumatic experiences at Thompson General Hospital, she refused to return

She decided to wait for her heart surgery at home At home, at least she was treated with dignity and

respect Her husband discovered her dead body on June 14,

2009 She had died of a heart attack; another tragic statistic of

the BRHA’s lack of care

Baby Girl McLeod Pimicikamak Cree Nation Baby Girl McLeod was frequently getting sick with

fever Her parents kept taking her to the clinic and hospital

in Thompson The hospital did not test or treat the child By the time they diagnosed the infection, there

had already been a lot of medical damage The child had to be on antibiotics for 6 months, and

has to have her kidneys checked on a regular basis to ensure that they are functioning

She was one of the lucky ones – there was no permanent damage

Baby Boy Beardy Pimicikamak Cree Nation

Baby Beardy was three years old at the time of this incident

He had been suffering from developmental delay and seizures

His parents took him to the Thompson General Hospital for help to control the seizures

Thompson was unable to help, yet refused to send him to a Winnipeg specialist

The parents kept asking why their son was being kept in the hospital when he could not be helped here

Baby Boy Beardy (cont’d)

The BRHA finally agreed to send him to Winnipeg, after putting the child and parents through a traumatic time

They felt that the hospital and the ambulance drivers looked down on them, and kept referring to them as “dirty”

Their perception was that they were being blamed for the child’s seizures, and this is why they would not help them

The seizures were damaging to the baby’s brain, and should have been dealt with immediately

Once the child was sent to Winnipeg, a plan was put in place to control the seizures and help the family

Meeting between MKO and BRHAre: patient complaints In approximately April 2009, the MKO Grand Chief

initiated a meeting with the BRHA to discuss complaints by MKO members about the standard of care they had received

In attendance were past MKO Grand Chief Sidney Garrioch, Roba McLeod, and Ann Kaciulis from MKO, and Gloria King, Marion Ellis, and Rusty Beardy from the BRHA

Meeting between MKO and BRHAre: patient complaints At the meeting, the cases of Joan Saunders, Baby

Girl McLeod, Baby Boy Beardy, and an MKO Chief’s son were discussed in detail

MKO technicians mentioned that there were more complaints of a similar nature

The BRHA promised to look into the matter and report back to MKO

MKO was supposed to follow up with another meeting to ensure compliance with that promise

Meeting between MKO and BRHAre: patient complaints That meeting never occurred, and the matter was

dropped Joan Saunders died shortly afterward, never seeing

justice done during her lifetime This shows that the BRHA was aware of the

complaints and chose to do nothing Since that time, more complaints have become

public There has been no attempt by MKO or other First

Nation organizations to make the BRHA accountable for their treatment of our people

Abuse of public funds* Overpaying for surgeons: The BRHA drove out their last surgeon

last year This has deprived all northern citizens of the last competent

surgeon in the region It also will cost an additional $750,000.00 in extra locum

costs (the cost of flying in surgeons) per year It would inconvenience countless patients who must now use

public monies to travel to and from Winnipeg with escorts It could take years to replace this

surgeon, as it is difficult to attract and retain highly skilled practitioners in this region

* Information in next sections based on article by Guisti, H. in Grassroots News, January 19, 2010 “BRHA must Walk the Talk”, (18 & 23) & February 16, 2010, “Incompetent Northern Hands” (17)

Abuse of public funds

Administration costs spike by millions: BRHA administration costs jumped nearly 400% in

2003-2004 to 2007-2008 Costs jumped from $1,558,000.00 to nearly

$6,000,000.00 - an increase of $4,442,000.00 This was the highest administration costs, per budget,

of all regional health authorities in Manitoba This issue was touched on by Tom Brodbeck, journalist

from the Winnipeg Sun, in his blog The issue was further raised by the Opposition in the

legislature June 2 (hansard transcriptions can be provided)

Abuse of public funds Northern Patient Transportation Program: The enormous $7,200,000.00 NPTP program may be

in need of an exhaustive 10 year audit The Liberal Party of Manitoba put out a press release

February 11, 2009 (available by request) In spite of this massive

spending, patients in the north are still fighting to get appropriate transpor-tation to and from medical appointments

