Manitoba health officials admit racism in care of Indigenous man who died of cancer – CBC

Case Report: Systemic Healthcare Failures and Sustainable Development Goals

Incident Overview: The Case of Stephen Rockwell

This report details the case of Mr. Stephen Rockwell, a 33-year-old Indigenous man and member of the Shamattawa First Nation, who died on March 13, 2024. His death occurred four months after a delayed diagnosis confirmed the recurrence of acute myelogenous leukemia. A subsequent review by the Northern Regional Health Authority in Manitoba acknowledged that racism was a contributing factor in the standard of care he received. This case presents a significant failure to uphold key United Nations Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 16 (Peace, Justice and Strong Institutions).

Analysis of Healthcare Delivery in Relation to SDG 3: Good Health and Well-being

Chronology of Medical Events

1. Early 2023: Mr. Rockwell was diagnosed with acute myelogenous leukemia and subsequently entered remission following chemotherapy in the summer.
2. October 2023: Mr. Rockwell began experiencing a severe decline in health, including debilitating back pain and other symptoms. He made three separate visits to the Thompson General Hospital.
3. Late 2023: During his hospital visits, his symptoms were reportedly dismissed. Medical staff attributed his condition to stress and, according to his family, stereotyped him as a “drug-seeker.”
4. Intervention: A chiropractor identified a mass in Mr. Rockwell’s spine and hip and issued a formal letter requesting a CT scan.
5. Diagnosis Confirmation: Following initial resistance from hospital staff, a CT scan was performed, revealing extensive tumors. He was immediately transferred to CancerCare in Winnipeg.
6. March 13, 2024: Mr. Rockwell passed away following aggressive but belated treatment.

Breaches of SDG Target 3.8: Universal Health Coverage

The case demonstrates a clear breach of SDG Target 3.8, which aims to ensure universal access to quality essential healthcare services. The barriers faced by Mr. Rockwell included:

• Failure to Provide Quality Care: The dismissal of severe pain and other symptoms in a high-risk cancer remission patient constitutes a failure in the provision of quality care.
• Lack of Equal Access: The family reports that Mr. Rockwell’s Indigenous identity led to discriminatory treatment, denying him the same level of care and diagnostic urgency afforded to other patients.
• Delayed Diagnostics: The refusal to conduct timely diagnostic imaging, despite clear indicators, delayed critical treatment and directly contravened the principles of universal health coverage.

Impact on SDG Target 3.4: Reduction of Premature Mortality

SDG Target 3.4 calls for a one-third reduction in premature mortality from non-communicable diseases like cancer. The delays in Mr. Rockwell’s treatment directly undermined this goal. Had his recurring cancer been identified during his initial visits in late 2023, the prognosis and treatment outcomes might have been substantially different, potentially preventing his premature death at age 33.

Racial Discrimination and a Failure to Meet SDG 10: Reduced Inequalities

Evidence of Discriminatory Practices (SDG Target 10.3)

The treatment of Mr. Rockwell highlights a failure to ensure equal opportunity and reduce inequalities of outcome, as mandated by SDG Target 10.3. Specific instances of discrimination reported by his family include:

• Negative Stereotyping: He was allegedly accused of seeking drugs, a common and harmful stereotype applied to Indigenous peoples seeking pain management.
• Perceived Bias: Mr. Rockwell reportedly felt his treatment was negatively impacted by the presence of his Cree mother, suggesting that visible Indigenous identity was a factor in the care he received.
• Unequal Standard of Care: The patient himself reportedly asked medical staff to treat him like everyone else, indicating a perceived disparity in his care.

This experience aligns with a June 2024 provincial report that found Indigenous patients and people of colour generally experience longer wait times in Winnipeg emergency departments, indicating a systemic, rather than isolated, issue of inequality.

Institutional Accountability and SDG 16: Peace, Justice and Strong Institutions

Institutional Response and Accountability (SDG Target 16.6)

SDG Target 16.6 emphasizes the need for effective, accountable, and transparent institutions. The response in this case reveals both systemic weaknesses and subsequent steps toward accountability.

• Initial Institutional Failure: Thompson General Hospital staff failed to provide an appropriate institutional response to a patient in severe distress, reflecting a lack of accountability at the point of care.
• Official Acknowledgment: The Northern Regional Health Authority later met with the family and formally admitted that racism was a factor in Mr. Rockwell’s treatment. This admission is a critical first step toward accountability.
• Government Commitment: Manitoba’s Health Minister acknowledged the existence of systemic racism within the healthcare system and commended the health authority for its admission, pledging to ensure such incidents are not repeated.
• Existing Frameworks: The health authority had previously signed a 2022 declaration to eliminate Indigenous-specific racism, indicating that while policy frameworks may exist, their implementation and enforcement remain a critical challenge.

