Dumped at the bus stop: Royal Jubilee Hospital patients and employees say racial discrimination is harming people in need of care (2022)

Just after daybreak, Robert Callahan found himself waiting in a wheelchair in the emergency department at Royal Jubilee Hospital. He had a painful twisted knee, but that wasn’t the main problem.

Callahan’s nose would not stop bleeding. The 64-year-old says he was on blood thinning medication and feared this was exacerbating the bleeding.

As he sat waiting to see a doctor, his clothes getting drenched with blood, Callahan said he was approached by hospital security staff who told him to cover up the bleeding.

“I said, ‘That’s what I’m here for. I’m here to get this bleeding stopped and get my knee looked at,’” Callahan said. “They told me, ‘Try not to cause a scene—people are getting nervous.’”

The minutes turned to an hour as Callahan waited with other patients in the department, bleeding the whole time. Then, he said, two security officers approached him again and asked him how he was doing. He replied that he wasn’t doing very well.

“They suggested that they take me outside so that people wouldn’t be so nervous anymore,” Callahan said.

The guards were being friendly, so Callahan trusted them when they wheeled him out of the hospital and across the parking lot.

“I thought they were taking me for a smoke,” he said. Instead, he says, he was taken to the bus stop.

“They stopped and took the chair from me and told me I wasn't welcome at the hospital anymore,” Callahan said.

Callahan is one of several people, from various walks of life, who told Capital Daily they experienced racism and mistreatment at the Royal Jubilee Hospital emergency department. Over the past few months, we have also heard from two Black women—one of whom is an employee at an Island hospital—who say they had similar, separate experiences of being treated with less compassion and understanding than their white counterparts.

We also talked to a former employee who worked in the same emergency department for two months before quitting due to the amount of racism and abuse he says he witnessed there.

One person who lives within view of Jubilee told Capital Daily he regularly sees hospital security guards dropping patients—like Callahan—off at the bus stop despite them appearing to still need medical care.

Island Health has denied some allegations, while pointing to their anti-racism initiatives in response to others. Neither the patients, nor the former employee feel their complaints were addressed by hospital management.

Callahan himself is Indigenous. He uses opioids and has been homeless in Victoria for the past 17 years but currently lives in a housing facility. He has been to the Jubilee ER after overdosing in the past and knows others who have as well.

“Basically, as soon as [hospital staff] find out you’re an addict, their whole attitude changes,” Callahan said.

Dumped at the bus stop

Between July and April 2021, Pierce Nettling worked from home in an apartment near the hospital. Every day, at least once a day, he says he witnessed hospital security guards drop patients off at that same bus stop—Richmond and Bay—in varying states of medical distress.

In some cases, “What ends up happening is the patient who was dropped barely moves,” Nettling told Capital Daily. “They sit down in a chair and they fall asleep.”

He says he has seen people dumped at the bus stop despite having open wounds; people screaming for help; people who looked like they had been sedated; and once, a person still hooked to an IV.

Nettling doesn’t always see the patients as they’re being dropped off, but says he can always recognize them later by their white hospital-issued blankets and their appearance.

“The one thing they have in common is, basically, they're not part of the ‘property class,’” Nettling said. “The worst ones are always [when] someone is dropped off with no bus ticket, no money, no shoes, no socks, no coat.”

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Island Health denies these allegations and told Capital Daily that patients are not discharged from the Royal Jubilee hospital if they still need acute medical care.

“Emergency department leaders may provide bus tickets and taxi vouchers to support vulnerable people,” the health authority said in a statement. “Island Health Protection Services Officers [security guards] periodically assist people who have been discharged but need assistance accessing transportation with getting into taxis or helping them get to the bus stop.”

Callahan’s account, and what Nettling has seen, run counter to the idea that patients who were discharged no longer needed medical care.

Dumped at the bus stop: Royal Jubilee Hospital patients and employees say racial discrimination is harming people in need of care (1)

On Sept. 10, Nettling sent Capital Daily a photo of one such incident, during which he says he saw security guards and paramedics laughing, surrounding a patient who was lying on the ground. That patient, he says, had been taken to the bus stop in a wheelchair, from the hospital, and dumped there by security guards earlier that day.

“I've seen a lot of things that made me question what goes on at Royal Jubilee in the last year,” Nettling said. “They prioritize different populations in the city over others, and if you’re not part of that population, you do not have a great experience at Royal Jubilee.”

Callahan was more fortunate than some of the patients Nettling described. On that day in April, he had brought a bus ticket and a change of clothes with him to the hospital. “I had to strip down to my underwear at the bus stop to put on the clothes I had,” he said.