If the BRHA was able to provide better care, transpor-tation costs would be lower


Shortage of ER physicians: Dr. Nizar Joundi, the backbone of the ER, suddenly

left his employment at the BRHA Why did he leave? Dr. Botha left afterwards so Dr Eiman had to replace

Dr. Small in Gillam It cost the tax payers $3,668,000.00 in locum costs

(costs of transporting medical personnel on a temporary basis) to cover the ER shortage in 2008-2009

This was up from $1,450,000.00 in 2006-2007 This is an increase of $2,218,000.00 in only 2 years

Abuse of public funds Anaesthesiologist failure costs over a $million: When the BRHA anaesthesiologist left, it cost the tax

payers an additional $1,000,000.00 in locum costs (cost of bringing in anaesthesiologists for surgeries taking place in the BRHA region)

It took 2.7 years to replace the anaesthesiologist. Journalist Paul Therrien noted in the Winnipeg Free

Press that he should have been replaced in spring (“early next year”) of 2009

He was not replaced until months later in fall 2009 The BRHA has a consistent record of not replacing

critical medical personnel The administration is extremely sloppy, and is sending

costs soaring


Wasting a half million dollars? The BRHA hired a third obstetrician when there

clearly was a glut of obstetric services in Thompson Eight months after hiring Dr. Hussam Azzam, they

kept hiring a non-BRHA, fee-for-service physician, Dr. Kania

Dr. Kania performed 71% of the BRHA’s births while the three salaried BRHA obstetricians COMBINED only handled 29% of the births

Abuse of public funds An across-the-board fair comparison gives Dr. Kania

5.7 births for every 1 birth by a BRHA obstetrician Every time a non-salaried physician had to come in

for births, it was at enormous cost to the region They didn’t need the third obstetrician they hired –

two of them could easily have handled the workload Instead, they hire an extra physician, and STILL

hired outside help to do most of the births! Why are the salaried obstetricians not doing their

jobs? Why are they over-hiring salaried physicians, and

then still hiring expensive outside physicians to do their work?

Abuse of public funds Huge jump in nursing locum costs: Under this administration, nursing locum costs jumped

from $640,751.00 in 2005 (just over half a million $) to $3,715,000.00 (almost $4 million) in 2008

This is an increase of approximately $3 million, or 579%

Our nurses are leaving the BRHA in huge numbers…why is that?

They are not being replaced Is this because the BRHA is unable

to attract nurses to the region? Or are they not even trying to

replace them?

Abuse of public funds Failure to commit pediatrician? 15,000 Aboriginal children were deprived of a regular

pediatrician when Dr. Barodia bolted after only 6 months on the job

It also cost the tax payer’s around a million dollars in added locum costs to replace him over the past year

Dr. Barodia claimed to his colleagues that the BRHA never committed him to a 2 year contract

His assessment took 6 months and around $80,000.00

The Opposition raised this issue in the legislature last April

Abuse of public funds Overpaid senior administration: In spite of a shocking lack of competence, VP

Marion Ellis and CEO Gloria King made more money than the Minister of Health, Theresa Oswald

Gloria KingCEO, BRHA

Marion EllisVP, BRHA

Theresa OswaldMinister of Health

Abuse of BRHA employees

Wrongful terminations: A senior physician/executive administrator was seen

in the company of a young woman, not his wife This was witnessed by the executive assistant of VP

Medicine Dr. Hussam Azzam She texted the assistant to the VP Aboriginal Affairs,

asking if she knew what was going on Administration found out about the text and fired

them both, moments apart They were fired for simply inquiring about the

conduct of a senior official at the BRHA


Fear of accountability: A journalist from Grassroots News officially

questioned the BRHA about firing the two secretaries

He sent it to the official work e-mail of Dr. Azzam Dr. Azzam threatened him with a lawsuit simply

because he was asked about this Dr. Azzam’s reply was highly unprofessional, and

bordered on criminal “uttering threats”


Here is the email, exactly as the journalist received it:Your reply reflect your level,culture and personality! So not surprising at all!! You should be worried and careful .As you now that you will not afford crossing the “professional” line although I know that you never been professional!!...So you should be scared!! You have been walking on a very thin ice lately and I really wish and hope you cross the line! Please do!”

