Florence Girard was so small when she died that she "looked like a child" in her casket, her sister told a British Columbia coroner's inquest into the death of the woman.
Sharon Bursey told the inquest jury in Burnaby, B.C., on Monday that she was ready to quit her job to take care of Girard — who required round-the-clock care — had she known the seriousness of her sister's condition and if the province provided additional support.
"I loved having her on my holidays," said Bursey, who paused frequently and sometimes broke into tears as she testified.
"She's part of my family. My kids grew up with her. She liked to tickle them, but she would hurt them because she had such pointy little fingers. Her laugh was the best.
"I'm at a loss. I have her in my ashes like my necklace. I have her urn next to my bed, because I can't bury her."
Girard died in 2018 weighing only about 50 pounds, and Astrid Dahl, who was caring for Girard as part of a program for people with developmental disabilities, was convicted in 2022 of failing to provide the necessities of life in the case.
The inquest is aimed at forming recommendations for B.C.'s care system to prevent similar deaths from happening in the future.
Bursey was the first to testify at the inquest and carried with her a photo of her family with Girard sitting in the middle.
She said that the provincial Crown corporation Community Living BC did not offer financial aid to help Girard stay with her family.
It meant that Girard had to live in Dahl's home who was overseen by the Kinsight Community Society, which had been contracted by Community Living BC.
Bursey told the inquest that Dahl either didn't answer her calls or said she would call back when she wanted an update on her sister leading up to her death in 2018.
Bursey said Girard was kept in a bedroom suite in the home that was blocked off by a baby gate, with a mattress on the floor and the movie "Titanic" playing in the background at all times.
"It's like she was thrown in the hole of the prison … where they just leave you to starve and die and go crazy for not seeing people, just looking at the walls 24/7," Bursey said.
"The last four years of her life were awful," she told the inquest. "I just can't believe that happens in Canada."
Dr. Juliyana Romey, who took over as Girard's family doctor from 2013 to the time of her death, told the inquest that she last saw Girard in 2014, and the woman was "generally looking well" with normal body temperature, blood pressure and respiration.
Romey noted, however, that Dahl did not bring Girard in for another visit.
"That is very unusual," she said. "Since she was still a patient at the office, it will happen that patients move away and we don't hear from them, but obviously she had not moved away."
Romey testified that her records did not show Girard being taken to an emergency room any time from 2014 to 2018, something that a family doctor would be notified about.
She said family doctors do not have procedures in place to proactively recall patients unless there was an unusual circumstance such as abnormal blood tests or other results.
"Other than that, it is the responsibility of the patient or the caregiver to initiate contact with us, to engage with us," Romey said.
"For the past 15 years, I have (had) a disabled family member living with me in my household, and I can confirm that is the caregiver's responsibility to initiate contact with doctors, with dentists, optometrists, or whoever they would need care from."
Romey said the next time she heard about Girard was when the BC Coroners Service sent her a note about the death.
"It was an unpleasant notification for me to receive," she said.
Bursey, who has repeatedly said the care process needs to be changed in order to avoid similar tragedies, told the jury that she is worried something like this will happen again.
"The amount of cases where people that have reached out to me, it's sickening," she said.
"She deserves so much better," Bursey said of her sister.
The inquest is scheduled for eight days.