Conclusion: A Call for Action Aligned with Sustainable Development Goals

The tragic death of Stephen Rockwell is a case study in how systemic racism in public institutions directly obstructs the achievement of global development goals. The failure to provide equitable and timely healthcare not only resulted in a preventable, premature death (violating SDG 3) but was rooted in discrimination that perpetuated systemic inequality (violating SDG 10). While the subsequent admission of fault by the health authority is a positive step toward institutional accountability (SDG 16), it underscores the urgent need for systemic reform.

Recommendations for SDG-Aligned Action

• Implement Mandatory Anti-Racism and Cultural Safety Training: All healthcare staff must undergo continuous, mandatory training to dismantle stereotypes and ensure equitable treatment for all patients, in line with SDG 10.
• Establish Transparent and Empowered Oversight Mechanisms: Create independent bodies to review patient complaints of discrimination, ensuring that institutional accountability (SDG 16) is swift, transparent, and just.
• Monitor Health Outcomes by Demographic Data: Actively collect and analyze race-based data to identify and rectify disparities in treatment times, diagnostic rates, and health outcomes, thereby advancing the goals of SDG 3 and SDG 10.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: This goal is central to the article, which details the failure of a healthcare system to provide timely and adequate care for a patient with cancer, leading to his premature death.
• SDG 10: Reduced Inequalities: The article explicitly states that racism against an Indigenous man was a factor in his treatment. This directly addresses the issue of inequality based on race and ethnicity within a critical public service.
• SDG 16: Peace, Justice and Strong Institutions: The article touches on the accountability of public institutions. The family’s struggle to have their concerns heard and the eventual admission of racism by the health authority relate to the need for effective, accountable, and transparent institutions.

2. What specific targets under those SDGs can be identified based on the article’s content?

• Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
  • Explanation: Stephen Rockwell died at age 33 from leukemia, a non-communicable disease. His death is described as potentially preventable had his cancer’s return been diagnosed and treated faster. His family’s questions, “What if they would have listened to us? What if they would have given him treatment faster?” highlight the failure in treatment that led to his premature mortality.
• Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
  • Explanation: The article demonstrates a failure to provide “access to quality essential health-care services.” Stephen Rockwell was denied a timely CT scan, his severe pain was dismissed, and he was stereotyped as a “drug-seeker.” This shows a lack of quality and effective care, which was only provided after a chiropractor intervened.
• Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.
  • Explanation: The article is a case study of the exclusion of an Indigenous person from proper healthcare. The health authority’s admission that he “was subject to racism while seeking treatment” confirms that his ethnicity was a barrier to his inclusion and fair treatment within the healthcare system.
• Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices and promoting appropriate legislation, policies and action in this regard.
  • Explanation: The unequal outcome for Stephen Rockwell was death. The article points to a discriminatory practice where a medical professional “accused her brother… of only visiting the hospital to get drugs” because he was Indigenous. The health authority’s commitment to “more education for staff around anti-racism” is a policy action aimed at eliminating such discriminatory practices.
• Target 16.b: Promote and enforce non-discriminatory laws and policies for sustainable development.
  • Explanation: The core issue is the failure to enforce non-discriminatory policies within the hospital. The treatment Stephen Rockwell received, based on racial stereotypes, is a direct violation of the principle of non-discrimination that should govern public institutions like healthcare. The health authority’s admission and subsequent promises are a response to this failure.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Mortality rate attributed to non-communicable diseases (related to Target 3.4):
  • Explanation: The article provides a specific case study of a premature death at age 33 from cancer. While not a statistical rate, it is a qualitative data point illustrating a failure to prevent premature mortality from a non-communicable disease.
• Disparities in healthcare access and quality based on ethnicity (related to Target 3.8 & 10.3):
  • Explanation: The article explicitly mentions a report that found “people of colour, including patients who identify as Indigenous, generally spend longer in Winnipeg emergency department waiting rooms than white people.” This provides a measurable indicator (comparative wait times) of unequal access to healthcare.
• Proportion of population reporting having personally felt discriminated against (related to Target 10.3):
  • Explanation: The entire narrative is a detailed report of discrimination. Stephen Rockwell’s family is certain “racism contributed to the medical treatment her son received,” and the health authority officially admitted that “racism played a role.” This serves as a documented instance for this indicator.
• Existence of independent national human rights institutions and institutional accountability mechanisms (related to Target 16.b):
  • Explanation: The article implies the use of accountability mechanisms. The family’s complaint to the Health Minister’s office, the subsequent meeting with the Northern Regional Health Authority, and the authority’s public admission and commitment to “eliminating all forms of Indigenous-specific racism” are all actions that reflect the functioning (or pressure upon) institutional accountability processes.

4. Summary Table of SDGs, Targets, and Indicators

Source: cbc.ca