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Whitehorse shelter deaths inquest suggests training, policy shortcomings

Coroner’s inquest into four deaths at emergency shelter hears about lacklustre overdose training
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The Yukon Coroners Service is currently holding an inquest into the deaths of four Indigenous women at the Whitehorse Emergency Shelter in 2022 and 2023. (Yukon News file)

The following story contains details which some readers may find distressing. Rapid access counselling is available in the Yukon from Mental Wellness and Substance Use Services by calling 867-456-3838. Additional support includes the Suicide Crisis Helpline (call or text 988), Hope for Wellness (1-855-242-3310) and the 24-Hour Residential School Survivor Crisis Line (1-866-925-4419). The Selkirk First Nation, the Little Salmon/Carmacks First Nation and the Vuntut Gwitchin Government are offering counselling and support specifically for their citizens.

A coroner’s inquest into the deaths of four Indigenous women at the Whitehorse Emergency Shelter continued on April 11 with testimony from shelter clients and a staff member.

The inquest is probing the deaths of Cassandra Warville, Myranda Aleisha Dawn Tizya-Charlie, Josephine Elizabeth Hager and Darla Skookum.

In the morning, video footage captured at the shelter was aired. It showed the final hours of Hager’s life. Hager was reported dead on Feb. 1, 2023, at the age of 38.

In the afternoon, after the footage was aired, witnesses who’d used the shelter’s services or worked there testified before the inquest about some of the deceased individuals. Witnesses’ names are now protected by a publication ban, which the Yukon Coroner’s Service issued on April 11.

One woman told the inquiry that she was with Warville and Tizya-Charlie on the evening they both died in a shower room at the shelter. She described them as “really good friends.”

“We were all pretty much drinking that night, pretty much hanging out at the shelter,” she said, speaking about the night of Jan. 18, 2022. She also recalled marijuana and crack cocaine being consumed.

The same witness was also present on the night of Hager’s death. She recalled that Hager felt poorly on the day she died.

“I remember telling her that she should go to the hospital. It was early on during the day, and she kept saying that her stomach was hurting [and] her chest pains, and I was worried. She wouldn’t go. She was always stubborn. She didn’t want to do it. She didn’t want to go,” she said.

In cross-examination of the witness, the lawyer for Connective, the company currently responsible for operating the Whitehorse Emergency Shelter, noted that the video footage of Hager’s final hours alive showed her “laying on the floor” with people walking past her. The lawyer asked if it was normal for Hager to sleep on the floor, to which the witness responded affirmatively.

Another witness, who has also utilized the emergency shelter’s services, said he was involved in efforts to revive Hager. He claimed that on the night of her death, “She was just lying there, no one to check on her and she wasn’t breathing or anything.”

He additionally claimed that shelter staff did nothing to help her.

“I tried to help her, because those workers left her there, laying on the ground, for so long, and I tried to feel her pulse and there was nothing,” the witness said, adding that he has first-aid training.”

He noted that it was not abnormal for shelter clients to “pass out” in common areas. However, he indicated that shelter staff don’t check on clients sleeping in common areas “as much as they should.” This witness repeatedly stated that shelter staff are “rude towards natives.”

The final person to testify on April 11 was a shelter employee who began working as a support worker there in March 2022. He also stated that it was not uncommon for Hager to sleep in the shelter’s common areas.

“Sometimes Josie wanted to be helped back to her room, but oftentimes she just wanted to stay where she was, and it was often on the floor or in a stairwell,” the shelter staffer told the inquest.

He said that his recollection of the night Hager died was not good. However, he did remember seeing her multiple times throughout the night. He recalled seeing Hager on the floor around 4:20 a.m.

“She was on the floor at that point, I believe. She appeared intoxicated based on slurring words, and her head would be down, she wouldn’t be looking up and found it hard focusing […] I was checking in on her, [asking] her how she’s doing, and she wasn’t interested in talking or receiving help from anyone at that point,” the shelter staffer said.

Legal counsel grilled the employee on when calling for emergency medical services was appropriate. The employee noted they’d sometimes call for paramedics, depending on the situation.

He also stated he was instructed not to call for emergency medical services unless the person in distress wanted help from paramedics. “We were also told that if people did not want paramedics, to not call paramedics, because they would come and the person wouldn’t want help,” the shelter staffer said.

“And then [the paramedics] would leave, and then they’d say, ‘Don’t call us.’ So, we were kind of discouraged if clients did not want any medical help from professionals. Obviously, you can make a call and call a paramedic. But they come in, and then they leave right away. So, we didn’t always call paramedics.”

He later alleged that paramedics and 911 dispatchers told him not to call for emergency medical services. He said Connective never discouraged staff from calling for emergency assistance and that it was encouraged “under the right circumstances,” such as if a client was unresponsive.

The shelter employee also said that he did not recall if Connective had a specific policy regarding when paramedics or police assistance should be called.

When asked if it was okay for people to consume drugs and alcohol in the shelter, the employee testified that there was not much that could be done to stop clients from using substances .

“The fact of the matter is, people don’t listen. We can say, ‘Don’t drink alcohol inside or outside. Don’t do drugs inside or outside.’ People don’t listen, and they do it anyway,” the shelter staffer said, adding that clients would be asked to leave if they were caught doing drugs on the premises.

Concerning emergency preparedness, the shelter staffer said he’d partook in drills during first-aid training but never participated in an overdose response drill or a medical response drill.

He further noted he did not recall receiving further training from his employer following Hager’s death.

Echoing comments about lacklustre training regarding substance use made on the inquest’s second day by former shelter employees, the staffer who testified on April 11 said that he did not receive training on how to recognize signs of alcohol intoxication.

Inquests held by the Yukon Coroner’s Service are intended to serve three main functions: determine the facts related to a death (or deaths), make recommendations — if appropriate and supported by evidence — to prevent future deaths in similar circumstances and assure the community that the death (or deaths) is not being overlooked or ignored.

Coroner’s inquests are not an adversarial process or trial and are not intended to assign blame.

Although inquests into more than one death are uncommon, the chief coroner can call a single inquest into more than one death if the facts and circumstances of the deaths are “sufficiently similar” to the extent that a “common inquest is the most efficient and effective way of inquiring into the deaths,” according to the Yukon’s Coroners Act.

The coroner’s inquest began on April 8 and is expected to last three weeks. It is expected the inquest will move on to Skookum’s death on or around April 15.

Skookum also died at the shelter in early 2023.

Contact Matthew Bossons at matthew.bossons@yukon-news.com.



Matthew Bossons

About the Author: Matthew Bossons

I grew up in a suburb of Vancouver and studied journalism there before moving to China in 2014 to work as a journalist and editor.
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