The content and aggressive tone are shocking, coming from a senior physician and executive administrator

Even the spelling and vocabulary are poor, as if written by a very young person

It begs the question as to the maturity and character of the people running the show at the BRHA


Defamation of Dr. Sardiwalla: Dr. Sardiwalla was the senior surgeon in the BRHA

for 7 years He had constant intense arguments with senior

management after this administration was in place There was an issue with the renewal of his medical

license, and the BRHA did not help in spite of his many years of service

He finally left and started practicing on the east coast, where he enjoyed his work and was doing well

A critical article about the BRHA appeared in the news, and BRHA senior management started to harass Dr. Sardiwalla to “rebut” the allegations


Defamation of Dr. Sardiwalla: He could not do this in good conscience because

the allegations were true He consistently ignored their requests The final request was a phone

call by Dr. Tassi, strongly “urging” him to write the rebuttal

He still refused, so Dr. Tassi threatened him

He told him that if he didn’t send in the rebuttal he "will never be able to work in the BRHA as locum or full time ever again."


Defamation of Dr. Sardiwalla: Dr. Sardiwalla still refused to give in to their

coercion, so they contacted his current employer and slandered him

After all his years in the BRHA, he said the current administration was the “worst”

This seems to be the way senior management operates – if physicians are not complicit in the cover-ups, they are “blackballed”


Harassing whistleblower? Dr. Adil Ibrahim, who worked as a physician at the

BRHA, claims he handed management a lengthy “40-point,15-page document on cases of BRHA mismanagement and excesses.”

As a result, “…they harassed, humiliated and intimidated me till I was forced to resign.”

He now works in Pine Falls where he says “I had morerespect in one and a half months here than at 3 years at the BRHA.”


Failure to retain physicians: Under this administration nearly 40% of the full-time

physicians handed in their resignations in 13 months VP Paul Therrien noted in the Winnipeg Free Press

on November 16, 2010 “we know we are going to lose four or five people in the course of the year”

They lost 12 or 240-300% more Many of the physicians who bolted over the past 3

years fled because of conflict with or failure of management

This was raised by the Opposition in the legislature on April 16, 2010

Ineffective management

Mental Health Failure: In the first 9 months of 2009, nearly half of the

mental health team in Thompson resigned, went on leave or were looking for work elsewhere

Some were extremely disgruntled and disappointed with management and demanded to meet with Gloria King

In clear violation of her announced “Open Door Policy”, she refused and referred them back to the two managers about whom they had complaints!

The Opposition raised it in the legislature during Mental Health Awareness Week on October 5, 2010


Conflict of interest: Dr. Hussam Azzam is not only VP Medicine, but is also

Chief of Staff Two positions that account to each other should typically

NOT be held by the same individual In addition, he was also at one time Acting Head of

Family Physicians His sister Dr. Lina Azzam is head of Surgical Services This much power concentrated in one person can explain

why irrational decisions are made, and there are no checks and balances

Ineffective management Deteriorating maternal outcomes: From 2004 to 2008 in the BRHA, still-births, newborn

deaths, and the number of newborns readmitted to hospital doubled

More mothers had to be readmitted due to compli-cations than any other RHA outside Winnipeg

The Opposition raised it in the legislature and issued 2 press releases on the subject

They also sent a “Letter to the Editor” of Thompson Citizen and Grassroots News


Spike in nursing vacancies: Under this administration

(from 2006 – 2009) the number of nursing vacancies has gone up 250% - from 12 to 30


Lack of concern for Aboriginal representation: In spite of the fact that the

BRHA serves mostly Aboriginal people, they are very casual about whether or not they have an Aboriginal person on the Senior Executive Council

In other words, no aboriginal people are then involved in decision making for their own region


Lack of concern for Aboriginal representation: There was a 500-day gap where there was no

Aboriginal person on the Council The BRHA excuse was that they needed that much

time to find a suitable candidate This is clearly not true, since there are many

qualified Aboriginal people in the north, and they only posted the position 2.5 months before they hired Rusty Beardy

