Racism, discrimination may lead to First Nations patients leaving emergency rooms: Alberta study

Systemic racism and inequity in health care may be contributing to why First Nations patients in Alberta disproportionately leave emergency departments without being seen, or against medical advice, according to a new study published in the Canadian Medical Association Journal.

The peer-reviewed paper builds on a previous one that found nearly seven per cent of First Nations patients' visits to emergency departments ended in them leaving without care, compared to nearly four per cent of visits by non-First Nations patients.

The team examined provincial administrative data for more than 11 million emergency department visits in Alberta from 2012 to 2017, controlling for patients' ages, geography, visit reasons and facility types.

"First Nations people, when we control for all of these other factors, have higher odds of leaving without completing care," said Patrick McLane, an adjunct associate professor in the University  of Alberta's department of emergency medicine. He co-authored the study.

The researchers also asked 64 health directors, emergency-care providers and First Nations patients to comment on their quantitative findings through sharing circles, a focus group and telephone interviews from 2019 to 2022.

McLane co-led the study with Lea Bill, the executive director of the Alberta First Nations Information Governance Centre. Elders and First Nations partner organizations helped shape the study and interpret its results.

Study participants, while commenting on the quantitative findings, raised a number of reasons why First Nations patients leave emergency departments without receiving care.

They shared stories of providers discriminating against First Nations patients and relying on stereotypes about them.

One participant, who was quoted in the study, reported walking out of one health care facility and visiting another after a doctor's first question was how much alcohol they had had to drink.

Another participant mentioned overhearing a racist rant at a nurses' station in an emergency department.

Participants also noted other barriers to receiving care, such as long wait times, transportation availability and health-care professionals using medical jargon while speaking with patients.

Siksika Nation Coun. Samuel Crowfoot said the study reflects what members of his community southeast of Calgary have long been experiencing: misdiagnoses, being targeted by hospital security, and physicians assuming intoxication.

The First Nation has encouraged members to share stories related to racism and discrimination in health care and signed an agreement with Alberta physicians to address both problems.

Benedict Crow Chief, of Siksika Nation, filed a human rights complaint last year against Alberta Health Services (AHS) and a hospital, alleging anti-Indigenous discrimination led to the death of his wife, Myra Crow Chief.