A Winnipeg doctor's testimony about the death of Brian Sinclair has some raising questions about how aboriginal people are viewed and treated in the health-care system.
Sinclair, a 45-year-old homeless double-amputee, died in his wheelchair after sitting for 34 hours at the Health Sciences Centre's emergency waiting room, without receiving treatment, in September 2008.
An inquest into Sinclair's death heard testimony on Thursday from from Dr. Marc Del Bigio, a neuropathologist who examined Sinclair's brain and spinal cord following his death.
The inquest was also told of an email that Del Bigio wrote to Manitoba's chief medical examiner and the head of the Winnipeg Regional Health Authority in 2009, suggesting that Sinclair's chronic solvent abuse caused the health problems that brought him to the hospital's emergency room.
"We should not lose sight of the fact that this man's problems were self-inflicted," Del Bigio's email states in part.
"His cognitive disability and neurogenic bladder were the consequence of decade of solvent/inhalant abuse. Societal blame can only go so far. At some level individuals must accept responsibility."
'They don't know our history,' says advocate
Kathy Mallett, co-director of the Community Education Development Association in Winnipeg, said the email suggests a "blame the victim" mentality that she believes aboriginal people face in the health-care system.
"That's really very judgmental," she told CBC News on Friday.
"They don't know our history, right? They don't understand the complexity of our issues and … the legacies that have been given to us."
Sinclair was awaiting a minor procedure but no one ever came to his assistance, even as he vomited in plain sight, the inquest has heard.
Security tape at the Health Sciences Centre shows Sinclair went to the triage desk and spoke to an aide before wheeling himself into the waiting room.
That appears to have been his only interaction with staff.
Almost a day and a half later, another person in the waiting room finally spoke up about Sinclair. Efforts to revive him were unsuccessful.
MD defends email, apologizes for wording
Sinclair's death was later attributed to a treatable bladder infection.
Chief medical examiner Dr. Thambirajah Balachandra testified earlier this week that all Sinclair would have needed was a catheter change and antibiotics.
Del Bigio defended the email after his testimony concluded on Thursday.
"I think the point I was trying to make, which I worded poorly in my email to Drs. Balachandra and [then WHRA president Brian Postl], is that people who partake in whatever kind of damaging substances — be it tobacco and alcohol or solvents — should be aware of the risks," he told reporters outside the Winnipeg courthouse.
On Friday, Del Bigio apologized for the wording of his email.
"I agree completely that it's irrelevant how someone ends up with … a medical problem. They needed to be treated the same way regardless," he told CBC News.
Arthur Schafer, a health-care ethicist at the University of Manitoba, said doctors should not be assigning blame to patients for their health problems.
"What have they got to do with the fact that his life was at risk, a simple procedure would have saved it, and he sat for 34 hours in the emergency department after presenting himself to admissions?" Schafer said.
The Brian Sinclair inquest continues on Monday.
Read the doctor's email
Below is the email by Dr. Marc Del Bigio to Manitoba's chief medical examiner and the Winnipeg Regional Health Authority about Brian Sinclair in 2009. The email was presented at the Sinclair inquest on Thursday.