After making it home, Callahan said a good friend drove him to the Victoria General Hospital, the other major hospital in Greater Victoria. There, more than 12 hours after the bleeding had begun, he finally received treatment.

A dark sense of humour

Dean worked in the Royal Jubilee Hospital emergency department for two months—June to August last year—and said going to Victoria General was the right call for someone like Callahan.

According to him, Victoria General is a far better place to be a patient if you’re part of a racial minority, unhoused, use drugs, and/or are having a mental health crisis.

“Because Royal Jubilee sees the majority of downtown vulnerable people come to that hospital, that's where most of the hostility and the negativity is,” Dean told Capital Daily. “I'd rather go out to Victoria General for an emergency. I don't recommend people go to Royal Jubilee at all.”

Dean has asked that his name be withheld to protect his career.

When racialized people go to the Jubilee emergency department while experiencing a mental health crisis or under the influence of substances, Dean said they are shown far less compassion than their white counterparts.

Nurses, security officers, and their managers, he said, were often short with these patients and did not answer their questions. He said he observed complaints or resistance—including verbal, non-violent questioning—reacted to with violence from security guards, adding that patients had been threatened with “another shot” or “another needle” to quiet them if they asked questions or raised their voices.

“We're strapping [down] Aboriginal, East Indian, [and] Asian people far longer than white people,” Dean said. “I couldn't deal with the way that they would manhandle people who were [showing] even just the slightest resistance. I've seen CCTV [footage of security guards] slamming people down to the ground, putting them in restraints, putting them in cuffs.”

A paramedic, who talked to Capital Daily on condition of anonymity, said some of these experiences are owed to the emergency department being chronically understaffed. When nurses are looking after eight patients at a time, he said, people who are at risk of being violent towards themselves or others are often strapped down.

At the same time, he said these measures are used against people from marginalized communities—so much so that it is not uncommon for unhoused people in medical distress to refuse to go to the Jubilee because of their past experiences in the emergency department.

“I'm trying to put this in a way that is fair to the burnout and stress of folks but also recognizes that that means that people aren't getting adequate care, and also recognize that some people are just assholes too,” the paramedic said.

People who have access to housing and follow-up care are also more likely than an unhoused person with the same affliction to get a robust treatment plan.

“When you have finite resources, this is battlefield triage,” the paramedic said. “I don't think the public understands how catastrophically overwhelmed the emergency services system is right now: we're in a full on abject failure freefall, and we have been for a year.”

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Once a patient was restrained, Dean said, overt racism would begin. Some nurses, security officers, and managers would use words like “pukes” and “scabs” to describe these patients and make racist jokes, often within earshot. When patients heard these terms, Dean said they would “scream and yell and call us assholes.”

“My supervisor would be like, ‘If you don't be quiet, we're gonna give you another shot,’” Dean said. “It just always happened to be either First Nations people, vulnerable people, [and] the homeless.”

In contrast, Dean said white people he saw in the hospital ER with alcohol poisoning—who would act in a similar manner to racialized people experiencing an overdose or mental health crisis—were treated with compassion and care.

With these patients, Dean saw nurses do their best to calm them down, rubbing their shoulders, using terms of endearment—“It’s okay, honey!”—and taking care to explain their treatment to them in detail.

Dean looks white, but is Indigenous. When he heard the “jokes” and witnessed the differential treatment of racialized people in the ER, he complained to his manager.

“My training manager told me specifically, ‘This is how we handle it. We have a dark sense of humour here. If you can't handle it, don't come here,’” he said. “I’m like…‘I don't have to make jokes about people going through a crisis in order to deal with the stress of the job.’”

Island Health did not directly respond to these allegations, saying in an emailed statement, “Racism has no place in any hospital, health-care setting, or in society. It most certainly has no place at Island Health.”

The health authority added that it has taken actions to better support Indigenous patients since the publication of the “In Plain Sight” report in November 2020.

That report was published after allegations surfaced of a racist guessing game—in which healthcare workers in emergency rooms played a Price is Right-type game to guess the blood alcohol level of Indigenous patients. The report did not find evidence of this game, but did uncover extensive anti-Indigenous racism in healthcare: 84% of Indigenous people who participated in the study said they had experienced discrimination from healthcare workers, often in the form of verbal and physical abuse.

“Since the In Plain Sight report, Island Health has taken action to act on the recommendations to improve the ways we support Indigenous People,” Island Health said in its statement. “This includes additional Indigenous Liaison Nurses, improved Cultural Safety training and practice standards to shift people from bystanders to allies, and additional information for patients.”

