Aboriginal people face racism when they enter a hospital emergency room - even though hospital staff might not realize it.
Dr. Janet Smylie, an expert in aboriginal health care in hospital emergency departments based at St. Michael's Hospital in Toronto, said different cultural backgrounds lead to the racism.
"First people receive second class treatment," she told an inquest looking into the death of Brian Sinclair in the Health Sciences Centre's emergency waiting room.
Smylie said studies in Australia have shown their aboriginal people don't receive the same level of care for heart attacks than non-aboriginal people receive.
Smylie said providing aboriginal food in a hospital setting is only "the tip of the iceberg" when trying to deal with cultural differences.
She said ways to help aboriginal patients include addressing stereotypes, recognizing social determinants, and have aboriginal specific training.
Smylie said "the client relationship never really got started for Mr. Sinclair and many of these factors interfered."
Smylie said health care providers have to recognize there is a power imbalance in their favour when treating aboriginal patients because of past aboriginal experiences.
"If somebody already had an abusive experience with somebody in authority they can bring that when dealing with a health care provider," she said.
Sinclair, 45, died in the waiting room of the Health Sciences Centre's emergency department in Sept. 2008, after waiting 34 hours to have his blocked urinary catheter treated.
A coroner said Sinclair died from a treatable bladder infection and may have died up to seven hours before staff were alerted by other waiting patients.
When emergency room staff started working on Sinclair they stopped when they realized rigor mortis was already setting in.