IQALUIT - A coroner's inquest into the death of a woman released to police by Qikiqtani General Hospital in August 2009 began hearing testimony last week.

Elisapee Michael died in an Ottawa hospital from head injuries sustained from a fall down the front steps of the Nova Inn in Iqaluit.

A six person jury - four women and two men - is examining the circumstances surrounding the death of the 52-year-old woman.

According to the facts stated by coroner Garth Eggenberger, who is presiding over the inquest, Michael had gone to the Nova Inn bar, where she consumed a number of alcoholic drinks. She was asked to leave the bar and was seen falling down the stairs of the hotel. A security guard found her unresponsive so an ambulance was called and Michael was taken to the hospital.

Michael was deemed disruptive at the hospital, the RCMP was called and she was taken into custody and put in a cell. She appeared to be intoxicated but co-operative. Shortly afterward, it was noted she had vomited. RCMP checked her periodically and she appeared to be sleeping. After a long period of time - which was not specified - concerns were raised and the RCMP entered the cells where Michael was found unresponsive. She was sent to the Qikiqtani General Hospital where it was noted she had a head injury. She was medevaced to an Ottawa hospital the next day where doctors determined Michael had a severe brain injury. After consultation with her family, Michael was taken off life support.

William Ishulutak, Michael's 34-year-old son, testified last Monday that on Aug. 8, 2009, he arrived at the Nova Inn at about 8 p.m. and found his mother sitting alone at a table at the Kickin' Caribou Lounge with two empty beer cans.

He ordered dinner and drank four beers while his mother had four more drinks. Ishulutak said he left at about 10 p.m. He added his mother asked for $40 and taxi fare, so he gave her $60.

Eva Michael, Elisapee's sister, testified she got a call at about 11:15 p.m that night from a cousin, saying Elisapee was unconscious outside the Nova Inn and an ambulance was about to pick her up. Eva said she arrived at the hospital at about 11:30 p.m., and spent about 45 minutes there. She said she saw her sister but was unable to talk to her as she was being sedated to calm her down.

Eva said she gave her phone number to the nurse to call her if her sister woke up. She said on Sunday she tried to find her sister, calling the hospital, her home and her other sister, to no avail. On Sunday night an interpreter at the hospital called to tell her Elisapee was unconscious and was to be medevaced to Ottawa the next day.

She said she previously received no calls from the RCMP nor the nurse that Elisapee was going into the cells nor did anybody explain why her sister was sent to the cells. Eva flew to Ottawa and arrived at the hospital at about 5 p.m.

She said the surgeon there told her the surgery had a 50/50 chance of success and the survival rate after surgery was less than 50 per cent. Her family chose not to proceed with the surgery, and Elisapee Michael died Aug. 13, 2009.

Eva said the surgeon told her had Elisapee been treated for her injury within two hours of falling down the stairs, it would have made a difference.

Dr. Bruce Johnson, speaking via video conference from the Invermere Hospital in Invermere, B.C., on Tuesday apologized twice for Michael's death.

"On hindsight, she did have a head injury and I personally regret this terribly," he said under cross-examination. "My clinical judgment was intoxication, not head injury."

The South African-trained doctor, the physician on duty at the emergency room of Qikiqtani General Hospital from 8 p.m. on Aug. 8, 2009, to 8 a.m. Aug. 9 testified for two hours.

Johnson testified he first encountered Michael at 11:30 p.m. on Aug. 8 in the hospital's emergency department as the patient was being examined by a second-year resident. He added he understood Michael had fallen down stairs outside an Iqaluit hotel and understood she also had been drinking.

The patient's level of consciousness improved, he said. The patient's body was examined, including her head where swelling was observed, as Johnson said he was looking for signs of a skull fracture. He added both he and the intern's gloves had blood on them but both could not find its source, nor could they confirm it came from the back of the patient's head.

As Michael was in a collar brace, Johnson said it made it difficult to examine the back of her head. He added it was decided to keep Michael for observation in the emergency, as the hospital was full. No X-rays were taken as the technician had already been to the hospital a few times that evening, and Johnson said he didn't want to disturb him.

Johnson said he could not definitely rule out a skull fracture, internal brain bleeding or brain bruising as there is no CT-scan machine in Iqaluit.

He also admitted the symptoms of head injury and intoxication can be similar but that he felt Michael was likely intoxicated.

A nurse at Qikiqtani General Hospital said Michael was sent to the RCMP cells because she was being combative and it was for her own protection and that of others.

"We couldn't control her," said Rob McLean, one of the two nurses on staff at the hospital when Michael arrived.

On Thursday, the inquest heard a tape of an interview police did with McLean, now deceased, recorded on Aug. 22, 2009.

McLean said Michael was yelling, swearing and had to be restrained.

"She said she didn't want qallunaat touching her," he said.

He said she spoke mostly in Inuktitut but there was no interpreter so no one knew what she was saying.

After she tried to walk out of the trauma room, she was placed in arm restraints and a security guard was brought in to watch her.

"She was taken to the cells for the safety of us and her," he said.

He said the decision to hand the patient over to the RCMP was made collectively by the doctor, himself and the other nurse on staff.

McLean said the police were told to bring her back to the hospital in the morning for further assessment when she was sober.

After she was found unresponsive in the RCMP cells on Aug. 9, Jamie Kennedy, an emergency medical technician with the City of Iqaluit, testified he noted Michael had scraping on her arms and other parts of her body. Kennedy described it as being like "if someone had dragged her across something rough."

When they arrived back at the hospital that evening, Kennedy said Dr. Shahin Shirzad was on staff.

"My primary concern was not being able to protect her airway," Shirzad testified via teleconference from British Columbia.

Shirzad said he was confused as to why the patient was only arriving in the evening as usually those coming from the cells were advised to come in the morning. After assessing the patient, he said he concluded the patient needed to be sent to Ottawa as soon as possible as he suspected a head injury.

"You're always trying to rule out the worst possible diagnosis," Shirzad said.

When McLean returned for his night shift on Aug. 9 Shirzad told him his patient was back.

"I can't believe this; I don't know what happened," McLean said.

Shirzad and McLean had a discussion about why Michael was sent to the cells.

Shirzad said this was not the first time he had talked to nurses about why it was "strongly suggested" intoxicated patients were to be transferred to RCMP cells.

The doctor said he had talked with McLean on several occasions as he had spent a lot of time working at the hospital. McLean had previously told the doctor the hospital had a policy if an intoxicated patient was kept for more than four to six hours they would be either admitted or discharged.

Shirzad checked with management and found no policy existed.

"Clearly the system was not working and it is something that needs to be addressed," Shirzad said.

Kennedy said when he handed over the patient upon the ambulance's arrival at the hospital, he overheard the doctor say "she should have never been let go."

The inquest continues this week.

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