If only. It’s a phrase that plays over and over again in Eva Mamakwa’s mind.
If only her daughter, Miranda Mamakwa, had made it to at least one followup appointment after open-heart surgery, she may be alive.
If only Indigenous Services Canada’s non-insured health benefits program had arranged travel for just one of her four missed appointments, Miranda may be alive.
The 31-year-old mother of three from Fort Severn First Nation died on Sept. 8, weeks after asking people on social media to seek action in case of her death.
“I don’t want this to happen to anyone else,” Eva Mamakwa said in an interview with The Canadian Press from her home before falling quiet, overcome with emotion. She is speaking out about her daughter’s death for the first time.
Since Miranda Mamakwa’s death, more than a dozen First Nations and tribal councils have filed a human rights complaint that alleges widespread neglect of their communities’ health needs, while chiefs have demanded reform from the federal agency in charge of arranging medical travel for remote First Nation people.
Indigenous Services Canada said it’s working to improve delivery of the service, while the minister in charge has said she requested a fact-finding mission on the circumstances that led to Miranda Mamakwa’s death.
Months ago, Mamakwa’s family was filled with hope as she underwent surgery at the University of Ottawa Heart Institute in April to replace a valve in her heart. She recovered over two weeks at the hospital in Ottawa, then two more weeks at the Thunder Bay Regional Health Sciences Centre.
On May 24, she arrived home in Fort Severn First Nation, the most northerly community in Ontario that sits near the mouth of the Severn River on Hudson Bay.
Her doctors wanted to see her for several followups. She had blood clots and had been put on blood thinners, which required testing on an ongoing basis, Eva Mamakwa said. Doctors booked her daughter for an echocardiogram and an appointment with a vascular surgeon in Thunder Bay.
Miranda Mamakwa was thrilled to be back home; her children were excited and her mother was caring for her.
That excitement would soon abate.
Eva Mamakwa said she went to the First Nation’s nursing station to begin the administrative process to arrange travel back to Thunder Bay for her daughter’s first followup appointment. Nurses soon faxed Miranda’s documentation to the non-insured health benefits program — faxes are protocol — and the family waited to hear back on travel plans.
She said the agency never responded and her daughter missed her first appointment on May 28. Eva Mamakwa then called NIHB’s office in Sioux Lookout, Ont., and got someone on the line.
“I told her that it was extremely important that Miranda go to her followup appointments,” she said. “I talked to her and she listened to me and she said they would send her travel, but travel never came.”
She said the NIHB told her the request never arrived despite more than one tranche of faxes being sent.
The same thing occurred for followup appointments on June 11, July 2 and Aug. 6, Eva Mamakwa said, despite multiple faxes and phone calls.
“They didn’t care at all,” she said.
As the summer progressed, Miranda Mamakwa became more tired, slept more and started losing feeling in her fingers.
On Aug. 19, she wrote a Facebook post about the problems with NIHB and the missed appointments.
“If I die, pls go after (them),” she wrote.
On Sept. 6, she started to feel sick. Her stomach hurt and she began vomiting. “We just thought she might have caught the flu from her kids,” her mother said.
But Eva Mamakwa soon realized that “something was terribly wrong.”
Her daughter needed immediate help. Later that day, Skycare, which operates on behalf of provincial air and land ambulance Ornge, arrived, and airlifted her to the intensive care unit of the Thunder Bay Regional Health Sciences Centre, some 850 kilometres away.
The next day, Eva Mamakwa and Mike Bluecoat, Miranda’s father, got a call from the ICU doctor.
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“He told me that Miranda had a lot of bleeding in her brain, she was hemorrhaging,” she said. “Even if they send her down south (to Toronto), to try and help her, that she wouldn’t have survived it.”
The doctor told them to fly to Thunder Bay so they did, with Miranda’s children in tow. Eva Mamakwa’s oldest daughter was already at the hospital to support her sister.
They arrived to crushing news.
“There was no brain activity at all and we had to make a very difficult decision to take her off life support or not,” Eva Mamakwa said through tears.
“As much as I wanted to keep her, it wouldn’t have been a good idea because it was the machine that was helping her breathe,” she said.
“It was very, very heartbreaking seeing my daughter being disconnected. But up until the end, when her heart stopped, and everything shut down, her children were beside her. All of us were beside her. And then we watched her go.”
Eva Mamakwa’s words failed, briefly, as tears rolled down her cheeks while she relived the nightmare.
“Today my daughter would be here if her travel was made to attend her appointments, but sadly it didn’t happen,” she said. “I am holding NIHB accountable for my daughter’s passing.”
Indigenous Services Minister Mandy Gull-Masty has said her department would review the circumstances of the case, and that Mamakwa’s community and family deserved answers.
Widespread issues
The woman’s death became a clarion call to First Nation leadership across Canada. It came after hundreds of people staged a sit-in at the NIHB office in Sioux Lookout over missed medical appointments, calling for urgent reform.
Chief Archie Wabasse of Wunnumin Lake First Nation, a remote fly-in community some 500 kilometres north of Thunder Bay and 330 kilometres south of Fort Severn, broke into tears as he discussed the issue in a recent interview.
He said that in his community of 800 people, about 80 residents had a total of 147 missed medical appointments between March 2025 and March 2026 due to lack of transport.
There is no full-time doctor in the First Nation, but one rotates in for a week or two every month, for 12 to 14 visits a year. Demand for the doctor’s time far exceeds availability, and those visits lead to referrals to specialists in southern parts of the province.
“The problem is getting worse for my people,” an emotional Wabasse said.
