Doctors spread thin in remote Ontario communities, inquest for First Nation woman told

The inquest for Ruthann Quequish from Kingfisher Lake First Nation in northwestern Ontario has shed light on health-care challenges in remote communities, and as it wraps up, her community's chief says it's clear to him that the "second-tier" health-care system failed the 31-year-old.

Quequish died of ketoacidosis, a complication of diabetes, at her home in the Oji-Cree community in northwestern Ontario in April 2017. She had visited Kingfisher's nursing station multiple times in the days leading up to her death.

Since the start of the inquest in Thunder Bay in late July, a five-person jury has heard from more than a dozen witnesses. 

"Medical professionals at the inquest have described that the health-care system in Kingfisher Lake and other First Nations communities in our area is second tier," said Kingfisher's Chief Eddie Mamakwa in an emailed statement to CBC News.

"The second-tier system is one which our community members experience every day. It is the system which failed Ruthann Quequish and her family," he said. "Health care is a treaty right and our people deserve health care that meets our needs."

The jury is expected to hear closing submissions from the parties with standing in the proceedings on Thursday before being tasked with answering five questions: identifying who died, when and where they died, their medical cause of death and by what means they died (classified as either natural causes, accident, homicide, suicide or undetermined).

Jurors then have the option to make recommendations on how to prevent future, similar deaths. 

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

"We've heard from a number of very interesting witnesses who I think have provided a clear and nuanced picture of the delivery of health-care services in remote northern Ontario First Nations communities," Leach said in an interview with CBC News.

"We have a very engaged jury who's clearly listening attentively and have been asking some excellent questions." 

Dr. Usne Josiah Butt, a remote and rural locum physician, primarily serves Sandy Lake First Nation's nursing station. He was called as a witness because he interpreted Quequish's lab results.

Physician services for northern communities in the region are flowed through Sioux Lookout Regional Physicians' Services Inc., which was formed in 2010.

Many nursing stations are operated by Indigenous Services Canada, but Kingfisher Lake runs its own nursing station. While a physician travels to the community five days a month, Butt said two of those days are largely taken up by travel, which means they're essentially "trying to see a month's worth of patients in three days."

Recruiting and retaining physicians has become harder, impacting the continuity of care. Butt said physicians serving the north haven't had a new contract with the province since 2010. While their workload has increased, "the financial compensation has not remained competitive."