Marilyn Johnson says she faced health-care discrimination because she is Indigenous and lives in the Downtown Eastside. Here’s what needs to change.
The Tyee: Marilyn Johnson, a Gitxsan woman, is full of energy. The ends of her hair are dyed blue. She sips her Tim Hortons coffee and smiles from ear to ear when talking about her loved ones. The walls of her Downtown Eastside apartment are filled with photos of her children, grandchildren and great-grandchildren.
But now, unlike in previous years, she is afraid to go to the hospital. Last winter, the 67-year-old endured a painful, traumatic day of encounters with health-care providers that have left her questioning B.C.’s health-care system.
In November 2022, Johnson injured her knee after her dog, Papoose, ran into it. A few days later, she fell in her Downtown Eastside apartment while trying to prepare food for Papoose, a Cane Corso husky mix. The fall was serious: Johnson reinjured her knee and sustained a head injury.
She called the nearby Kílala Lelum Health Centre, an organization in the Downtown Eastside that pairs Indigenous Elders with health-care providers. The centre sent a nurse to assist her. The nurse took a photo of Johnson’s sore knee, sending the image to a locum at the clinic who was filling in for Johnson’s usual doctor. The locum wrote a prescription for Johnson’s pain and a pharmacist was sent to her home to deliver the medication.
When the pharmacist arrived, Johnson was directed to take the entire prescription of slow-release morphine.
To Johnson, taking the entire prescription at once didn’t seem to make sense because she had never been required to do this before. She questioned the pharmacist, asking him repeatedly if he was sure she was supposed to consume all of it. She said he told her he was unable to leave unless she did. Johnson took the medication. At the time, she didn’t know that the locum had made a medical error and misprescribed her.
Shortly after, she began feeling ill and said she felt like she was struggling to breathe. She called her friend Neil Manson to come check on her. When he saw her, he immediately called an ambulance. Paramedics administered the fast-acting opioid agonist naloxone; she had received an overdose of medication. They brought her to the emergency room at St. Paul’s Hospital in downtown Vancouver.
When she first met the emergency room doctor, Johnson said he grabbed her aching knee, which prompted her to cry out in pain. “‘I guess you’re telling the truth about that one,’” she said he told her. When Johnson asked who he was, she said he told her he was an “addict physician.” She said he then asked her: “How long have you taken fentanyl or heroin?” Johnson’s response was that she hadn’t and that she wasn’t a person who uses drugs. He proceeded to ask her the question again. And again.
He said it was up to him to determine whether she used drugs, according to Johnson.
The doctor then ordered her a urine test. Despite the state she was in — in pain and sedated — she said no one on the health-care team assisted her. She was groggy and the railings weren’t up on the bed to prevent her from falling. At one point, she nodded off. When she did, she said the nurse and doctor looked at her, yelling, “Wake up! You’re going to fall off the bed.”
When the urine test results came back proving she was not a drug user — what Johnson had been trying to tell the health-care providers all along — she was told to leave. A nurse pushed her in a wheelchair to the exit door and left her outside to wait for Manson, her friend who had come to pick her up.
“They just dumped her at the door,” Manson said.
Stereotyping, prejudice are common experiences
It’s been more than five months since the distressing experience. Johnson has only started to physically recover, but the mental and emotional trauma remain. “What I want to see is St. Paul’s Hospital to start thinking of ourselves as human,” she said.
The Tyee asked to speak with the CEO of Providence Health Care, a Catholic health-care provider that operates St. Paul’s Hospital, about Johnson’s experience but was instead provided a statement. “Providence Health Care is unable to comment on individual cases due to patient confidentiality,” the statement said.
In 2020, a first-of-its kind report on anti-Indigenous racism in B.C.’s health-care system called In Plain Sight was published. It found racism was “widespread and insidious” and included hundreds of stories similar to Johnson’s.
According to the findings, 84 per cent of Indigenous patients had experienced racism in a health-care setting.
Stereotyping and prejudice were common experiences for Indigenous people at all levels of the province’s health-care system, according to the report — especially urgent care. Twenty-six per cent of respondents reported they were asked about substance use or were assumed to be drunk. The report called for transformative change and listed 24 recommendations directed at health-care providers, colleges and the provincial government.
