One of Canada's top aboriginal public health experts says native people face racism and discrimination in the country's emergency departments.

Janet Smylie told an inquest into the death of an aboriginal man during a 34-hour wait in a Winnipeg hospital's ER that Canada's health care wasn't set up to include aboriginals.

Smylie, a Métis physician at St. Michael's Hospital in Toronto, suggested the health system is a loose extension of colonialism because it is founded on the belief that one set of people are superior to another.

"Our health-care services were set up with the best intentions in mind," Smylie testified Tuesday. "They weren't set up with indigenous people in mind."

Studies have found aboriginal people are less likely to get some life-saving treatment, Smylie said.

Many face overt racism while others suffer from less explicit bias and stereotyping, she said. But while health-care racial discrimination has been studied and tracked in the United States and Australia, it is still an uncomfortable subject in Canada, she added.

Surveys have shown aboriginal people expect discrimination and judgment when they go to an emergency room and actually develop strategies to deal with it, Smylie said.

"We actually accompany our family members to the emergency department because we're so concerned," Smylie said. "We are anticipating they will receive unequal treatment."

No one thought he was waiting for care

Brian Sinclair was referred to the emergency department in September 2008 because of a blocked catheter. Although the double-amputee spoke to a triage aide when he arrived at the hospital, he was never formally entered into the hospital triage system.

He languished in the waiting room for hours as his condition deteriorated. Sinclair vomited several times but was never asked if he was waiting for medical treatment.

By the time he was discovered dead, rigor mortis had set in.

Although many hospital staff testified they saw Sinclair, no one thought he was waiting for care. An internal report following his death found some thought the aboriginal man was drunk and was waiting for a ride or just needed a warm place to rest.

"Everybody had good intentions but I wonder about these implicit associations," said Smylie, who noted that many mistakenly assumed Sinclair was homeless.

"That could have been an assumption people made based on stereotyping. The problem is, the diagnosis was wrong."

Canada has to address the subtle racism that fuels biases and stereotypes in health care, she said. Cultural training should include testing that reveals implicit assumptions people make, Smylie said.

More training needed for ER staff, inquest told

Equally important is the need to address "compassion fatigue and burnout" among emergency department staff. Medical staff can learn to be more attuned to those who walk in the door through compassion training, Smylie suggested.

Working in an emergency room is demanding emotionally and staff have to take care of themselves as well as their patients, she said.

More training is also required for health-care professionals regarding aboriginal history to give them insight into the trauma and legacy of Indian residential schools, Smylie said.

"It's actually training the health-care professional to be responsive and help them feel safe versus retraumatized."

The health authority has argued it has made numerous changes since Sinclair's death, including to the layout of the waiting room so patients can be better monitored. All incoming patients are greeted by a security guard.

That might not set the right tone, especially for some who have a complicated history with authority, Smylie said.

"I don't understand why, if we're trying to help people, why we have a security guard screening people."

Health authority lawyer Bill Olson said the inner-city hospital has tried volunteer greeters at the door but it didn't work.

The inquest is in its final week and is expected to conclude Thursday with final recommendations from the Winnipeg Regional Health Authority, the Sinclair family and the Manitoba Nurses Union.