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Esther Joyce Grant, Brian Sinclair's sister, was first at the inquest to raise the issue of racism playing a part in her brother's lack of care. (Ryan Hicks/CBC)

The inquest into Brian Sinclair’s death came face-to-face with the issue of racism and prejudice in Manitoba’s health care system last week.

It reiterates the fact that inquest Judge Timothy Preston will have to face the issue head-on during his deliberations.

Aboriginal, homeless, and wheelchair-bound, Sinclair was found dead in the waiting room in the Health Sciences Centre emergency department, 34 hours after he arrived.

He had approached the triage desk, spoke to a hospital employee and then sat in the waiting room until he died.

A matter of hours is all it took for someone to thrust the "R" word onto the table at the Brian Sinclair inquest. After her testimony on day one, Esther Joyce Grant, the sister of Brian Sinclair, was the first to put it out there.

"It’s all to do with racists," she told reporters on the steps of the law courts.

The following day, the province’s chief medical examiner, Dr. Thambirajah Balachandra, waded into the debate.

"Even if Snow White had gone there, she would have got the same treatment under the same circumstances," he told the inquest.

He believes issues with the triage system are to blame for Sinclair’s death, not racism.

The death of Brian Sinclair raised questions about how the health care system treats aboriginal people.

Last Thursday, an email tabled as evidence from the Winnipeg neuropathologist who examined Sinclair after he died pushed that question even further into the spotlight. It made some people wonder about the attitudes of health care workers towards aboriginal patients.

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Dr. Thambirajah Balachandra, Manitoba's chief medical examiner, believes issues with the triage system are to blame for Sinclair’s death, not racism. (Ryan Hicks/CBC)

Dr. Marc Del Bigio examined Sinclair’s brain and spinal cord after he died. In the wake of the uproar over Sinclair’s death, Dr. Del Bigio penned an email in June 2009 to then-head of the Winnipeg Regional Health Authority, Dr. Brian Postl, and Dr. Balachandra.

"We should not lose sight of the fact that this man's problems were self-inflicted," Del Bigio wrote.

"His cognitive disability and neurogenic bladder were the consequence of decades of solvent/inhalant abuse. Societal blame can only go so far. At some level individuals must accept responsibility."

On the stand, Dr. Del Bigio admitted it was an "emotional" response to the outcry and that he used "less than optimal" language.

However, he made a judgment and assigned at least some blame to Sinclair for his health problems. The email, which Dr. Del Bigio didn’t want made public at the time, has some people wondering if it’s reflective of a general attitude to aboriginal patients.

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Dr. Marc Del Bigio speaks with reporters outside the courthouse following his testimony at the inquest. (Ryan Hicks/CBC)

The notion that race did not play a role in Brian Sinclair’s death is hard for some people to swallow. One of those people is Kathy Mallett, co-director of the Community Education Development Association.

She is aboriginal and has been an advocate for the community for over 30 years. A strong woman who tells it like it is.

She told me about a time last year when she and her brother were at a local hospital, walking down the hallway to see her brother who was dying. She said a staff member stopped them and asked, "what are you people doing here?"

"I don’t understand this kind of mentality. Questioning. I’m sure if we were white they wouldn't have asked us what were we doing here," she said.

She said during medical visits of her own, that kind of attitude has followed her into the examination room.

"It’s almost like they [health care workers]

don’t believe you that there’s something actually wrong with you. Like you’re making it up or it’s all in your head. Well take a blood test and see what’s wrong," said Mallett.

She said she’s so scared of the health care system, she feels she needs an advocate at her side her when getting care.

Blame-the-victim mentality

She feels that same kind of blame-the-victim mentality symbolizes an underlying attitude of prejudice towards aboriginal patients. Mallett said she does not know where it comes from, possibly from a lack of understanding.

When it comes to Dr. Del Bigio’s email, Mallett said his words demonstrate a lack of understanding of the aboriginal experience that permeates the health care system.

"Addiction is a symptom of a problem. A much deeper, deeper problem. How complex our problems are in terms of the oppression and the whole colonization process our people have gone through," she said. "It’s much more complex. It’s not as simple as the doctor stated ... he wouldn’t be saying those kinds of thing if he knew about those issues."

I called Dr. Del Bigio on Friday to follow-up on his testimony and to get his perspective on some of the backlash to his email. He told me he wrote the email at a time when he felt race was distracting "from looking at all of the other factors that led Mr. Sinclair to the HSC emergency that day."

He also backed away from the wording of his missive to Drs. Postl and Balachandra.

"I agree it’s irrelevant how someone develops a medical problem. They need to be treated regardless. I regret using the word ‘blame,"’ he said.

"I stand by my conclusion that there are multiple factors that played into his death and some of them relate to his lack of medical care and some relate to his chronic disease state and that chronic disease state was a consequence of solvent abuse."

He also said he appreciates "the difficulties some of the First Nations and aboriginal communities have" and hopes this tragedy raises awareness about solvent abuse.

Just how much of a factor prejudice and racism in Manitoba’s health care system played in this case is an issue that Judge Timothy Preston will have to address in his final decision, one way or another.

After the first week of the inquest, it is clearly one that cannot be swept under the rug.