He lists a number of community members who need help. One, with a pacemaker, who has already missed a few appointments. Another who needs dialysis in a few days, but has not heard back from NIHB about his travel. In one case, the band paid about $3,000 to send an elder to a specialist in Winnipeg after NIHB did not return calls, he said.
Wabasse said he met with the Indigenous Services minister to talk about the issue, months before Miranda Mamakwa’s death.
He said Gull-Masty told the chiefs in attendance about improvements being made to NIHB, but she declined their request to sit down with them and resolve on the spot what he sees as a relatively straightforward administrative issue.
“It is a solvable problem, but what we’re trying to do here is advocating, telling the minister, the decision makers, the prime minister, this could be solved in one day,” Wabasse said.
When asked about Wabasse’s description of that meeting with the minister, Indigenous Services Canada said regular dialogue with First Nations leaders about NIHB “has been an important part of our work to improve service levels.”
Human rights complaint
More than 12 First Nations and tribal councils filed a complaint on Oct. 1 with the Canadian Human Rights Commission against Indigenous Services Canada over what they say is effectively a denial of health care in their communities.
The joint complaint from Wunnumin Lake First Nation, Matawa Chiefs Council and Windigo First Nations Council alleges the federal department’s non-insured health benefits program is failing to meet the needs of community members for medical transportation.
The NIHB program for First Nations and Inuit people covers medical, dental and mental health care not available through private insurance or provincial health plans. First Nations leaders and physicians have long said the program is not working for communities, and that its employees are notorious for being slow in responding to queries, requests and filing reimbursements.
The complainants say NIHB fails to consistently arrange medical transportation, or it informs patients so late about the transport that they are forced to miss their appointments.
They say Eabametoong First Nation community members miss about 50 appointments per month, while North Caribou First Nation members missed almost 100 appointments in the past year.
The complaint said First Nations have attempted to raise the issue with Indigenous Services Canada from as early as 2014, to no avail.
“Due to ISC’s actions, First Nations are suffering and dying. This is known to ISC, and yet nothing has been done to change it,” the complaint said. “Years of NIHB failing to approve requests on a timely basis, considered in the context of costs associated with First Nation service-provision and remoteness, represents a choice to deny First Nations health care.”
The complainants are requesting a formal review and reform of the benefits program, along with $20,000 in compensation for each individual who missed an appointment due to NIHB’s failures, and an additional $20,000 for pain and suffering.
“The continued failure regarding medical transportation is the newest chapter in a long history of Canada’s colonial practices devaluing the health and safety of Indigenous people,” the complaint said.
Indigenous Services Canada spokesperson Carolane Gratton said the department recognizes the serious impacts any gaps in service can have on people who rely on NIHB for medical transportation, and that it’s working to strengthen the delivery of the service.
The department implemented a simplified travel submission process in early October, meant to provide clients with more direct support from local medical transportation co-ordinators and create a “more consistent and streamlined experience,” Gratton wrote in an emailed statement. She said the department is looking into other actions that could improve call centre performance.
Indigenous Services Canada did not provide details when asked if there is a service standard for arranging medical transportation, nor how often that standard is met.
Gratton said the department takes seriously any complaints to the Canadian Human Rights Commission, and that it would respond “through the appropriate process.”
Julian Falconer, a longtime human rights lawyer who is representing the First Nations and tribal councils in the case, said their complaint is not about “simple negligence.”
“We are talking recklessness when it comes to the sanctity of life,” he said. “It’s an outrage.”
The government’s response is a “perfect parallel” to what happened to Miranda Mamakwa after her surgery, he said.
“The ignoring continues to this day,” Falconer said. “The minister promised an urgent review. We’re six weeks out and it’s crickets.”
Doctor says system is a ‘black hole’
Pediatrician and infectious disease specialist Anna Banerji, who travels to see patients in northern communities, said administration of the NIHB is discriminatory.
She said First Nations children, some of whom have serious health issues, are often no-shows for their appointments.
“Their flights were not booked,” she said.
Lack of transport has also led to missed mammogram appointments, allowing cancers to spread, and high-risk pregnancy symptoms that aren’t caught early and lead to complications for mothers and babies, she said.
Banerji said when concerns have been raised to NIHB, it’s like a “black hole.”
“(Patients) don’t know if the flight is booked, or when it’s booked, and if you try to communicate with (NIHB) again, no one ever picks up the phone. They can send faxes, and no one responds to the faxes,” she said.
“At the last minute they’ll say, ‘You have a flight in an hour.’ Well, (patients) have other responsibilities. They have other children, they have elderly people at home, they have jobs and suddenly they have to drop everything they’re doing last minute to go on a flight. It’s just disrespectful.”
Banerji said if the NIHB was any other system in Canada, it would be dismantled.
“My conclusion is, after 30 years of observing it, this is all racism. It’s a double standard. It’s discriminatory,” she said.
“I would go so far as to say when you give one group of people certain rights and you deny that to another group based on race … it’s called apartheid.”
Banerji said Miranda Mamakwa’s death was preventable, but not unpredictable, and called for a national inquiry into the system.
For Mamakwa’s family, the past month has been difficult.
Her children, aged 7, 9 and 11, are struggling. Eva Mamakwa said her youngest grandson often says, “I want my mom back.”
They trek to her grave to visit. They’re just trying to get through the days.
“My grandson, he wakes up early in the morning and he cries and in the evenings, that’s when it gets really hard for all of us,” Eva Mamakwa said, choking up.
“I cry every day. There are times I get extremely angry. What happened with our daughter? I miss her. I miss talking to her.”
This report by The Canadian Press was first published Oct. 20, 2026.
