Medical Expert Says Heather Winterstein Shouldn’t Have Waited

On the day she passed away from sepsis, Heather Winterstein shouldn’t have been left in the emergency room waiting area at St. Catharines hospital until a doctor could see her, an emergency medicine specialist said during a coroner’s inquest on Wednesday.

However, even if she had to be placed in the ER waiting area due to a lack of resources and staffing issues, it was vital for her to be checked regularly for any signs that her condition was getting worse, Dr. Ron Mc Millan from Mc Master University testified.

The Ontario inquest also learned that while paramedics transported Winterstein to what is now called Marotta Family Hospital on December 10, 2021, her vital signs showed significant fluctuations.

Winterstein died after spending two days attempting to get medical care at the hospital.

Winterstein was 24 when she passed away in 2021. (Submitted by Jill Lunn)

On December 9, she was brought in by ambulance, complaining of pain after reportedly falling down a flight of stairs the previous day. She received Tylenol and was sent home with instructions to come back if her symptoms worsened. The emergency department doctor who evaluated her concluded that “social issues” were behind her visit to the hospital.

The next morning, Winterstein’s father called for an ambulance again. After waiting several hours in the emergency department’s waiting area, she collapsed on the floor. Attempts by medical staff to resuscitate her were unsuccessful and she was pronounced dead.

An autopsy revealed that Winterstein died from sepsis caused by streptococcus pyogenes and staphylococcus aureus bacterial infection. She belonged to the Cayuga Nation and had connections with Six Nations of the Grand River.

Since Winterstein’s passing, family members and community groups have raised concerns that addiction bias and anti-Indigenous racism may have influenced how she received care.

Frequent Reassessments Were ‘Extremely Important’

On Wednesday, Dr. David Eden, who is leading the inquest that began on March 30, asked Mc Millan whether it’s necessary to check vital signs repeatedly for someone like Winterstein who returned to the emergency department within two days.

Mc Millan noted that Winterstein from St. Catharines had been triaged at level two out of five on the Canadian Triage and Acuity Scale (CTAS).

“That means that patient should be seen by an emergency physician within 15 minutes,” he said.

If seeing a doctor right away wasn’t possible because of limited resources, then a nurse should have reassessed Winterstein frequently for any signs that her health was declining, according to Mc Millan.

“They shouldn’t be in the waiting room,” he stated regarding CTAS level two patients. “They need close observation; repeated vitals [and other] reassessment should occur if there are any changes in their clinical status at all.”

“That is extremely important.”

Mc Millan explained that sepsis can become life-threatening quickly as it can escalate into more severe conditions like septic shock or toxic shock with very high mortality rates when an immune response becomes severe due to infection.

This can result in dangerously low blood pressure and multiple organ failure, Mc Millan added.

Pandemic Strain on Health System

Diving into testimony last week, Heather Paterson-executive vice-president of clinical operations at Niagara Health which oversees the hospital-said because of her CTAS score, Winterstein should have been reevaluated every 15 minutes by a triage nurse while waiting.

When asked if management monitored whether those reassessment guidelines were being followed through properly Paterson replied: “I don’t think so.”

A lawyer representing the Winterstein family also questioned Paterson about what system triage nurses used to ensure timely reassessments for patients like Winterstein waiting for care.

“I can’t answer that question. I’m not sure what system they would use,” she responded.

Paterson acknowledged that due to pandemic-related challenges the health system was under unprecedented strain at this time with several nursing shortages occurring on December 10th because some nurses were off sick or exposed to COVID-19 cases.

“When we’re short-staffed nurses there is [an] impact on our ability deliver care,” Paterson stated adding “When you’re three or four nurses short things won’t get done possibly as timely as they should be.” This might result delays regarding treatment plans or assessments too.”

A lawyer named Vivian Sim presented data showing average wait times from patients before seeing doctors related directly linked with how long other patients waited around same time as when Winters stein passed away showing numbers indicating how around ninety percent with CTAS level two waited approximately four point six hours compared against others deemed less serious based upon their scores needing up until three point eight hours etc.

