Tylenol poisoning led to the death of Cynthia Blackjack, said a lawyer representing the Council of Yukon First Nations during the inquest into her death.
“We now know that the cause of death of Cynthia Blackjack was acetaminophen poisoning,” Gregg Rafter told the jury Jan. 28.
However, the original coroner’s report from 2014 says Blackjack died because of multiple-organ failure. Why her liver failed, though, remains unclear.
“The pathologist speculated that given the need for Ms. Blackjack to take ibuprofen and acetaminophen on a regular basis for her dental pain, these medications, in conjunction with chronic alcohol consumption, may have been the precipitants of her liver failure,” it says.
There has been no evidence submitted during the inquest to date that ascertains exactly how Blackjack died, said Debbie Hoffman, legal counsel to presiding coroner Peter Chisholm.
Pathologist Dr. Matthew Orde is expected to testify on Jan. 29 followed by Dr. Robert Saunders, who is to provide his opinion about the likely cause of Blackjack’s multiple organ failure.
A central focus of CYFN’s legal team this week hinges on whether Tylenol played any part in Blackjack’s death. Rafter asked medical professionals why, among other things, she wasn’t screened for having acetaminophen in her system and, upon doing that, an antidote administered, despite one being “readily available.”
The suggestion is that an alcohol-Tylenol cocktail could have proved deadly.
Matt Lewis, a nurse who testified this week, said a blood sample wasn’t taken on Nov. 6, 2013 in order to determine how much acetaminophen was in Blackjack’s system. She was tentatively diagnosed with alcohol-induced gastritis then.
“I certainly did not suspect any sort of acute ingestion of a large amount of acetaminophen,” said Lewis, adding that he was unsure whether the antidote was available. “At that time, I was not thinking of acetaminophen levels, to be honest.”
Lewis said he advised Blackjack to go to the hospital in Whitehorse in order to see a doctor, to follow up with the heath centre about it. She didn’t, he said, adding that she didn’t require an ambulance that day.
Jake Morash, who was a medevac physician the day Blackjack died, testified on Jan. 28. He said medical staff did their best to help Blackjack.
Asked whether treatment would have been altered had it been known Tylenol was in Blackjack’s system, Morash said, “In this case, I don’t think that would indicate any difference in the way we treated her.”
Lucille Stuart, a doctor who tended to Blackjack at the health centre on the day she died, testified that Blackjack couldn’t communicate how much Tylenol she took because she wasn’t speaking. It didn’t matter how much Tylenol was present, she continued — it was an emergency and nurses, along with herself, had to act fast to stabilize her.
A history of Tylenol ingestion would have been necessary and the antidote administered quickly, Stuart said.
“We were taking good care of Cynthia,” she said. “I want everyone to know that.”
Last week, Blackjack’s cousin, Dacia Tulk, said she gave her roughly six Tylenol and two Gravol. She said she did this because Blackjack worried no one would help her at the health centre.
Tylenol 3s, which is what Blackjack ostensibly took, have very low doses of acetaminophen per tablet, Stuart said.
“It should really not cause liver failure,” she said. “It’s impossible to say whether Tylenol did or did not contribute because we don’t have any accurate, objective information about her actual Tylenol consumption.”
Stuart said she was informed that Blackjack hadn’t been taking a potentially dangerous amount of Tylenol.
Another theme of the inquest deals with inadequate transportation to the hospital in Whitehorse, whether Blackjack should have somehow been ensured a ride ahead of Nov. 7 by health centre staff.
The Yukon government needs to address a dearth of medical-related transportation from communities to the hospital, Stuart said.
“That’s the piece that has always been missing in the territories … Patients have to get their own ride. Across the board, everyone has the same problem getting to Whitehorse,” she said.
“There is no system in place in any community in the Yukon to get people who aren’t acutely ill to Whitehorse. It’s actually not the job of nurses or the doctors to find rides for people and it’s a frustration because clients say they can’t find rides but it’s really not our jobs.”
Blackjack died minutes before touching down in Whitehorse via medevac. She had contacted the Carmacks health centre in the days leading up to her death complaining of dental pain, and the day before she died, gone to the centre in person, where she was tentatively diagnosed with alcohol-induced gastritis.
Contact Julien Gignac at firstname.lastname@example.org