A journalist from Grassroots News wrote and op-ed piece about this and was interviewed by CBC radio on this subject


Failure to recruit physicians: The BRHA had 34 full-time physician on their payroll

in March 2008 Ten months later they had only

23, including new recruits This is a 12 month net loss

of 39%, which includes all new recruits


Patient complaints: Over the four fiscal

years 2003-2008, the number of patient complaints shot up 237%


The few physicians employed by the BRHA are not culturally appropriate

There is not one Aboriginal physician in the BRHA Most of them are brought in from other countries,

where none speak the traditional languages and do not understand First Nation culture

Sometimes there is a language barrier where patients find it difficult to understand the physician

There is no cultural training for medical professionals working in the north

This often results in poor communication and understanding between physician and patient

Public Health: What is it?

Public health relates to contagious diseases that can become epidemics

For example, TB was eradicated in Europe in the late 1800's not through medication but by improvement in social conditions

This includes vaccinations, sanitation, clean water, water fluoridation, garbage collection, healthy lifestyle (good nutrition, hand-washing, exercise, healthy housing, addictions treatment, recreation), etc

It also includes public prevention measures, and quick and adequate response to outbreaks

Public health: Third world vs. wealthy nations Diseases generally fall into two categories These are those that affect:

Third world countries Wealthy nations

For example, tuberculosis, malaria and brucellosis (chronic flu) are diseases of the poor nations

Colon cancer and cardio-vascular diseases (heart attacks) are generally considered diseases of the developed countries

Public Health: Critical to life

In the West, since 1920, life expectancy has shot up by 30 years

This is due mainly to mainly to improved public health

This is far more important than advances in medical treatment to decrease disease and improve life expectancy

Public Health: Third world conditions in the north Whenever Third World diseases strike some parts of

the developed world, it is usually because of a failure of public health

Northern First Nation reserves rate very poorly on public health

Healthy food is expensive, poor sanitation systems, mould in houses, overcrowding, and many others

This makes the north vulnerable to outbreaks that do not affect the rest of Canada

There has been an alarming outbreak of several 'Third World' diseases northern Manitoba over the past two years

Public Health: Vaccinations

Obviously, not all aspects of public health can be fixed by the health care system

But the health authority has an enormous role to play in these outbreaks

One of these responsibilities is vaccinations For example, provincial health officials confirmed

there's been a recent upswing in the number of reported cases of pertussis (whooping cough) in 2010

All children in Manitoba are supposed to be vaccinated, so this is a failure of the BRHA to protect its citizens

Public Health: MRSA

There has also been an outbreak of the super-bug Methicillin-Resistant Staphylococcus Aureus (MRSA)

This is a serious infection people usually get from hospitalsIn 2008, Canadian Public Health Agency (CPHA) reported that MRSA rates in remote First Nation reserves in Manitoba were “30 times higher than the Canadian average.”

The CPHA stated that 1,000 positive test results were reported from Aug. 1, 2009 to March 31, 2010.

Public Health: An Elder’s story In 2006, a dignified, traditional Elder in Thompson

General Hospital became seriously ill with infection The hospital refused to provide him with antibiotics

(reason unknown) His wife was worried, and by his

side all the time Two advocates found out

what was going on and wrote letters to Gloria King demanding that the Elder receive antibiotics

Public Health: An Elder’s story Instead of immediately providing antibiotics for this

suffering man, the hospital told his devoted wife that she had infected him

The advocates found her in tears the next day, thinking she had made her husbandsick

It turned out to be MRSA, which he would have gotten from the hospital

They finally agreed to give him antibiotics, but only after there was a threat to publicize the matter

Public Health: TB

The situation with TB is even worse The latest provincial disease statistics reveal

Manitoba recorded 156 TB cases in 2009 -- the highest number recorded in a single year since the late 1970s

In the past four years TB cases have jumped by 50 per cent, leaving Manitoba with higher rates of the disease than any other province

A recent Winnipeg Free Press series revealed some Manitoba First Nations have recorded some of the highest rates of TB in the world since the mid-1970s

Public Health: TB

Some northern Manitoba communities have recorded more than 600 cases of TB per 100,000

By comparison, Canada's national rate is five cases per 100,000

This means that these northern communities have 120 times the national average rates of TB

Who would have thought we would have an outbreak of TB in this day and age?

