An Rx against racist behaviour in Alberta emergency departments

After years of studying systemic racism in hospital emergency care, a team of researchers and First Nations organizations will create ways to ensure all patients are treated equitably and with dignity.

An emergency room entrance at night (Photo: Getty Images)

U of A researchers are collaborating with eight First Nations organizations to create an anti-racism intervention that will ensure patients in Alberta emergency departments are treated equitably and with dignity. (Photo: Getty Images)

For the last six years, First Nations organizations have supported a team of researchers including Bonnie Healy and Patrick McLane to study the quality of care for First Nations members in Alberta’s emergency departments. The results demonstrate systemic racism in emergency care.

Now, eight First Nations organizations are ready to launch the critical next phase of their work to create an anti-racism intervention that will ensure patients needing help will be treated equitably and with dignity. The Alberta First Nations Information Governance Centre, Blackfoot Confederacy Tribal Council, Stoney Nakoda Tsuut’ina Tribal Council, Bigstone Health Commission, Maskwacis Health Services, Paul First Nation Health Services, Yellowhead Tribal Council, and Kee Tas Kee Now Tribal Council are supporting the work.

The project, made possible by a $1.75-million grant from the Canadian Institutes of Health Research, will create several partnerships between Alberta emergency departments and Indigenous organizations, says McLane, an adjunct associate professor in the Faculty of Medicine & Dentistry and assistant scientific director of Alberta Health Services’ Emergency Strategic Clinical Network.

The partnerships will lay the foundation for training hospital staff in anti-racism strategies, changing emergency department processes to help meet the unique needs of each patient and addressing barriers to followup care. 

“We’re going to build relationships between three emergency departments and a Nation or a First Nations organization that wants to work with that department and direct change in that department,” McLane says.

“What I really would like to show is that by making changes in the departments and educating staff and building relationships, we can ultimately impact patient experiences.” 

Lea Bill, a registered nurse, Indigenous knowledge holder and executive director of the Alberta First Nations Information Governance Centre, and Esther Tailfeathers, a member of the Kainai Nation and senior medical director of the Provincial Indigenous Wellness Core at Alberta Health Services, are McLane’s co-leads on the new project. The team’s work applies First Nations knowledges, languages and worldviews to contextualize and analyze data, and inform research methods. 

“We’re able to see the racism in the data”

Healy, member of the Kainai Nation and health director of the Blackfoot Confederacy Tribal Council, has been working with McLane since 2017. In that time, they and their collaborators have co-authored five studies relating to racism and inequity First Nations people experience when seeking emergency care.

In two of the studies — one published in May 2021, the other in January 2022 — the research team analyzed health records from April 2012 to March 2017. They found that the rate of emergency visits is nearly three times higher for First Nations persons than non-First Nations persons, and First Nations women seek emergency care more than non-First Nations women. The researchers link this higher use of emergency departments to issues in equitable access to appropriate primary and specialty care.

The data also showed many First Nations visits end in patients leaving without completing treatment. And it revealed that First Nations patients with health issues like long bone fractures, acute upper respiratory infections and anxiety had greater odds of receiving less urgent triage scores than comparable non-First Nations patients with the same diagnoses.

“I don’t know if you’ve ever had a long bone fracture, but they’re not pleasant,” says Healy, who has been a nurse for 33 years and is ER trained. “People are walking away with [them]. That shouldn’t be happening anywhere.”

In a third paper, published in June 2022, the researchers interviewed emergency care providers to get their perspectives on care of First Nations patients in emergency. The providers described that First Nations patients are exposed to disrespect through tone and body language, experience overt racism and may be neglected or not taken seriously. 

“That was a unique article,” says McLane. “It was non-Indigenous physicians and nurses who we interviewed for the project, and then we were interpreting what they said with First Nations partners like Bonnie. 

“Instead of western analysts analyzing Indigenous patients, we had First Nations researchers analyzing the words of providers.”

Healy says there is value in having data to confirm what many Indigenous people living in Canada already know. She pointed to examples like Brian Sinclair, who died untreated in a Winnipeg emergency room in 2008, and Joyce Echaquan, an Atikamekw woman who died shortly after livestreaming racist remarks from hospital staff in Quebec.

“It’s foundational work because not only did we combine qualitative data and the honest comments by these staff that work in these spaces, but we looked at the quantitative data — the surveillance data that we received from Alberta Health Services — and we’re able to see the racism in the data.”

Creating best practices

In the paper studying providers’ perspectives, Healy, McLane and their co-authors included recommendations for best practices to improve emergency care for First Nations patients. Some of the suggestions:

  • Providers must treat each patient as a unique individual when diagnosing health issues, and making decisions about treatment.
  • Emergency departments should build formal relationships with First Nations communities. 
  • Emergency departments should have the resources necessary to offer contextually tailored care and resolve barriers that affect the patient’s continuity of care.

McLane and Healy hope that the project will result in fewer experiences of racism and a greater sense of cultural safety for First Nations people seeking emergency care. In turn, they hope to see fewer instances of First Nations people leaving without having been treated.

