This article contains the names of Indigenous people who have died.
Four years after a 24-year-old Canadian First Nations woman died in a hospital waiting room in Ontario, her family is waiting for a coroner's inquest into why she wasn't provided with adequate medical care.
On 9 December, 2021, Heather Winterstein went to the Marotta Family Hospital in St. Catharine's with a severe backache, her family told CBC Hamilton. She was sent home with paracetamol but returned the next day and collapsed in the waiting area; dying shortly after.
Her family later found out the cause was a Strep A blood infection.
Ms Winterstein had family roots in the Saugeen and Six Nations of the Grand River First Nations.
In a statement to the CBC earlier this month, Ms Winterstein's aunt, Jill Lunn, said: "Heather's death devastated us. Her family believes that her death was preventable."
Ms Lunn described Ms Winterstein as a beautiful, "quiet soul" who loved her parents, animals and the colour pink.
Ms Winterstein family believes she did not receive proper medical assessment or care at the hospital because of systemic racism and biases; issues a coroner's inquest would explore, possibly prompting change that could help other Indigenous patients, the CBC reports.
"Many questions remain and we are still waiting for answers," Ms Lunn said.
There is no statute of limitations in Ontario on inquests. Last year, the province's Ministry of the Solicitor General announced an inquest would take place to "examine the circumstances" of Ms Winterstein's death and give a jury the opportunity to make recommendations, but no date or location has been set for the inquest, a ministry spokesperson told the CBC.
Systemic racism in healthcare - a threat to Indigenous people around the world
The case has parallels in Australia, with several high profile cases involving Indigenous people denied adequate medical care, some sent home with painkillers or antibiotics, misdiagnosed - resulting in their deaths.
Recurrent, untreated Strep A infections of the throat or skin can lead to acute rheumatic fever and rheumatic heart disease - life-threatening illnesses. Three women in Doomadgee, north Queensland - Yvette Booth, referred to as Betty, Adele Sandy, known as Ms Sandy and Shakaya George, or Kaya - died in 2019 and 2020 while suffering rheumatic heart disease. They had sought medical attention, and the inquest into their deaths ultimately found the health systems had failed them.
In 2014, Ms Dhu called South Hedland Police for help after being assaulted. Instead of being protected she was arrested for unpaid parking fines, locked up in a police watch house, and denied medical care. She died from staphylococcal septicaemia and pneumonia with osteomyelitis.
Kamilaroi-Dunghutti man Ricky 'Dougie' Hampson Jr, 36, died on a friend's couch from two undiagnosed perforated duodenal ulcers in 2021. Deputy State Coroner Erin Kennedy said the father of eight's death was "totally unnecessary" and "preventable", after he was misdiagnosed with cannabinoid hyperemesis syndrome (CHS) - an illness identified in long-term cannabis users - and then sent home the next day without a CT scan. Despite a confessed fear of hospitals, he had checked into the emergency department with "ten out of ten" pain.
In November, in a case currently under review by the WA Health Department, fifty-nine-year-old Indigenous woman Janet Till was taken to Fitzroy Crossing Hospital with a fever, was sent home with antibiotics and died by the following morning.
Report revealed Heather Winterstein wasn't assessed at hospital
Linda Boich, a vice-president at Niagara Health, which runs the St. Catharine's hospital, told the CBC Ms Winterstein's death was "a tragedy".
"We acknowledge the broader concerns about racism and bias in healthcare, including in hospitals like ours," said Ms Boich, who oversees patient experience and integrated care, in an email Canada's national broadcaster.
"And we remain committed to confronting this and making meaningful, ongoing improvements."
The CBC reports that a third-party panel review - conducted in 2022 and finalised in 2023 - found despite Ms Winterstein having abnormal vital signs at her first hospital visit, she was discharged without being assessed. It also found the diagnosis given by hospital staff had pointed, wrongly, to social issues rather than physical illness.
When Ms Winterstein returned to the hospital the next day, she waited two-and-a-half hours.
The review panel said CCTV footage of the hospital waiting room was "difficult to witness", showing Ms Winterstein attempt to get comfortable in a wheelchair and then on the waiting room floor.
"On several occasions staff from housekeeping and security are seen getting her a blanket and assisting her back into a wheelchair," the report states.
Another patient took her in the wheelchair to the triage desk to speak to a nurse before she collapsed.
"Unconscious bias may have played a role in [Winterstein's] care because she was labelled as experiencing both addiction and homelessness," the panel concluded.
Niagara Health accepted all of the panel's recommendations, Ms Boich told the CBC. The vice-president said Niagara Health has since made cultural safety training for staff mandatory; opened a dedicated Indigenous space at the Marotta Family Hospital; created an Indigenous Health Services and Reconciliation team to support Indigenous patients; and begun working to increase Indigenous representation on advisory and decision-making bodies, and to recruit and retrain Indigenous employees, physicians and volunteers.
'Justice for Heather Winterstein would be lasting, meaningful and impactful change to Indigenous health care'
Ms Lunn said she is hopeful when the inquiry does eventually happen, her niece will get justice.
"Justice for Heather Winterstein would be lasting, meaningful and impactful change to Indigenous health care," she told the CBC.
"The system needs an overhaul. Anti-Indigenous racism and bias must be disrupted and stopped in all areas of health care and all levels within institutions that offer care to our people."