The health authority also added that it is conducting an assessment to review “the current state of education and development” at the Jubilee’s emergency department to determine its level of cultural safety training. “This review will recommend changes needed to better support staff in their learning.”

The behaviour alleged by Dean, Callahan, and others largely took place after the In Plain Sight report was published. Dean worked at the Jubilee hospital the summer after the report came out and said it made no difference to what was happening on the front lines.

“As my training went on, the first month I did what I was told to do, and by the second month, I was starting to see it for what it is basically,” Dean said. “I started to mentally and emotionally and physically pull away from what I was seeing and what I was learning.”

Dean was diagnosed with anxiety after he quit the job two months in. Even as he recounted the story nearly a year later, he said it was mentally distressing to relive the trauma he witnessed against other Indigenous and racialized people.

“If they’re coming here for care and we’re hurting them in the process, then what the hell are we doing?” he wondered out loud.

No water

One of the first things Island Health asks when confronted with an allegation of discrimination is whether or not the patient—or staff member—lodged a complaint with their Patient Care Quality Office.

Dean, for example, did not do so after his complaints were routinely dismissed by his superiors. He said he regularly heard patients’ families in the emergency department complain about how their relatives were being treated and ask why they were strapped down to the bed. Nothing was ever done about those complaints on site, he said.

One person who did formally complain about her experience said it was “the most useless conversation I’ve ever had in my life.”

Assetou Coulibaly’s experience at the Royal Jubilee was reported by Saanich News last summer. A young Black woman, Coulibaly went to the hospital in May 2021 with intense migraines, after being told by a doctor to go to the ER because her symptoms aligned with meningitis.

One of the first questions she was asked by a nurse was whether or not she was drunk. During the many hours she waited to see a doctor, she remembers crying and asking nurses for water, to no avail.

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“The doctor was the only one who [had] actually given me information and who had actually been nice to me,” Coulibaly told Capital Daily. After the doctor left and nurses were left to administer IV medication and conduct a blood test, she said they ignored her questions and concerns and did not explain the effects her medication would have.

“I started to go into a panic attack, because, how she told me I was gonna feel, I did not feel it,” Coulibaly said. “I felt like I was literally out of my body and that there were just things crawling in my body.”

Her anxiety worsened to the point where she decided to leave the hospital. “I remember [thinking]... the worst thing that could happen to me is I die, and I would rather die a dignified death in my home, safe and at least at peace and being treated like a human being,” she said.

Coulibaly was contacted by a specialist about a week later; that was her first contact with anyone from the hospital since she left. That was when she decided to formally complain to the Patient Care Quality Office.

“What she said was that there’s not a lot she can do,” Coulibaly said. She was told that the Patient Care Quality Office would send a memo to the nurses’ manager about Coulibaly’s experience. Coulibaly said she never received a formal apology from any of the nurses involved, and said there were no commitments to change.

Island Health said it takes all patient complaints seriously. “We are always concerned when the care received does not meet a client’s expectation,” they said in their statement. “Clinical leadership take learnings from patient care quality reviews to connect back with front line clinical staff to continue to reinforce culturally safe standards of care.”

Coulibaly is certain her experience was a result of racism. She witnessed nurses going out of their way to help white patients who were waiting in the same department, while ignoring her simplest request: a cup of water.

“Honestly, I would rather go anywhere else [besides the Jubilee]. I don't care how much I have to pay in cab fare,” she said. “When I was at my most fragile, I was treated like absolute scum.”

In the last few years Coulibaly has heard of several other people of colour who have had similar racist experiences at the Royal Jubilee emergency department. One of them is her friend who is also Black—and an Island Health employee.

Danielle works in a hospital in Victoria, and requested to remain unnamed in fear of retaliation from her managers. When she went to the Jubilee emergency room in November 2020 with chest pains from a severe anxiety attack, Danielle says she was treated with the same level of indifference that Coulibaly described.

Through heavy tears, chest pain, and an anxiety attack that made her feel like her legs were going numb, Danielle says she was met with nothing but blank stares from nurses. She says no one offered her water or kleenex, but she watched them pay far closer attention to the needs of white patients.

“I was the only one in there that was actually having an external crisis and they did nothing about it,” Danielle said. “I just felt a lot of shame when I was there because of the way that the nurses were just looking at me as I was crying.”

Like Coulibaly, Danielle remembers feeling as if the nurses did not see her as a human being. And like Coulibaly, she said she will not return to the Jubilee emergency department again by choice.

