MONTREAL -- The health executive who oversaw the Quebec hospital where an Indigenous patient was mocked and insulted before she died testified Friday he wasn't aware of a racism problem involving Atikamekw patients at the institution.

Daniel Castonguay, who was head of the health board serving Quebec's Lanaudiere region from 2015 until being reassigned by the Quebec government last December, testified at a coroner's inquest investigating the Sept. 28 death of Joyce Echaquan.

Echaquan, a 37-year-old Atikamekw mother of seven, filmed herself on Facebook Live as a nurse and an orderly were heard making derogatory comments toward her at the hospital in Joliette, Que., northeast of Montreal.

The inquiry has heard that Atikamekw patients did not want to visit the hospital because of the alleged mistreatment they received from staff.

On Friday, Castonguay said there was a long-standing toxic work environment at the facility, but just 10 formal complaints were received from Atikamekw patients during his tenure. "It didn't come out that we had a racism problem in our establishment, given the frequency of the complaints," Castonguay said.

The coroner's inquiry heard that concerns about the hospital were raised by about 20 Atikamekw community members who testified in 2018 during the Viens Commission, a Quebec inquiry that found systemic discrimination toward First Nations and Inuit peoples in their relations with the provincial government.

Castonguay said he'd read the Viens Commisison report and even moved to implement some recommendations, but he did not look at the specific testimony from Atikamekw witnesses until after Echaquan's death in the fall of 2020.

In retrospect, Castonguay said there were things he could have done differently, including having more frequent meetings with the Atikamekw community to build bridges. He also said he should have overhauled management at the hospital.

As was the case with other management witnesses, Castonguay testified he first heard of Echaquan when he was told a patient had been caught filming staff, and he said he was shocked when he heard the comments on the video.

The inquest has heard that Echaquan died of a pulmonary edema and was suffering from a rare heart condition, which led to heart failure and fluid collecting in her lungs. On Thursday, an emergency room physician who studied Echaquan's case concluded the death was preventable had there been better surveillance of her condition by experienced staff.

Dr. Alain Vadeboncoeur found that by the time Echaquan was transferred to a reanimation room, it was already too late to save her.

Echaquan was in the care of a nurse in training with just a few months experience who witnesses have said should not have been allowed to have unstable patients under her care.

Earlier Friday, Nancy Pellerin, the nursing coordinator at the time, said nurses in training had only recently been brought back to work in the emergency room. She said she felt the arrangement was workable if they were paired with experienced nurses.

"If it harmed the care of Ms. Echaquan, I'm very sorry, it was not my intention," Pellerin said, apologizing to Echaquan's family. "Honestly, if I'd seen the video in real time, I would have done everything to go help Joyce. I'm so sorry for what happened."

The inquiry, presided by coroner Gehane Kamel in Trois-Rivieres, continues until June 2. It has begun hearing from experts providing recommendations.

-- this report by The Canadian Press was first published May 28, 2021.