A Blood Alcohol Guessing Game and a False Accusation of Racism

A number of years ago, I worked as a low level emergency responder. When allegations surfaced in June that ER workers across British Columbia were playing a blood alcohol level guessing game that targeted Indigenous patients, I was skeptical. The game sounded real, but not as the cynical, systemic racist scourge that had been described. I pictured the odd pair of healthcare workers playfully guessing a patient’s BAC results to inject some levity into an otherwise traumatic profession—and then going about their business.

I couldn’t see this affecting patient care. I especially couldn’t see it targeting Indigenous people. If a visibly drunk white person came into the ER, the staff would surely also play the game. It didn’t make sense.

The allegations came from an anonymous healthcare worker as part of an Indigenous cultural safety training program conducted in April 2020. They sparked a predictable media frenzy and incensed the public. British Columbia’s Minister of Health Adrian Dix responded as if he were already guilty and appointed an independent, Indigenous-led team to investigate the claim and report their findings by the end of the year.

On 30 November, the review reported that they had found no evidence of an organized “The Price is Right” guessing game in B.C. hospitals:

The review produced anecdotal and episodic evidence of multiple activities in the health care system that resemble these allegations in some fashion, but none of them could be described as coordinated, organized, widespread or targeting only Indigenous patients. If such games did occur in the past, they are not occurring today.

So not only was the game not racist, it was not found to exist outside of isolated incidents, the most credible of which were antiquated. The whistleblower referred to in the report as Participant X later amended his allegation, but it was further mischaracterized by preliminary investigators and journalists. What started as a widespread, Indigenous-targeted, emergency room gambling ring became, over the course of the investigation, an offhand, non-discriminatory time-waster played by a cluster of ER workers nine years ago.

In his interview with the review commission, Participant X commented that “some of the things that are coming out [in the media] are hard to understand.” In particular, he was concerned that the estimation of blood alcohol levels by hospital staff was being portrayed as exclusive to Indigenous patients. “I struggle with the racism piece, because it wasn’t targeted at people as much as it was at someone who had enough alcohol or drugs onboard to be hospitalized … It was never about targeting and so it’s morphed into something it wasn’t.” He also denied having called the alcohol estimation game “The Price is Right.”

He later recalled that the game had generally involved nursing staff and possibly a lab tech. Physician involvement was rare, he said, as the single doctor on staff in the ER was usually too busy to engage. He never saw money or any other benefit change hands as the result of a successful guess: “There’s nothing to win, it’s something to pass the time.” He also noted that, “I feel from the news that this was [portrayed as] happening every day and all the time, and this wasn’t happening every day and [wasn’t] something people would line up for.”

The investigators made it clear that they had been misled as well:

The claim that “the game” is played in three hospitals and two health authorities could not be confirmed by the Review. As the issue was escalated through San’yas (the Indigenous cultural training program), up the PHSA (Provincial Health Services Authority) ranks, to other health authorities and Indigenous partner organizations, and to the Ministry of Health, this information was framed as “facts,” and the fact that Participant X’s observations were nearly a decade old was not conveyed.

The investigators also ascertained that, in many cases, guessing blood alcohol and other markers “may be clinically appropriate.”

They concluded: “It is the Independent Reviewer’s conclusion that the eventual public and media accounts of ‘the game’ that spurred this Review were inaccurate.”

The guessing game review is but a small part of the 236-page report. The rest describes legitimate anti-Indigenous racism in the British Columbia healthcare system. The investigators surveyed 2,780 Indigenous people and 5,440 healthcare workers. Eighty-four percent of Indigenous people reported experiencing racism within the system. Fifty-two percent of Indigenous healthcare workers also reported having experienced racism, mostly from their colleagues. Thirty-five percent of healthcare workers reported having witnessed racism directed at Indigenous patients or their families. The review also cites numerous inequities in Indigenous health, including the difference in life expectancy between Indigenous British Columbians and other British Columbians (73.4 years vs. 82.7 years) and the difference in infant mortality between Indigenous and others (5.8 percent vs. 3.4 percent). Such inequities can be attributed both to current practices and historical, Canada-wide, government-perpetrated atrocities, namely violated treaties, reservation segregation, culture- and innocence-destroying residential schools and the withholding of equal rights (in certain provinces “status Indians” couldn’t enter bars or even vote until the 1960s). The negative assumptions that created these racist policies persist, generating unequal treatment for Indigenous Canadians in many contexts.

But not in this case. The central accusation under scrutiny—the allegations of an extremely sinister game that compelled a five-month-long, 9,000-participant probe into the healthcare system—was a sham. It was in the best interests of the Indigenous-led investigative team to substantiate the claim in order to justify the media attention and public outrage—and of course to give extra credence to systemic racism. They could not. That is significant.

Unsurprisingly, this discovery didn’t make many headlines. “‘We have a major problem’: Investigation finds ‘pervasive racism’ against Indigenous people in B.C. health care” announced Toronto.com. The Vancouver Sun’s headline read: “Widespread systemic racism in B.C.’s health-care system: report.” According to The Tyee, “Report Finds ‘Widespread and Insidious’ Racism against Indigenous People in Health Care.” The article devotes only one sentence to the debunked guessing game allegation.

Emergency responders are among the most remarkable people I’ve known. They exist “beyond the scope of typical human experience,” confronting that which the rest of us desperately try to avoid. Their misrepresented game was described by a paramedic—who is said to be “a member of a minority community”—as a “type of dark humour, a way to blow off steam for people working in a high intensity environment that constantly deals with trauma.” (As we saw above, Participant X described it similarly, as “a way to pass the time.”) Over 80 percent of first responders have been traumatized on the job. Paramedics have the highest prevalence of PTSD (14.6%), double the rate of firefighters and more than triple the rate of police officers. One in four Canadian paramedics is expected to develop PTSD in her lifetime. As for ER staff, 20 percent met PTSD symptom criteria and 12 percent met formal diagnostic PTSD criteria in a study conducted at a B.C. hospital.

That such people were presumed to be racists for making their jobs less of a hell by playing a goofy game was not only an injustice in its own right but proved how much the plight and emotional health of emergency workers are minimized and dismissed. The suicide rate of Canadians is 11 per 100,000 persons. The suicide rate of Indigenous Canadians is 24 per 100,000. The estimated suicide rate of Canadian paramedics is 56 per 100,000.

Emergency workers are duty-bound to do whatever is in their power to save the life of every person who comes into their care. Framing their innocuous guessing game as gambling with the lives of Canada’s most vulnerable people did an additional disservice to their future Indigenous patients. The unjust distrust of ER workers that could result from this allegation could lead to more inequitable healthcare.

Just as it’s important to point out where racism exists, it’s important to point out where it doesn’t.