Niagara hospital system aims to overcome fear and mistrust among Indigenous patients

An Indigenous health leader in Niagara is hoping that a deep-seated fear that many Indigenous people feel in hospital is something that is being chipped away. 

Charity Beland, who is a member of Six Nations of the Grand River, Mohawk, Turtle Clan, is the manager of Indigenous Health Services and Reconciliation at Niagara Health, which operates three hospitals and two urgent care centres. There, she leads a team who make it their mission to create hospital settings where Indigenous people feel safe and valued.

The ongoing efforts by Niagara Health to improve Indigenous patients’ experience has earned the praise of a major Indigenous umbrella group in Ontario, with the caveat that there is still a long road ahead to regain trust.

It was the death of Heather Winterstein in 2021 at Niagara Health’s hospital in St. Catharines — now known as the Marotta Family Hospital — that led the hospital system to embark on a process of self-examination on the experience of Indigenous patients.

At the coroner’s inquest into her death earlier this year, testimony revealed that Winterstein, 24, sought care for extreme pain on two consecutive days but ended up collapsing after languishing for hours in the emergency department waiting room.

The inquest jury ruled she died from septic shock due to sepsis with delayed treatment, caused by a bacterial infection.

Testimony at the inquest suggested treatment decisions by some hospital medical staff may have been influenced by Winterstein’s Indigenous background, her history of substance use and anxiety. 

Ingrained racism a reality, expert says

Suzanne Shoush, a family physician who examines the experiences of Indigenous people trying to access care, testified at the inquest that bias in the healthcare system, where fewer than one per cent of doctors are Indigenous, makes many Indigenous people fearful of seeking care.

For generations, many Indigenous people have felt a sense of dread if they had to seek treatment for a medical condition at a Canadian hospital, where they often came face-to-face with anti-Indigenous bias or outright discrimination, says Shoush.

Shoush, Indigenous faculty lead at the University of Toronto’s department of family and community medicine, said that ingrained racism contributes to shorter lifespans, increased chance of preventable death and longer wait times for Indigenous people.

She stressed that cultural safety training must apply to everyone working in a hospital, from security and housekeeping staff, to top management and board members.

After Winterstein’s death, Niagara Health conducted an internal review and initiated an independent, third-party emergency department review that resulted in recommendations such as instilling cultural safety throughout Niagara Health’s staff, physicians and volunteers; promoting an Indigenous patient navigator team; seeking out Indigenous representation for governance; working on recruiting and retaining Indigenous employees, doctors and volunteers; and creating a separate Indigenous space for reflection and gatherings.

Niagara Health accepted all the recommendations.

In 2024, Niagara Health launched its first Indigenous health services plan to improve hospital services and experiences for Indigenous patients and their families.

The plan includes initiatives designed to improve access to healthcare services, enhance cultural safety, promote traditional healing practices within the hospital, strengthen relations with Indigenous groups, outline strategies for recruiting and retaining Indigenous healthcare professionals, and provide education and training for staff on cultural safety.

Some of the initiatives launched by Niagara Health include:

• Installing Indigenous artwork at all its sites.
• Allowing smudging ceremonies, which any patient or family member identifying as Indigenous can request. At the Marotta hospital, ceremonies can take place in patients’ rooms.
• Opening of an Indigenous community room, the Gathering of Good Minds, at the Marotta hospital. 
• Launching specialized training focused on cultural sensitivity and awareness.
• Planning an Indigenous healing centre at the new South Niagara hospital under construction in Niagara Falls. The hospital will also have an Indigenous healing garden.

Cultural sensitivity and awareness training

Beland said cultural sensitivity and awareness training began with top leadership, and has moved on to front line staff. The training is mandatory.

“Last I checked, I think we were at 77 per cent completion,” she said. “For a large organization we’ve had really, really good buy-in.”

Sean Longboat, chief executive officer of the Ontario Federation of Indigenous Friendship Centres, praised the efforts of Niagara Health. 

“We are encouraged to see the direction Niagara Health has taken to advance Indigenous health equity within their network system,” he said in a statement to CBC News. “Other hospital systems can and should learn from Niagara Health’s efforts.”

Other hospital systems can and should learn from Niagara Health’s efforts.– Sean Longboat, chief executive officer of the Ontario Federation of Indigenous Friendship Centres

But, “it will take time to regain Indigenous people’s trust, especially after losing a treasured family and community member like Heather Winterstein,” Longboat said.

Trust can only be repaired through sustained action and allowing Indigenous people to exert their autonomy and self-determination in the design and delivery of health services, he said.  

“More importantly, trust can only be regained when Indigenous people directly see the benefits of these initiatives on their lives and in their community.”

In 2025, Niagara Health entered a formal partnership with the Indigenous Primary Health Care Council to develop joint initiatives aimed at improving Indigenous health outcomes and addressing healthcare inequities. It was the first agreement of its kind with a hospital system, Niagara Health said.

The health council works with Indigenous primary healthcare organizations across Ontario to promote the health and well-being of First Nations, Inuit and Métis communities.

“This partnership is an important step towards creating a healthcare system that is responsive and respectful of Indigenous needs,” Caroline Lidstone-Jones, CEO of the health council, said last year.

Beland said it’s important not to shy away from using terms such as racism and discrimination when describing the Indigenous experience in hospitals, as uncomfortable as that may be.

“If we don’t use the words and we don’t use the language… then we’re doing the work a disservice,” she said. 

Beland said it’s “been really inspiring and surprising” to see a major hospital system commit to and follow through on efforts to policies aimed at improving the Indigenous experience.

“Our driving force is really making sure that the approaches we’re taking and initiatives that we’re moving forward are based on what the community identifies as important to them,” she said.

Coroner’s recommendations

The coroner’s inquest jury made 68 recommendations, most of which target Niagara Health alone or in conjunction with other agencies.

Longboat said the inquest recommendations provide a “roadmap for meaningful change” that other hospital systems should take seriously, and said discrimination and anti-Indigenous racism must be confronted head-on. 

Longboat said the provincial government, which plays a key role in accountability mechanisms that govern healthcare, must commit to holding itself to a higher standard to ensure the healthcare system cares for everyone living in Ontario.

“We cannot have another death like Heather Winterstein’s.”

Niagara Health president and CEO Lynn Guerriero, who testified at the inquest that discrimination and biases are ingrained in the healthcare system in Ontario and Canada, said in a statement to CBC News in April that Niagara Health will move forward in a “careful and deliberate way” to implement the recommendations.

“We know that systemic racism exists in healthcare, and addressing it is essential to improving safety, trust and outcomes for Indigenous patients and their families,” she said.