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Miranda Mamakwa of Fort Severn First Nation, who died on Sept. 8 from a brain hemorrhage several months after undergoing open-heart surgery, in an undated photo provided by her mother, Eva.HO/The Canadian Press
The federal government says it is improving access to medical care for Indigenous patients in the remote North and reviewing the circumstances surrounding the death of a 31-year-old woman who missed follow-up appointments after open-heart surgery.
Miranda Mamakwa, from Fort Severn First Nation, a remote community along the Hudson Bay, underwent open-heart surgery in April and died in September. She was a recipient of Non-Insured Health Benefits, a federal program run by Indigenous Services Canada. Among its responsibilities is providing transportation and accommodations for First Nations patients who must travel to a different community to receive medical services.
Ms. Mamakwa’s family alleges she missed four scheduled postsurgery appointments because the NIHB failed to make such arrangements.
“ISC is in full agreement that it is important to have an understanding of Ms. Mamakwa’s interactions with the health care system, included programs and services directly delivered by ISC, and the circumstances surrounding her death,” Carolane Gratton, a spokesperson for Indigenous Services Canada, said in an e-mailed statement to The Globe and Mail.
The statement said the department is working at improving service efficiency, including a newly implemented “simplified travel submission process” organized and supported by on-site community medical transportation co-ordinators.
Ms. Gratton said that ISC recognizes the service gaps in the NIHB program and the “very serious impacts” on patients. “ISC acknowledges that medical transportation is a critical service for remote and fly-in communities.”
First Nations leaders, family demand answers for woman’s death after she was denied medical travel
Sol Mamakwa, the MPP for Kiiwetinoong, which includes Fort Severn First Nation, said more is needed.
“The actions that Indigenous Services Canada has taken are not enough to bring accountability for their repeated failure to arrange Miranda Mamakwa’s medical travel,” Mr. Mamakwa told The Globe. (He is not related to Ms. Mamakwa.)
“It’s time for ISC to make real change so no one else dies a preventable death because their medical travel was not arranged.”
Indigenous patients in the remote North, particularly where there is no road access to urban health care, rely heavily on the Non-Insured Health Benefits program – part of the federal government’s treaty obligations – because of the complicated and expensive logistics involved with travel.
To get to her follow-up appointment in Thunder Bay, about 850 kilometres south, Ms. Mamakwa would have faced a 2.5-hour flight to Sioux Lookout – longer if a direct flight wasn’t available – a four-hour layover and then an hour-long flight to Thunder Bay. Airfare for a one-way trip on a Dash 8 runs between $1,700 and $2,400, according to the Wasaya Airways website.
Flights in and out of the North are also unreliable, often cancelled or postponed because of weather, mechanical issues and other reasons.
Federal staff in Sioux Lookout are responsible for approving and processing travel arrangements for regional patients in the NIHB program after receiving referrals from a patient’s local nursing station staff or other health care providers.
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The federal program has long been sharply criticized by some Indigenous leaders, who call it a systemic failure bound by red-tape bureaucracy that has cost lives.
A news release issued by the Sioux Lookout First Nations Health Authority and Nishnawbe Aski Nation after Ms. Mamakwa’s death demanded accountability from the feds. It said Ms. Mamakwa’s death was a result of failures of the federal program responsible for getting her to appointments.
The family of Ms. Mamakwa has asked the Ontario Provincial Police Commissioner to investigate federal officials for criminal negligence. Her parents, Eva Mamakwa and Mike Bluecoat, said in a press release last week that their daughter’s death was preventable.
“This should never have happened to Miranda. She should be alive today. We deserve to know how something like this happened, and we want the individual or individuals responsible for failing to respond to these urgent requests for transportation to be held accountable. They cost Miranda her life. They cost her children a future without their mother.”
The statement, put out by Falconers LLP, which is representing the family, says after Ms. Mamakwa had her open-heart surgery in April in Ottawa, she recovered in Thunder Bay before going home to Fort Severn in May.
A total of four follow-up appointments were scheduled to take place in Thunder Bay over the summer, said the statement, and the local nursing station had faxed the required paperwork to the NIHB office in Sioux Lookout requesting arrangements be made. But the NIHB failed to respond, never making any travel arrangements for Ms. Mamakwa despite follow-up calls and requests, the law firm said.
In September, Ms. Mamakwa went to the Fort Severn nursing station in medical distress and was medevaced to Thunder Bay. She died on Sept. 8 after being removed from life support.
In the weeks before her death, Ms. Mamakwa wrote a Facebook post telling people to “go after” the NIHB program if she were to die.
The statement from Falconers said that the disregard shown for Ms. Mamakwa’s life must be investigated and that public officials should be held accountable.
The Ontario Provincial Police said in an e-mailed statement to The Globe that it is reviewing the letter from the Mamakwa family and will not comment further at this time.