“I would like to see First Nations, when they do experience racism in any space within health, feel that they will be heard, they will be safe and they can trust the process to report and resolve incidences of these experiences,” says Healy.

As for the $1.75 million in funding, McLane says the intensive effort of this project means it couldn’t go ahead without it.

“We’re going to generate data on what works when we attempt to do anti-racism — and really granular data, so that we can look at what made this successful, or unsuccessful if that should be the case,” he says. “That kind of implementation is made possible by the CIHR grant.”

CIHR-funded projects at the U of A

The project is one of 29 at the U of A receiving a total of $17.9 million from CIHR:

Adetola Adesida, Faculty of Medicine & Dentistry
Towards the development of clinically implantable bioengineered human nasal cartilage grafts 

Kristi Baker, Faculty of Medicine & Dentistry
Harnessing dendritic cells to regulate antitumor immunity in colorectal cancer

Troy Baldwin, Faculty of Medicine & Dentistry
Mechanisms regulating non-deletional T cell central tolerance

Hyo-Jick Choi, Faculty of Engineering
Development of visible light-responsive antimicrobial coatings for personal protective equipment

Javier Clemente-Casares, Faculty of Medicine & Dentistry
Neutrophil responses in doxorubicin-induced myopathy

David Collister, Faculty of Medicine & Dentistry
The impact of gender affirming hormone therapy on biomarkers of kidney function and glomerular filtration rate in transgender adults

Patrick MacDonald, Faculty of Medicine & Dentistry
Dysfunctional and resistant islet cell populations in human diabetes

Patrick McLane, Faculty of Medicine & Dentistry
Advancing anti-racist and equity-oriented care in the emergency department with First Nations partners

Salima Meherali, Faculty of Nursing
Engaging adolescents for sexual and reproductive health and rights and family planning advocacy in Pakistan

Sue-Ann Mok, Faculty of Medicine & Dentistry
Systematic manipulation of tau protein aggregation: bridging biochemical and pathological properties

Hannah O’Rourke, Faculty of Nursing
Connecting today to combat social isolation and loneliness: A pragmatic cluster RCT of a remote visiting program for care home residents living with dementia

Mohamed Osman, Faculty of Medicine & Dentistry
MUC16 (CA125) mutations promote fibrosis and autoimmunity in systemic sclerosis

Silvia Pagliardini, Faculty of Medicine & Dentistry
Cellular and system investigation of the role of sex hormones and PHOX2B on respiratory control

Carla Prado, Faculty of Agricultural, Life & Environmental Sciences
Using a multimodal and digital intervention to optimize waist circumference, body composition, and cardiometabolic health in endometrial cancer survivors

Tracy Raivio, Faculty of Science
Microbial adaptation to the mammalian gastrointestinal tract

Meghan Riddell, Faculty of Medicine & Dentistry
The contribution of uterine endothelial cell ageing to reproductive decline with advanced age

Tejas Sankar, Faculty of Medicine & Dentistry
Understanding and predicting response to surgery for trigeminal neuralgia

John Seubert, Faculty of Pharmacy and Pharmaceutical Sciences
Synthetic analogues based on metabolites of omega-3 fatty acids protect mitochondria

Andrew Simmonds, Faculty of Medicine & Dentistry
How do canonical roles for peroxisomes and newly discovered non-canonical roles for peroxins at lipid droplets support neuronal differentiation during early development

Simonetta Sipione, Faculty of Medicine & Dentistry
A novel role for lipid droplets in proteostasis: Implications for misfolded protein diseases of the nervous system

Denise Spitzer, School of Public Health
Canadian mines/global Issues: An examination of policy context and the social, health, and environmental effects of Canadian mining in three focal communities in Brazil, the Kyrgyz Republic, and the Philippines

Gopinath Sutendra, Faculty of Medicine & Dentistry
Tumor-secreted nucleosides can promote RbFox1 degradation and signalling pathways relevant to dedifferentiation in cardiomyocytes: A two-hit hypothesis with implications for cardiotoxicity

Justine Turner, Faculty of Medicine & Dentistry
Establishing the relationship between the intestinotrophic factor glucagon like peptide-2 and the microbiome in neonatal piglets with short bowel syndrome

Hasan Uludag, Faculty of Engineering
New treatment of blood cancers with improved delivery of nucleic acids

John Ussher, Faculty of Pharmacy and Pharmaceutical Sciences
Aging and metabolic flexibility

John Vederas, Faculty of Science
Design, synthesis and testing of oxidatively robust inhibitors for cysteine proteases in SARS2 virus and poliovirus

Zhixiang Wang, Faculty of Medicine & Dentistry
Novel function of Rac1 in nuclear speckle, its regulation and implication in breast cancer

Michael Woodside, Faculty of Science
Using engineered heterodimers to probe prion-like propagation of misfolding in SOD1

Shelby Yamamoto, School of Public Health
Understanding the perceptions and health impacts of climate change among 2SLGBTQIA+ people in Alberta: A mixed-methods pilot study