Expert tells Yukon inquest Cynthia Blackjack had acute liver failure

A doctor who reviewed Cynthia Blackjack's autopsy and medical history says she likely would have died even if she got to Whitehorse a day sooner.

Robert Saunders says only way to treat Blackjack was through liver transplant

A coroner's inquest into the 2013 death of Cynthia Blackjack is being held at the Kwanlin Dun Cultural Centre in Whitehorse. (Chris Windeyer/CBC)

An expert who reviewed Cynthia Blackjack's autopsy results and medical history says she had one of the most severe cases of liver damage he's ever seen.

Robert Saunders is a coroner and medical consultant in British Columbia. He reviewed the autopsy performed on Blackjack's body, as well as her medical history.

The coroner's inquest into Blackjack's 2013 death began earlier this week in Whitehorse. Testimony is expected to wrap up on Thursday.

Saunders told the inquest looking into Blackjack's death the only possible treatment for her would have been a liver transplant. 

"The intricacies and complexities involved in preparation for a liver transplant usually means that it takes weeks or months, at a minimum, before the procedure can be done," he wrote in a report presented to the jury as evidence.

"I see no conceivable way this would have been possible in Cynthia Blackjack's case."

Blackjack's degree of liver damage also meant it would likely have made no difference whether she had been taken to Whitehorse a day sooner.

One of the questions the inquest is grappling with is whether Blackjack should have been sent to Whitehorse General Hospital by ambulance Nov. 6, 2013, when she arrived at the Carmacks health centre suffering from stomach pain.

A nurse at the health centre treated Blackjack for gastritis Nov. 6. Saunders said that was consistent with her symptoms. The nurse told Blackjack she should try to find a way to Whitehorse General, and to return to the health centre that day if she couldn't get a ride.

The next day, a friend called for an ambulance because Blackjack was incoherent and moaning in pain. Staff at the health centre called a medevac flight which brought Blackjack to Whitehorse, but she died before the plane landed.

Saunders said the treatment Blackjack received at the health centre, and aboard the medevac flight, was appropriate.

In his report, Saunders found that the likely cause of Blackjack's liver failure was acetaminophen poisoning. But he cautioned it's impossible to know for sure, because acetaminophen disappears from the bloodstream within 24 hours.

Lawyers for the Little Salmon Carmacks First Nation and the Council of Yukon First Nations have pressed witnesses on whether Blackjack should have been given acetylcysteine, an antidote for acetaminophen overdose.

Saunders said Blackjack's case of liver failure was too advanced for the antidote to work.