Two elderly men arrive at the Grace Hospital emergency room on separate occasions some 24 hours apart.
Both men are treated and discharged sometime later and sent on their way in taxicabs.
Neither man makes it home alive, each found dead on the sidewalk in frigid late-December weather before they even make it to their doorsteps.
How could two men meet such a tragic end in such a short time after leaving the same emergency ward?
"That's what we want to find out," Arlene Wilgosh, president and CEO of the Winnipeg Regional Heath Authority, told reporters Friday, announcing the WRHA will investigate the two deaths, which have been classified "critical incidents."
"We are also looking for answers here," Wilgosh said. "The investigation has already begun and it will continue. We are concerned about what has transpired with these two cases. We know that our staff and our physicians are equally concerned. We will be looking for answers. We will be sharing whatever information we have gleaned with the families."
Also Friday, Health Minister Erin Selby said city taxi drivers will be given the mandatory responsibility of ensuring discharged hospital patients they transport make it home safely. Manitoba Health is drafting new rules spelling out cabbies' responsibilities.
'We are concerned about what has transpired with these two cases. We know that our staff and our physicians are equally concerned. We will be looking for answers'
In total, there have been three reported deaths of discharged patients, including the two elderly men. The third case, from January 2012, will be the subject of a provincial inquest. Heather Brenan, 68, was discharged from Seven Oaks Hospital and sent home in a taxi. Using a walker, she got to her front door before she collapsed. She died the next day.
"I think it's clear that when a patient is discharged from hospital and returned by taxi, that should include that that patient makes it through the front door safely," Selby said. "My office is working with the WRHA and the other RHAs across the province to ensure that this becomes mandatory.
"Clearly, there were gaps and we need to address that, and that is what we are doing today," Selby said.
"We're making sure that anybody who is sent home by taxicab, there will be an onus to make sure that that person gets through the front door safely. It's what families expect. It's what I would expect."
Wilgosh said the WRHA will meet with Manitoba Taxicab Board representatives next week to discuss the incidents.
"I think there are lessons and opportunities for both the health system as well as the transportation system to learn how we can work more closely together to ensure the safe transport of patients who are leaving health-care facilities in Winnipeg," she said.
Asked if the WRHA is blaming taxi drivers, she replied: "No, that's not what I said. What I said was we need to work with them."
Attempts by the Free Press to contact members of the taxicab board Friday were unsuccessful.
In one of the two recent deaths, a man in his late 50s or early 60s -- the WRHA would not confirm his name or age -- was discharged from the Grace about 8:25 a.m Dec. 29. About 9 a.m., residents in the 100 block of Arlington Street discovered the man lying unresponsive on the sidewalk. His pants were around his ankles, according to eyewitness Shawn Zelma.
Area residents who went to the scene tried to cover up the heavy-set man, Zelma said, adding: "His eyes were wide open and glazed over."
The weather that morning was in the range of -30 C, plus the wind chill.
Emergency crews responded "within an hour," but the man was officially declared dead.
WRHA officials wouldn't say why he was admitted to Grace Hospital or the cause of death.
"He was seen and treated at the hospital... for a lengthy period of time. It would be in the 24-hour range," Wilgosh said. "It was not a quick in-and-out. He was thoroughly investigated."
David Silver, 78, died Dec. 31 after being dropped off at home by cab about 1:30 a.m.
He'd just been discharged from the Grace ER, where he was diagnosed with kidney stones and gallstones, told to see his family doctor and sent home.
He had 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.
Wilgosh said harsh winter weather will be a point of discussion in the investigation and review.
"We know it was extremely cold," she said. "That is one of the questions we'll be pondering: Do we need to have additional protocol in place... between the months of November and April? Is there some extra precaution we should take?"
The WRHA's hospital emergency rooms get about 280,000 visitors annually. Wilgosh said the decision to discharge a patient is based on "the best medical assessment and judgment."
In both the most recent discharge fatalities, neither man had immediate family in Winnipeg. One asked the hospital not to call his contact because of the late hour. In the other case, a person in the same housing unit was notified of the discharge.
Wilgosh said the hospitals will continue during the investigation to use taxicabs as one source of transportation for discharged patients.
When asked about the frequency of patient deaths so shortly after discharge, Wilgosh said she asked WRHA administration after Brenan's death to investigate if it was a "systemic issue." Their reply: "It was not."
Wilgosh was asked what she would say to family of parents or grandparents admitted to hospital in light of the deaths of the discharged patients.
"I would be encouraging people to feel safe," she said. "I would encourage them to ask whatever questions they have."