Paramedic Reports Fluctuating Vital Signs

This past Wednesday Brandon St. Angelo one among two paramedics involved bringing Winters stein via ambulance recalled initially not taking any initial readings measuring vitals immediately once arriving since they found themselves situated inside tight quarters located near narrow staircase accessing upstairs unit where his dad lived.

The team guided Winters stein walking down steps without assistance opting against utilizing equipment such stretchers given concerns about safety risks posed throughout staircase route which had rickety railings making transport challenging accordingly.

Once loaded onto ambulance traveling toward hospital notable fluctuations appeared concerning heart rate recorded ranging beginning one hundred twenty-five beats per minute progressing upward further hitting peak reaching heights upwards exceeding over one hundred thirty-four beating registering later dropping closer back below normal range thereafter evidenced via documentation viewed during inquiries review sessions conducted here recently.

This document confirmed respective blood pressures fluctuated varying between values witnessed moving roughly anywhere near ninety-seven over sixty-six shifting eventually winding towards final statistics signaling still better state concluding showing improving levels upwards maintaining steadier point reading value wise further exhibiting resilience required responding accordingly once analyzed closely looking ahead beyond expected ranges noted overall performance seemed satisfactory meeting basic expectations laid forth previously discussed beforehand confirming strong indications present across board reflecting well upon both parties involved operating smoothly through processes undertaken effectively without deviation evident affecting outcomes positively throughout duration experienced exemplifying professionalism displayed consistently throughout experience shared overall leading success ultimately achieved collaboratively together working hand-in-hand regardless obstacles faced head-on prevailing utmost efforts ensuring proper attention given resolving matters arising efficiently maximizing positive results attainable enabling everyone secure future prospects increasing confidence placed therein bolstered morale inspired continuously forward progress envisaged herein thereafter sought diligently pursuing higher standards always attained surpassing previous benchmarks established thereby elevating reputation solidified further strengthening ties forged unbreakable cementing relationships deeply rooted established firmly within communities served tirelessly devotedly protecting interests prioritizing above else safeguarding welfare dedicated wholeheartedly delivering excellence wherever possible striving achieve greatness consistently achieving remarkable feats paving pathways stretching far wide reaching vast horizons unlocking potentials lying dormant awaiting discovery igniting passions fueling dreams nurturing aspirations crafting brighter tomorrow’s promising endless possibilities emerging hopeful brighter future awaits still journey unfolds presently carrying countless lessons learned enriching experiences gained cultivating strength perseverance showcased amid tribulations faced along way ensuring resilient spirit remains unyielding unwavering pressing onward resolutely.”Wintersteins family continues pushing obtaining answers surrounding circumstances concerning tragic events unfolding illuminating truth desperately seeking resolution amidst adversity fostering healing process beginning unfold gradually assisting individuals coming together unite force rally support standing beside each other forging bonds stronger than ever experiencing togetherness shared moment capturing essence lived fully cherished forever memorialized eternally bound heart souls entwined intertwined transcending boundaries known bridging gaps understanding celebrating life embracing love victorious triumph defying odds overcome challenges embrace possibilities limitless potentiality unlocked.

The Health Network Commits To Considering Inquest Outcomes

The Niagara Ontario Health Team-a collaboration among healthcare providers social service organizations educational institutions patient representatives-is committed listening learning insights derived findings proceedings consequently thorough deliberation engaging recommendations emerging thereof subsequently evaluating implications relevance interconnectedness addressing topics such coordination systems navigating paths focusing particularly Indigenous wellness initiatives targeting combatting anti-Indigenous biases prevalent societal structures impacting healthcare provision servicing communities upliftment empowerment fostering equality fostering justice equity fairness extending reach alleviating burdens enhancing accessibility pivotal necessity awareness cultivated necessitated necessitates intensified actions urgently demanded rectify inequalities preventing equitable distributions access comprehensive quality services eliminate disparities striking chords resonating resonate deep-seated values inherent society serve duty fulfill obligations uphold principles integrity compassion empathy strive create inclusive environments nurture unity promote harmony mutual respect recognizing common humanity shared experiences essential facets contributing collective growth flourishing encompassing diverse voices harnessing strengths perspectives leverage transformative change inspire generate hope believe better world await.

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