Public Health: H1N1 – Response of MKO and KTC The response of MKO and KTC to the impending

outbreak of H1N1 was immediate, efficient and thorough

Staff were sent to Winnipeg for a week to train on how to handle a pandemic

Trained staff were then sent to all the MKO communities to take stock of what was available on reserve, what was needed, and to train health professionals and the public on prevention and containment

Each community then hired a pandemic coordinator The BRHA was not involved in this process

Public Health: H1N1 flu

Most people remember theH1N1 pandemicthat hit Burntwood last year with an incidence rate of 900% the provincial average

Public Health: Flesh-eating disease From 2005-2007 there was an outbreak of

Necrotizing Fasciitis, known as “flesh-eating disease”

With death possibly striking in less than 24 hours, it is the fastest known killer on this planet

The incidence rate in Burntwood in 2006 was 16,500% the national average

The BRHA covered it up until it was exposed by a Grassroots News reporter

Public Health: Who is responsible? Some responsibility lies with each individual, to

make healthy choices (nutritious diet, exercise, hand washing, etc.)

The federal government, together with First Nation leadership, are working on improving the living conditions in the north

However, the responsibility of public health in the reserves lies mainly with Health Canada

The regional health authorities, including the BRHA, have the front-line responsibility

Public Health: Responsibility of BRHA Under the Manitoba Public Health Act, the BRHA is

mandated to do three things with these kinds of diseases: Investigate Control Protect the public

This means admitting an outbreak exists and undertaking an aggressive public health awareness campaign

The BRHA has a miserable record on handling pandemics, which is allowing the problem to continue

Instead of dealing with the problem head-on, they have stayed silent

Sexual abuse of patient

There has been at least one confirmed complaint of sexual molestation of an attractive female patient

This patient accused a senior physician/executive administrator of unnecessarily pulling down her gown without her permission

She was traumatized by the incident and made a formal complaint to the College of Physicians and Surgeons

The outcome of the case is not yet known

Conflict of interest?

Does the BRHA provide MKO or any other First Nation organization with program monies?

Are there programs which are funded in partnership between MKO and the BRHA?

It seems strange that our leaders would allow these serious allegations to be pushed under the rug

It is the role of our elected leaders and First Nation organizations to speak up on behalf of our people

If they do not do this because there is financial dependency, this would be a conflict of interest

Media attention People have been becoming more vocal about

mistreatment in the northern Manitoba healthcare system

Many articles have been published over the past few years criticizing their operations and treatment of patients

Wendy Saric’s story garnered international attention

One critical journalist was barred for life from BRHA meetings

A “high-ranking BRHA official”attempted to blackmail this same journalist from publicly criticizing the BRHA

Media attention

There are now numerous websites about the critical state of healthcare in northern Manitoba

Many of these sites have attracted global attention, including people from Australia, United States, and even Africa

There have been worldwide offers to help in any way they can

Some of these sites include:

Political criticism On August 17th, Dr. Jon Gerrard, Liberal Party Leader

of Manitoba, wrote a sharply worded article in Grassroots News about how the BRHA is trying to control the negative publicity

He stated:“The BRHA is trying to silence thecritics of its poor performance andin doing so is trying to convince youthat the level of health care you are receiving is excellent”.

He stated that barring a journalist frommeetings only confirms that they have something to hide

A light in the darkness….

The BRHA has had an enormous accomplishment with Northern Spirit Manor, the new 35-bed personal care home

The home is a benchmark and should be used as an example for other personal care homes

The design of the building is lovely…the seniors have big windows in their rooms, some with a view

The programs are run smoothly, and staff bring a positive atmosphere that is immediately noticeable

This positivity transfers to the seniors themselves, who seem happy and at home

If the rest of the BRHA were run like this, we would have an excellent standard of care in this region

Debates in the provincial Legislature The northern healthcare crisis and the actions of the

BRHA have been brought up numerous times in the provincial legislature

Ample evidence has been brought forward that the BRHA in particular is mismanaging healthcare and neglecting and abusing patients