Lack of urgency

At the Jubilee Hospital—and in other facilities that offer these services—the level of care afforded to patients experiencing a mental health crisis has also been criticized for being subpar.

The Psychiatric Emergency Services department at the hospital has faced repeated allegations of patient mistreatment at the hands of healthcare workers. Earlier this fall, Capital Daily reported on the death of Glen Fawkes, who died by suicide after he was told to “take back your autonomy” by the psychiatrist who discharged him.

But even before it is decided whether a patient needs to be admitted to PES, people experiencing a mental health crisis have to go through screening procedures, during which many face racial discrimination.

Amy Allard, co-founder of grassroots, Indigenous-led non-profit See Spring Mental Wellness Coalition, says her team has been trying to get funding to rent a building across from the Jubilee hospital. There, they hope to establish a 24/7 peer-support site where people—particularly Indigenous and racialized folks—can have someone to talk to while waiting to see a doctor.

“When people present to the ER, if they're having a panic attack, feeling suicidal self harm, hearing voices, postpartum depression, all of those issues could be dealt with across the street at a peer center, and it would be open 24/7, especially on the holidays, run by people with lived experience,” Allard told Capital Daily. “It wouldn’t need nurses and doctors who are so short staffed right now.”

The group prioritizes Indigenous-led care, and says at least half the staff running this peer support centre would be Indigenous.

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“Right now, with all these unmarked graves that have been found, there's a real heavy state of unrest in [First Nations] communities,” said Jessica Underwood, the group’s head Indigenous advisor from Tsawout First Nation. “Suicide is at an all-time high rate in my community, and there's no one for them to talk to.”

Allard said she decided to found See Spring after witnessing a racist encounter at the Jubilee’s emergency room in December 2020, while waiting to get tested for COVID-19.

“I witnessed an elderly First Nations man recoiling at the COVID test,” Allard said. “The physician was very frustrated…and he screamed, ‘you fucking drunken Indians.’”

According to Allard, the patient’s family tried to complain but she says staff took no action. Allard remembers the man’s daughter looking around the room, at the 30 or so patients gathered there, and challenging their lack of action.

“In that moment, she locked eyes with me and I just made a promise with her that I was not going to walk away and be one of those people that pretended that didn’t happen,” Allard said.

In recent months, See Spring has been working on providing mental health care on the front lines after receiving a grant that allowed them to set up a phone line for people who are experiencing—or witness someone experiencing—a mental health crisis, instead of calling the police.

But after months of trying to talk to Island Health about acquiring the building across from the hospital to establish a peer support centre, they have yet to be approved.

“As far as I know, the building is still available, but we have not heard back yet,” Allard said.

Island Health told Capital Daily it is aware of the group’s proposal but has no details to share.

Ministries respond

In an interview with Capital Daily, BC’s Minister of Mental Health and Addictions Sheila Malcolmson said she had been unaware of the allegations of racism and discrimination described in this article, but added that her government is committed to creating a healthcare system that is free of racism.

“Broadly, across the province, we want, when people reach out for help, for them to be met with care in a dignified and respectful and racism-free way. And that's work that we have well underway, but we know that there's much more to do. It's vital,” Malcolmson said.

“At the same time, our public health care system is understaffed. We're fighting two public health emergencies, and I recognize everybody is under tremendous pressure. If not for the pandemic…we would have been further ahead.”

Many of the patients and staff members who shared their experiences with Capital Daily said they’ve heard from others who have gone through similar racist and discriminatory incidents at the Royal Jubilee Hospital emergency department that predate the pandemic.

The systemic racism that plagues Victoria’s healthcare system, they say, has not abated with time, despite politicians and health authorities repeatedly proclaiming their commitment to change.

The Ministry of Health also responded to some of these allegations, saying it is aware of ongoing discrimination against Indigenous people across the province, but did not respond to allegations of patients being dumped at the bus stop while still in need of medical care.

To address anti-Indigenous racism, the ministry said it has created an Indigenous Health and Reconciliation Division within the Ministry of Health, and will soon be releasing a report to track the progress of implementing the In Plain Sight recommendations.

“We acknowledge that we cannot move fast enough to respond to historic and ongoing Indigenous-specific racism,” the ministry said in its statement. “Profound systems transformation takes time, dedication, and ongoing work to ensure cultural humility is embedded and Indigenous-specific racism is eradicated.”

Before working at the Jubilee, Dean said he had read about the allegations of racism in hospitals in the news.

“I was like, ‘I don't believe that, I'd never see it,” he said. “But seeing the level of care, and the disregard that they have at the hospital…I believe it now.”

—With files from Tori Marlan

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