In a statement to The Tyee, the Ministry of Health outlined what it had done since the report, such as issuing an apology in 2020, implementing legislation including the Anti-Racism Data Act in 2022, and ensuring that all health authorities have appointed Indigenous board members and established Indigenous health positions. “We will continue our efforts until all [In Plain Sight] recommendations are implemented in our health-care system,” a spokesperson for the Ministry of Health said.
When The Tyee asked if the Ministry of Health has standardized anti-racism training for health-care workers, a ministry representative responded that health-care workers in B.C. are offered the opportunity to participate in the San’Yas Anti-Racism Indigenous Cultural Safety Training Program, a program that aims to address racism, discrimination and stereotyping of Indigenous people.
‘A series of system failures’
Dr. David Tu, Johnson’s doctor, is a settler and family physician who works at Kílala Lelum Health Centre where he’s a medical co-lead for primary care. Tu wasn’t working the November day on which Johnson was misprescribed medication and went to the emergency room, but said the team has discussed and analyzed how this occurred.
Tu said the locum doctor was using an electronic medical record they weren’t familiar with. On that day, there were four patients with similar-sounding names given to the locum at the same time. The doctor didn’t know how to expand the electronic medical record to see the full names of patients, which led to them giving the wrong prescription to Johnson. “That error could have happened to lots of people,” Tu said. “After that, there is a series of system failures that tumble forward from this first medical error.”
Johnson was supposed to have been prescribed a low-potency opiate medication for the pain in her knee. Instead, she was given slow-release morphine that was prescribed with a requirement to have a witness for the medication ingestion, which is why the pharmacist needed to see Johnson consume all of it.
Tu said in an ideal world, after the first error occurred, there should have been oversight from the pharmacy to check why someone like Johnson — who had never been prescribed slow-release morphine — would be receiving it. “There should have been some flags that went up that didn’t go up,” he said. “Just the way that power dynamic played out — I don’t know, I wasn’t there — but against Marilyn’s better judgment, she took the full dose of morphine.”
The error could have been life threatening, according to Tu.
The next distressing event to occur was how she was treated at the hospital following this poisoning. The physician said he believes Johnson’s Downtown Eastside address played a role into how she was received. “If her address was in Kerrisdale and she was the same age, but presented as a retired school teacher, she would have gotten that royal treatment. She would have been believed at face value,” he said.
Tu pointed to the implicit biases that likely impacted how she was cared for — and how those biases become more pronounced in high-stress environments. “We know that when you’re stressed and you’re overworked, your ability to navigate your implicit biases go down,” he said. “The deep listening to understand her story and then the compassionate response that that story should elicit were absent because I think it took some time for them to realize… that her story was accurate, that she is not an opiate user and that she was a victim of a medical error.”
‘This kind of treatment is so prevalent’
Johnson has filed a complaint with the College of Physicians and Surgeons, the BC College of Nurses and Midwives, the College of Pharmacists of British Columbia, and is in the process of finishing her complaint directed at St. Paul’s Hospital. The complaints address the negligence and covert discrimination she faced as an Indigenous Elder living on the Downtown Eastside. After submitting these complaints, Johnson plans to pursue a medical malpractice lawsuit.
The complaint process was singled out in the In Plain Sight report for being inaccessible, lacking space for Indigenous cultural processes and methods of dispute resolution and found to be re-traumatizing. Of the Indigenous patients who experienced discrimination while trying to access care, 32 per cent were not at all likely to make a complaint. Some of the barriers identified in making a complaint included not being taken seriously, expecting poor treatment throughout the complaint process and the belief that making a complaint could initiate worse treatment from health-care staff in the future.
Lexi Fisher, a social navigator and acting team lead at Kílala Lelum Health Centre, who is assisting Johnson with her complaint, said she knows many people who have tried to do the same, but were deterred after finding the process daunting and unfamiliar.
