Assessment of Heather Winterstein’s Care at St. Catharines Hospital Questioned

Heather Winterstein didn’t exhibit the typical warning signs of potentially life-threatening sepsis during her triage screening the day before she passed away at a hospital in St. Catharines, Ont., an emergency medical expert testified at the coroner’s inquest for the 24-year-old.

Identifying the extreme response to a bacterial infection that led to Winterstein’s death on Dec. 10, 2021, is crucial, but Dr. Ron Mc Millan explained that there isn’t a simple solution for diagnosing this condition.

Mc Millan, an expert from Mc Master University, reviewed hospital records and a post-mortem examination report on Winterstein. On Tuesday, he appeared to validate many clinical choices made by emergency physician Dr. Emad Nour, who treated Winterstein on Dec. 9, 2021, just before her untimely passing.

Winterstein had reported body pain, especially in her right leg. Although Nour examined her for possible signs of infection, he ultimately concluded that she didn’t have one.

Nour testified last week as the inquest began on March 30 and is expected to continue his testimony later this week.

This virtual inquest was announced in 2024 and will feature twenty-two witnesses over thirteen days. Among those who have already testified are members of Winterstein’s family, a police officer and paramedic, a triage nurse and a senior executive with Niagara Health-now known as Marotta Family Hospital-where she was treated.

Inquests are conducted to inform the public about the circumstances surrounding a death but do not assign blame or determine guilt or innocence. A coroner’s jury reviews evidence to establish facts regarding a death and may suggest recommendations to prevent similar occurrences.

Winterstein’s mother expressed hope earlier that the jury would make recommendations. Since her daughter’s passing, family members and community organizations have raised concerns about whether addiction discrimination and anti-Indigenous racism affected how Winterstein was treated.

‘You cannot have sepsis without infection’

On Tuesday, Mc Millan noted that triage screening indicated Winterstein had nearly normal temperature levels along with blood pressure considered low-normal and normal respiration rates. While her pulse was slightly high at 115 beats per minute, he mentioned this could be linked to reasons other than sepsis.

Nour chose not to retake Winterstein’s vital signs nor did he decide to send her for blood tests; these details came out during previous inquiries.

Instead of further testing or treatment options like bloodwork, she received Tylenol and was instructed to return if her symptoms worsened. Tragically, Winterstein died at this St. Catharines hospital on Dec. 10, 2021.
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Nour noted in his report that “social issues” were behind her visit to the hospital.

The following morning after leaving the hospital initially, Winterstein’s family called for an ambulance again; she returned but spent hours waiting in the emergency department before collapsing on the floor where resuscitation attempts were unsuccessful.

Mc Millan defended numerous decisions made by Nour when questioned by lawyer Jaan Lilles representing Nour along with three other doctors.

Mc Millan pointed out that Nour found no indications of infection in Winterstein’s case.

“Sepsis is a life-threatening condition,” he said. “[But] you cannot have sepsis without infection.”

Mc Millan also highlighted that the post-mortem report indicated no source of infection was found.
“That’s important because the post-mortem is factual and objective. If there’s no source of infection identified,
that supports the clinical examination that was done by Dr. Nour on Dec.9.”

A significant widespread infection such as sepsis usually requires confirmation through fever indicators which were not recorded according to Mc Millan.
“The temperature recorded bythe triage nurse didn’t show that,”.

When asked if he believed Nour should’ve ordered blood tests,
Mc Millan responded: “No; I don’t think any laboratory investigations were warranted based onthe clinical assessment done on Dec.9.”.

Praising Decision Not To Prescribe Antibiotics Without Infection

The question from a lawyer representing winter Stein’s family led Mc Millan also defending nour’s choice against starting antibiotics
for patients without infections present.
“It’s essential first identify there’s an infection before prescribing antibiotics,”,Mcmillian stated while elaborating. This helps avoid increasing antibiotic resistance risks globally.“While it’s vital treating infections quickly，it’s critical ensuring they exist first,”.

Mcmillian Supported dr nour when He Chose against retaking vitals measurements As well. He noted cases individuals developing Sepsis Could experience septic shock Or Specific types Bacterial Infections May lead toxic shock resulting dangerously low Blood pressure along multiple organ failures “That kind Shock can happen incredibly fast within hours.”

Mcmillian commented The hospitals Have Screening Tools include inflammatory response syndrome (SIRS) test However added criteria winter Stein lack Qualifies For Sepsis Diagnosis “No Single Test Can Diagnose Sepsis”. Those tools aid initial detection Yet aren’t definitive stated Mcmillian “They shouldn’t Replace Clinical Judgments When Assessing Patients.” H2 >Expert Reflects Physician Social Issues Diagnosis

Mcmillian explained His perspective On Doctor Nours Controversial social issues note referring substance abuse history Housing instability Wasn’t Unusual Emergency Department assessments “‘Social issues’ Typically applied Where Clear Diagnoses Aren’t apparent From Clinical Evaluations “It’s definitely Not definitive Diagnosis But it Is standard Practice By Emergency Physicians.”

Mcmillian Recognized Psychosocial Factors Mental Health Concerns And housing difficulties Cause Physical Symptoms Emergencies

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