The Little Salmon-Carmacks First Nation and the family of Cynthia Blackjack are requesting the chief coroner of Yukon to hold an inquest into her death.

Represented by Susanna Roothman, they argued in Yukon Supreme Court in Whitehorse last week that the coroner’s original investigation did not examine the role systemic racism may have played.

Blackjack, 29, died on Nov. 7, 2013 while being medevaced from Carmacks to Whitehorse.

Roothman claimed there is systemic racism at the Carmack’s Health Centre, especially when the First Nation’s members require an ambulance.

“In some cases, people are so sick that they are carried to the nursing station by a family member,” she said.

The First Nation made complaints about the health centre in 2011, but according to Roothman, “nothing was really done about it.”

She filed letters from a previous chief, a councillor, and a member of the First Nation with the court. They detailed concerns about the medical treatment that Blackjack received.

“Many people do not want to seek medical attention now due to the outcome of what happened to Cynthia,” read one of the letters.

Following Blackjack’s death, chief coroner Kirsten Macdonald began an investigation.

It included having Blackjack’s teeth examined by a forensic dentist, seizing and testing blood taken at the nursing station, interviewing people who saw Blackjack leading up to her death, and referring material to medical professionals in Ontario.

She concluded that Blackjack’s death was “natural” and a result of multi-organ failure due to hyperacute liver failure of an unknown cause.

She also made eight recommendations to the territorial Department of Health and Social Services.

Justice Ron Veale noted that “the Coroner’s Act is ancient, it’s really not suitable for modern times.”

Within the “narrow focus” of a coroner’s inquest into medical reasons for the death, however, Macdonald did “a pretty detailed job,” Veale said.

“What you’re seeking to do is to broaden a coroner’s inquest into something relevant to today’s society and to the First Nation,” he said to Roothman.

But Veale expressed concerns that an inquest would be repetitive of the work done in the original investigation.

A coroner’s inquest is a quasi-judicial process where a six-member jury hears witness testimony and evidence about a death.

They determine the exact circumstances of death and make recommendations that are not legally binding.

Section nine of the Coroner’s Act states that the coroner may hold an inquest if he or she has reason to believe someone died due to “violence, misadventure or unfair means as a result of negligence, misconduct or malpractice on the part of others or under any circumstances that require an inquest.”

Roothman argued that an inquest should be ordered in this case under “any circumstances.”

However, Richard Buchanan, the lawyer for Macdonald, said this is too broad.

“How wide do we want to open the gates up to an inquiry?” he asked.

“If you open up the door to a much broader range of issues, then it could be extremely broad.”

Roothman noted that an inquest would shed a light on the issue of systemic racism in health care provision experienced by First Nation members in northern communities.

“As long as these issues are not publicly aired, publicly questioned, nothing will be done about it,” she said.

“This will be wiped underneath the carpet and onto the next person who dies under similar circumstances.”

Buchanan suggested a public inquiry may be a more appropriate venue.

However, Veale noted the First Nation has already gone back and forth with the Yukon government on this issue.

“They weren’t getting anywhere pursuing that avenue,” he said.

Buchanan also argued the court has no jurisdiction, as Macdonald already decided against an inquest in Blackjack’s death.

In 2015, the First Nation asked Macdonald for an inquest but she refused.

“There may very well be and quite likely is some degree of discrimination in our health care system,” said Buchanan, noting the coroner takes no position on this issue.

But he claimed in this case, there is no hard evidence linking systemic racism to Blackjack’s death.

“It’s all speculative,” he said.

“There’s more evidence before the court today of alcoholism than racism.”

On Nov. 6, 2013 Blackjack visited the health centre complaining of a toothache, abdominal pain and vomiting.

She was tentatively diagnosed with alcohol-induced gastritis and treated accordingly.

She was known to health centre staff as suffering with alcoholism.

She was also urged to make her way to Whitehorse General Hospital or come back later that day. She did not make the two-hour drive nor return.

The following day, she was brought to the health centre by ambulance in an “agitated and disoriented state.”

There was an alleged hour-and-a-half delay with the ambulance, and ventilation equipment failed to work at the centre.

The decision was made at 11:15 a.m. to medevac Blackjack to Whitehorse General Hospital, and the flight left Carmacks at around 5:11 p.m. A blood transfusion was delayed due to wrong tubing on the plane.

During the flight, she lost vital signs 10 minutes outside of Whitehorse. She was pronounced dead at 5:59 p.m.

Veale noted that he found many facts surrounding Blackjack’s death “very bizarre,” including that she was told to find her own way to the hospital, and the ambulance delay.

He also questioned why the coroner did not address the First Nation’s concerns earlier.

“It doesn’t seem to me that’s an appropriate response, whether the inquiry was over or not,” he said.

Veale has reserved his decision in the case.