Winnipeg Free Press - PRINT EDITION

ER patient dies outside his home

Senior discharged, put in taxicab

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A Winnipeg senior who died on his front walk after being discharged from the Grace Hospital emergency room has sparked calls for changes to the way Winnipeg hospitals ensure patients, especially elderly ones, get home safely.

David Silver, 78, died Dec. 31 after being dropped off by a cab at about 1:30 a.m. He'd just been discharged from the ER, diagnosed with kidney stones and gallstones and told to see his family doctor, but he suffered a heart attack seconds after the cab pulled away. He wasn't found until much later that day, when his housekeeper discovered him lying a short distance from his front door in frigid temperatures.

Silver's death has shocked his family and triggered an investigation by the Winnipeg Regional Health Authority. Silver's family is asking for new discharge practices to make sure frail, elderly or disabled patients make it home safely after visiting an emergency room.

"It's a systemic problem," said Miles Pollock, Silver's nephew. "It's the middle of the night. It's minus 40. He's an old man who's sick. He's not dressed to be outside, and a) you send him home and b) you send him home unaccompanied in a taxi."

'It's a systemic problem. It's the middle of the night. It's minus 40. He's an old man who's sick. He's not dressed to be outside, and a) you send him home and b) you send him home unaccompanied in a taxi' -- Miles Pollock, David Silver's nephew

Lori Lamont, vice-president and chief nursing officer with the WRHA, said the health authority has launched an investigation into the treatment Silver received at the Grace, the circumstances around the discharge and exactly what happened once he arrived home. It could be several more days until the WRHA has the results of the investigation, which could be elevated to a formal critical incident.

"We're very concerned for Mr. Silver and certainly feel badly for the loss," she said. "The circumstances make the family's loss even more distressing, when they happen in an unusual way."

Pollock said his 87-year-old mother -- Silver's older sister -- is beside herself.

"It makes her crazy to think he was lying outside for 12 to 13 hours," said Pollock.

Staff from the medical examiner's office told Pollock Silver suffered from an enlarged heart, blocked arteries and high blood pressure, problems Pollock said ought to have been picked up at the Grace. But the ME's office said Silver either died instantly or was unconscious when he hit the ground, meaning he didn't die from the cold.

That offers some comfort to the family.

Silver first called 911 Dec. 30 when he felt nauseous, with a stomach ache and headache, symptoms he also suffered several days before.

After an abdominal X-ray, Grace Hospital doctors determined Silver suffered from kidney stones and gallstones but wasn't sick enough to admit. Wearing just his pyjama bottoms, bedroom slippers and coat, Pollock was given a cab slip and sent home, told to call his family doctor to arrange treatment.

Lamont said Winnipeg hospitals follow safe-discharge guidelines where staff ensure a patient is ambulatory, capable of making decisions and has a decent living situation, among other factors. That might include arranging for a family member to pick a patient up, sending them home in a taxi or even occasionally arranging for a stretcher service to take a patient home. Lamont said typically taxi drivers will assist people in and out of the cab. Why that didn't happen in Silver's case is part of the investigation.

A gentle homebody, Silver was a draftsman by trade and lived with his two brothers for years in their Garden City home. Both brothers were ailing before they died, and Silver looked after them.

"He was kind of the family caregiver," said Pollock. " He loved his family. It was everything to him."

Though he talked to his sister several times a week and had a cousin in Winnipeg, Silver wouldn't have wanted to bother them late at night, said Pollock.

maryagnes.welch@freepress.mb.ca

Republished from the Winnipeg Free Press print edition January 10, 2014 A4

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