Joyce Echaquan inquest: Why the focus on form over function?

It’s been hard to follow the inquest into the tragic death of Joyce Echaquan. The details of her final moments, the callousness of the mistreatment afforded her by the nurses and orderlies, the fact that she was left restrained and alone contrary to safety protocols, the nurse’s frantic decision to later delete the incriminating video, and the repeated insistence that they were overworked have been frustrating to listen to.

“A f*cking idiot…” who was “better at sleeping around.” That’s what an orderly told Echaquan while she lay in pain in a Joliette Hospital, restrained by all four limbs. Fatigue, of course, isn’t a source of racism. Nothing could excuse a healthcare professional treating a patient in this way and coroner Géhane Kamel, chairing the inquest, made that perfectly clear when she admonished the nurse.

So, imagine my surprise when the public conversation suddenly shifted from the disturbing details emerging from the inquest to the coroner’s conduct. Suddenly, people were no longer focusing on the actions of the people directly implicated in that horrific night when a 37-year-old mother of seven died in pain while the last words she heard were mockery and insults. Suddenly, the spotlight was on function versus form. Coroner Géhane Kamel’s form to be exact. 

Coroner’s tone criticized

“There’s a woman dying in front of you — because that’s what is happening— and you’re telling me you’re thinking about your break and your incident report?” Kamel was quoted as telling the nurse.

Kamel’s explosive reaction to the nurse’s lack of accountability is now the focus of much discussion. One would say it’s eclipsed all other discussions surrounding the inquest, which is telling. La Presse columnist Isabelle Hachey wrote a piece on Kamel’s tone, in which a retired judge criticizes her for a lack of restraint. 

After that column, I saw people suddenly emboldened to share their discomfort about the fact that Kamel appeared agitated. I saw people stating Echaquan’s family was dealing with enough and didn’t need the coroner’s histrionics, which was interesting considering the family themselves insisted the nurse watch the seven-minute video in their presence because they desperately want to see some accountability and remorse and they haven’t seen much of that yet. 

Quebec’s chief coroner Pascale Descary has said she has “full confidence” in Kamel’s abilities. The latter knows the file well, as she is already in charge of a coroner’s office committee examining mortality rates among Indigenous and Inuit communities in Quebec. So, with that in mind, one must ask: Are the people scandalized by the coroner’s confrontational style interested in the lofty goals of impartiality and the integrity of the process, or are they interested in distracting from findings that make our healthcare system and the people working in it look bad? Why the need to prioritize this “devoir de réserve” over the urgency of finding out the exact circumstances surrounding a woman’s death, unless the first group’s slight discomfort is deemed more important than the abhorrent cruelty incurred by the second group?

Tone policing is an oppression tactic

Systemic racism manifests in various ways. The decision to protect the staff’s names by a publication ban, even though there is video proof of their guilt, is one way. Contrast this to how Mamadi Camara was treated, his name and image plastered all over the front pages of papers, while only a suspect. Another way is also the tone-policing that is now publicly afforded this coroner — coincidentally a woman of colour — which completely distracts from and dismisses her credibility and her findings under the guise of “respect” for the process. 

“Tone policing is when members of majority groups focus on the language and perceived emotion of marginalized or underrepresented groups during discussions of inequality,” says Dr. Zuleyka Zevallos. “The majority group sees themselves as entitled to infer ‘illegitimate’ arguments based solely on the words being used, rather than the meaning of what is being said. This is an attempt to silence or derail discussions, to shift power away from the lived experiences and knowledge of minorities or disempowered groups.” 

Even if sometimes done unconsciously, tone policing is an oppression tactic. Think of the times you were (rightfully) confronting someone and they told you to “calm down.” If you’re choosing to address the style of communication instead of the content, you’re tone-policing. You’re also gaslighting minorities trying to get justice. Historically, the language of “civility” has been used to dismiss social movements, justify oppression and destabilize those trying to equal the playing field. 

I haven’t seen a single member of the Atikamekw community express dismay at the process or a lack of faith in Kamel. I’ve only seen them express a profound and urgent need for accountability. In sharp contrast, I’ve seen a lot of white folks suddenly transform into inquest experts, surprisingly familiar with the nuances of inquest proceedings, apparently shocked and scandalized by the unseemly behaviour of a coroner. Shouldn’t we be reserving at least a fragment of that shock for a nurse who erased video proof of malpractice and racism? 

An inquest isn’t a trial

No one is on trial at an inquest. The coroner’s job is to bring out the facts relating to the circumstances of the death and all the elements that led to it. Kamel does not have the power to assign criminal or civil responsibility. An inquest is a Q&A, a deep dive into the details of something bad, a way to unearth what happened, and hopefully prevent it from ever happening again. Kamel’s job is to expose those elements and to push and prod when people are sidestepping or minimizing them. Her reaction and tone have been more about confronting the realities of systemic racism and awful prejudices so many have about Indigenous communities, and not allowing the nurse (and the system she represents and works in) to attempt to explain it away as an unfortunate incident caused by unfortunate circumstances.

“I prefer people be honest,” Kamel was quoted as telling the witnesses. “We’re not conducting a trial,” she said, “we are trying to understand.” The coroner has made it clear from the beginning of the inquiry that the only way to understand the circumstances of her death would be by carefully dissecting and scrutinizing the behaviour and attitude of hospital staff toward Echaquan. She has every right to be frustrated at the apparent contradictions in the nurse’s testimony and to challenge her when she feels she’s not getting truthful replies. 

Are we expected to believe that a woman writhing in pain died at the hospital while videotaping her last moments and no one at the hospital discussed it? That no one had opinions or thoughts about it? Or is it, perhaps, that the nurse is hesitant to discuss the thoughts and opinions expressed because it would expose long-standing prejudices staff harbour against Indigenous communities? 

What’s the point of the Echaquan inquest? 

Without complete honesty, without real accountability, without real talk, and an admission of negative perceptions and how they colour the care that these staff members give, there is no point to this inquest and no meeting point where everyone can come together and move forward. It’s just a polite exercise in futility, a check to tick off in a box of expectations after a woman’s tragic death, an attempt to morally assuage a majority that wants to feel like it did something while doing little. Until the next time it happens… and then we get to do it all over again and feign surprise that such a thing could ever occur in a place where our very own government denies that systemic racism exists. 

Prejudice, systemic racism and bias towards the Atikamekw community of Manawan are what caused Joyce Echaquan’s death. The staff’s mistaken beliefs that she was on drugs and suffering from withdrawal prompted them to disregard her pain and treat it as unimportant. It’s not “one bad nurse” having “one bad day” that killed her, but an entire system that treats people like her as less deserving of fair treatment and respect. It’s generations of medical colonialism that, once again, harmed someone seeking help. 

It’s no coincidence that members of Echaquan’s community admitted during the public inquiry that they were afraid of going to the Joliette hospital for treatment. Their fears are not irrational — they’re rooted in a brutal colonial past that saw so much harm come to their parents and grandparents from the ones who swore they would “do no harm.” It’s a system that continues to do them harm today. 

But instead of this being the focus of the inquest, we are now being treated to non-stop discussions and concerns about the coroner’s lack of objectivity and emotional conduct, while the people struggling to be heard have, once again, been pushed aside. 

UPDATE: On Tuesday morning, Kamel said that she apologizes if certain words she used during the inquest may have upset some people and that she takes note of it, saying that she will “recalibrate” her words. But she insists that she is impartial and does not recuse herself. Quebec’s chief coroner has reiterated her support for Kamel’s work. ■

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Read more editorials by Toula Drimonis here.