“Complaints take a long time and when you’re in that trauma state of mind, you just need it to be done with so you can go back to your life,” she said. “This kind of treatment is so prevalent and so when they’re faced with the difficulties of doing the complaints, the idea comes to mind that even if I do all of this, it’s not really going to change it next time I go in anyway because that’s how they treat us.”
In April 2023, the BC College of Nurses and Midwives released a report titled Looking Back to Look Forward, analyzing its complaint process. It found that its current system was complicated, confusing and inaccessible.
Cynthia Johansen, the CEO and registrar at the BC College of Nurses and Midwives, acknowledged that the health-care system has historically cultivated little to no trust with Indigenous people and that the complaint system is part of that. “I know that we will be regulating in a culturally safe and humble way when Indigenous people tell me that I am,” she told The Tyee. “Until we meet that outcome, we are on our journey working to get there.” She said she’s hopeful the recommendations from the Looking Back to Look Forward report will be made by the end of this year.
‘We can make progress on this issue’
“If I had been afraid to go to the hospital at that time, I probably would have died,” Johnson said. Indigenous women and girls are disproportionately impacted by racism in the health-care system due to interacting with it more frequently than Indigenous men, according to the In Plain Sight report.
The report found that Indigenous men were 83 per cent more likely than Indigenous women to feel “completely safe” when visiting emergency departments.
Harmony Johnson, or sɛƛakəs, from the Tla’amin Nation, co-authored the report and is the vice-president of Indigenous Wellness and Reconciliation at Providence Health Care. Johnson said the hospital sees a high number of Indigenous patients, some of who fly in from elsewhere in the province or reside in the Downtown Eastside. “I don’t know if this is a solvable problem, but we can make progress on this issue,” she said.
Johnson said in the last two years, Providence has looked at what it can do to support point-of-care changes — where medical care is received — for Indigenous patients. The emergency department at St. Paul’s is an immediate priority.
A pilot project is currently underway to increase the Indigenous wellness liaison program, a team that provides cultural, spiritual, social and emotional support to Indigenous patients. The team has five liaisons who are in the emergency department five days a week, eight hours per day. Their job is to help connect patients with the services they need right away in order to provide positive point-of-care outcomes.
“Liaisons actually provide cultural and spiritual care that is critically necessary for our folks,” she said. “Interactions between an Indigenous wellness liaison and an Indigenous person radically improve the experience for an Indigenous patient.”
The goal is to expand the pilot once the project culminates. Johnson believes expanding the number of Indigenous wellness liaisons at St. Paul’s is a fundamental solution to the inequities Indigenous people face in health care. She says it will do much to build trust in the health-care system. “We’ve been trained to distrust institutional care because of residential schools, because of Indian hospitals, because we’ve been surveilled by the Crown,” she said.
Compared to two per cent in Vancouver and 4.8 per cent in British Columbia as a whole, 8.5 per cent of people living in the Downtown Eastside are Indigenous. Many residents are living with intergenerational trauma from the impacts of colonialism, the residential school system and the ’60s scoop. Marilyn Johnson has lived in the neighbourhood for more than three decades. She believes part of the reason she was discriminated against was because of her postal code.
Report Finds ‘Widespread and Insidious’ Racism against Indigenous People in Health Care
“Just because we live down here [in the Downtown Eastside], doesn’t mean we’re all bad,” Johnson said.
Fisher, who has become close with Johnson through her work at Kílala Lelum, said it’s a sentiment she often hears from those who judge the area. “We as Indigenous people, people who use substances, people from the Downtown Eastside have historically, and even today are told that if you don’t want to be treated like this, then move out of that area,” Fisher said.
Of the complaint process, Fisher notes, “All Marilyn wants from this is for people to see people as people.” As a child growing up in Hazelton, Marilyn Johnson remembers that she was quiet, often too afraid to speak. “We were not supposed to say anything about what happened to us,” she said. “And then I came to Vancouver. I said, ‘Nobody knows me there. I’m going to talk.’”
Which is why she is adamant her story, while difficult and a reminder of how much more needs to be done, be told.
Isabella Zavarise is a freelance journalist and podcast producer. Her reporting interests include gender and social justice issues.