In spite of this, no action has been taken by the Province

With some notable exceptions, our own leaders have mostlybeen silent

Support from our leadership

Former Chief Jim Moore of the Nisichawayasihk Cree Nation publicly demanded to know why the BRHA is failing First Nations in their delivery of healthcare

He stated:“There have been many reports lately by First Nation members about the incompetence and negligence of the BRHA and instead of taking responsibility for the state of health delivery in the BRHA region, senior management seems to be attempting to sweep the mess under the carpet and continue with the status quo”

Other First Nation leadership support There are some other First Nation leaders who

recognize the seriousness of this problem Chief Michael Constant of OCN is supportive of

efforts to clean up the mess at the BRHA and make them accountable for their treatment of patients

Chief Garrison Settee of PCN stated to Ann Kaciulis:“We will be bringing up the issues you have been talking about at the MKO Health Conference in March [2011]”

Chief Jeffrey Napoakesik of Shamattawa told Paddy Massan that he “supports him 100%” with regard to getting answers about the death of his wife, Bertha

Other First Nation Leadership Support Current Chief Primrose of NCN has been very

supportive of Wendy Saric There are likely many other MKO chiefs who have

been unaware of the extent of the problems at the BRHA

If they had been aware, they would likely have taken action on the issue

The BRHA has been trying very hard to cover up their mistakes, so it is not surprising that their efforts have been successful to some degree

Damage control

On November 24, 2010, the BRHA praised their own performance at their Annual General Meeting

A follow-up article was published in the Nickel Belt News on December 3rd with the headline “BRHA claims to have made strides”

In attendance were an MKO Chief and past Chair of the BRHA board (who spoke on behalf of the MKO Grand Chief), and the KTC Grand Chief, praising the performance of the BRHA

Why would our leaders support an institution that is consistently hurting our people?

Why has nothing been done?

The issues at the BRHA have been published extensively in newspapers and other media

There have been lawsuits and letters of complaint to the Minister of Health

Issues have been raised in the Manitoba legislature How is it possible that nothing has been done about

it? Why is the Minister of Health and the Manitoba

Premier allowing this to continue? If Manitoba First Nation leaders get together on this,

ACTION WILL BE TAKEN It is our money that’s being wasted…our citizens

at risk…our people who are suffering.

Call for public Inquiry

In the February 16, 2010 issue of Grassroots News, Southern Chiefs Organization called for a “Public Inquiry into Aboriginal Health”

This would be equivalent to the Aboriginal Justice Inquiry

The article mentioned tragedies that occurred in southern Manitoba

The problem in northern Manitoba is magnified many times, and the care northern patients receive is grossly inferior to that of the rest of the province

An Inquiry would publicly expose the issues and force change

MKO Resolution

A special “thank you”…

We would like to express our thanks to Dr. Hussain Guisti, physician, journalist and activist

Without his courageous determination to uncover corruption in the northern healthcare system, and exhaustive research, many of these issues would have been swept under the rug

All northern medical patients owe a debt to him for advocating tirelessly on their behalf

Wendy’s Dreams and TearsHot, scalding, burning down my cheeks....Looking at my children...., it makes me weep.

So many questions, the tears blind me......Crying for the grandchildren, I may only see...from the spirit world…crying for me.

My mother, my father...I watch them weep.Helpless, powerless...I can’t sleep.

My sister’s arms, I feel around me...Hot tears, falling, falling, falling...forever falling.My strength, my rock…it rips her heart…Fearing I may soon depart.

My brothers, how I love you...I feel your pain, I want to hug you,

And hug you and hug you.What can I do? What can I do?I want to live, I pray each day...“Why did they not help me?” I pray…and pray.

They took an oath...on the bible they swore.“First do no harm” was their rallying call.“Why did they neglect me? THEY caused me to fall!”

There is only one thing I want right now...I WANT TO LIVE AND I VOW...To fight this monster and the ones who harmed me.I have the Creator all around me.

I won’t go with just a whimper...I have my family, my friendsand the faith to know...there are plans for me...so I won’t go.

~Written for Wendy Saric

by Ann Kaciulis and Karen Chevillard

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