Yukon inquest hears from doctors who treated Cynthia Blackjack

Two doctors who treated Cynthia Blackjack on the day she died say it did not make sense to administer an antidote for acetaminophen poisoning, despite Blackjack's history of alcoholism. 

Lucille Stuart and Jake Morash both gave evidence in Whitehorse on Tuesday, at a coroner's inquest into Blackjack's death.

Stuart was at the Carmacks health centre for a regular clinic day on Nov. 7, 2013, while Morash was the doctor aboard the medevac flight that was dispatched to bring Blackjack to Whitehorse.

At the inquest, lawyers for the Little Salmon Carmacks First Nation and the Council of Yukon First Nations both pressed the doctors on whether they should have administered acetylcysteine or NAC, which is used to treat acetaminophen overdoses.

The inquest has heard that Blackjack had a history of heavy drinking and had also been given acetaminophen by nurses at the Carmacks health centre and by friends. Susan Roothman, the lawyer for the Little Salmon Carmacks First Nation, has suggested to witnesses that the amount of Tylenol given to Blackjack should have been better recorded on patient forms.

It's not known how much of the drug Blackjack actually consumed, but acetaminophen can be dangerous for people with histories of heavy alcohol use.

Stuart said when Blackjack arrived at the Carmacks health centre by ambulance on Nov. 7, 2013, she showed signs of sepsis, as well as gastrointestinal bleeding, kidney failure and a possible gall bladder infection.

Under cross-examination by Roothman, Stuart said Blackjack urgently needed treatment for sepsis, which took priority.

"It would have been incredibly inappropriate to have a long conversation about how many Tylenol pills [Blackjack] had," Stuart said. 

Morash took over care of Blackjack when the medevac team arrived at the Carmacks medical centre. He said Blackjack was given a blood transfusion and put on a ventilator. There were problems with the ventilator and it was replaced with a bag ventilator mask, he said.

During the flight to Whitehorse, Blackjack was initially stable but her oxygen level began to decline. Approximately 10 minutes before landing, her heart rate abruptly dropped. Morash said he performed chest compressions for nearly 20 minutes before declaring her dead.

Gregg Rafter, a lawyer for the Council of Yukon First Nations, said NAC, the acetaminophen antidote, is cheap and effective with relatively few side effects. He asked why doctors would not administer it.

Morash said NAC is best administered intravenously, and that he has never seen it used outside an emergency room. He said Blackjack was suffering from several conditions at once, and with "only so many ports for medication" the medevac crew had to prioritize.

Recommendations

Lawyers at the inquest have been asking some witnesses what recommendations they'd make to prevent similar deaths in the future.

Both Morash and Stuart said electronic patient records could help provide medical responders with more information.

Stuart also said Yukon needs an organized system to provide transportation for patients who need to get to Whitehorse for non-emergency cases. The inquest has heard Blackjack was urged to get to Whitehorse to see a doctor on Nov. 6, but that her condition was not serious enough to warrant an ambulance transfer.

Stuart said she recently had a patient who needed to travel from a community to Whitehorse for cancer treatment and had to hitchhike in –20 C weather.

"Patients have to get their own ride, regardless if they're First Nations people or non-First Nations people," she said. "Across the board, everyone has the same problem in getting to Whitehorse."