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Nurse was 'shocked' by Cynthia Blackjack's deteriorating condition, inquest hears

The nurse who treated Cynthia Blackjack the day before she died in 2013 took the stand on Monday, at the inquest into Blackjack's death.

Carmacks health centre staff initially determined Blackjack's case was serious but not urgent, inquest hears

A coroner's inquest is probing the circumstances of 29-year-old Cynthia Blackjack's death in 2013. It's being held at the Kwanlin Dun Cultural Centre in Whitehorse. (Chris Windeyer/CBC)

Former Carmacks health centre nurse Matt Lewis testified Monday he was "shocked" by the overnight deterioration of Cynthia Blackjack's condition shortly before she died.

Blackjack, 29, died aboard a medevac flight bound for Whitehorse in 2013. A coroner's inquest is probing the circumstances of her death, including whether systemic racism played a role.

Lewis told the jury Monday he treated Blackjack on Nov. 6, 2013. She arrived at the Carmacks health centre reporting serious abdominal pain. She was given morphine, an IV and an antacid.

Lewis said he considered her condition serious, but said she did not appear to need emergency care.

"I felt she was well enough to go in a vehicle and not in an ambulance," he said. "I was shocked to see how sick she was Nov. 7."

That's why health centre staff tried to arrange a ride for Blackjack to Whitehorse, instead of arranging to send her in Carmacks' only ambulance. Last week, Deb Crosby, the former nurse in charge of the health centre, testified she had to use caution sending out patients by ambulance, in case a more serious case emerged while it was out of town.

Blackjack left the health centre Nov. 6 with instructions to come back if she could not find a ride.

Conflicting accounts

The inquest has heard conflicting accounts of efforts to get Blackjack to Whitehorse.

Blackjack's friend, Bill Johnie, testified he was prepared to take Blackjack in a van owned by the Little Salmon Carmacks First Nation. But Johnie said someone at the health centre told him the First Nation wouldn't allow it.

The Carmacks Health Centre. The inquest heard that health centre staff tried to arrange a ride for Blackjack to Whitehorse in November 2013, instead of arranging to send her in Carmacks' only ambulance. (Chris Windeyer/CBC)

The inquest earlier heard the First Nation would regularly transport its citizens to Whitehorse for appointments. But Rachel Byers, the First Nation's health director, said drivers weren't normally cleared to take emergency cases because they don't have medical training.

Johnie testified he encountered Byers in the weeks after Blackjack's death and Byers said the First Nation was prepared to hire Johnie to take Blackjack to the city. Byers did not mention this conversation during her testimony.

Nurse's notes questioned

Lewis also faced questions about the terminology used by nurses in patient notes. Lewis described Blackjack as "unkempt" and another nurse described her as "dramatic."

Susan Roothman, a lawyer for the Little Salmon Carmacks First Nation, asked Lewis whether the use of such terms amounts to stereotyping.

Lewis responded that such language was not meant as a judgment, but to describe a patient's condition.

Roothman and Gregg Rafter, a lawyer for the Council of Yukon First Nations, also zeroed in on the amount of acetaminophen given to Blackjack in the days leading up to her death. Acetaminophen can cause liver damage in patients with alcoholism.

Blackjack had a drinking problem, but her family and friends say she was sober before she died. Lewis told the inquest Blackjack was "completely sober" when she arrived at the health centre Nov. 6. He said he did not give Blackjack any acetaminophen that day.

Response times reasonable, expert says

On Monday the inquest also heard from Corey Banks, an expert on medevac services who is based in Bangor, Maine. 

In a 14-page report entered into evidence, Banks wrote that he found no evidence that Yukon's Emergency Medical Services, which operates medevac flights in the territory, contributed to Blackjack's death.

Banks told the jury the response times by both the local volunteer ambulance in Carmacks, and the medevac crew in Whitehorse, were reasonable.

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