Winnipeg Free Press - PRINT EDITION

Stop the cascades

  • Print

The inquest unravelling how Brian Sinclair died after waiting 34 hours at the HSC emergency ward in 2008 has adjourned until January, but the testimony to date has revealed some telling truths. Common threads among the recollections of the two days he spent quietly dying amid nurses, security guards and others in line for care point to classic signs of a massive medical error in the making.

First, nurses and security guards questioned at the inquest made undeserved assumptions about why Mr. Sinclair, who died for want of a change of his urinary catheter, sat almost in the same place over two days. Staff testified they thought the legless, aboriginal man in a wheelchair was silently sitting in front of the TV because he needed to sober up, sleep it off or just wanted shelter, noting homeless people often came in for those reasons. But Mr. Sinclair was not homeless, and there's no evidence he was drunk.

Also, nurses and security guards dismissed repeated pleadings they attend him from people also waiting for care. Finally, a woman demanded attention for the man who was already dead.

Medical errors usually result from not one, but a cascade of critical mistakes. The inquest is showing what widespread assumptions and the dismissal of warnings can do. All of Manitoba's hospitals should be heeding these early lessons to stress the need for vigilance and a higher duty of care in the ER and all wards.

Editorials are the consensus view of the Winnipeg Free Press’ editorial board, comprising Catherine Mitchell, David O’Brien, Shannon Sampert, and Paul Samyn.

Republished from the Winnipeg Free Press print edition November 4, 2013 A10

Fact Check

Fact Check

Have you found an error, or know of something we’ve missed in one of our stories?
Please use the form below and let us know.

* Required
  • Please post the headline of the story or the title of the video with the error.

  • Please post exactly what was wrong with the story.

  • Please indicate your source for the correct information.

  • Yes

    No

  • This will only be used to contact you if we have a question about your submission, it will not be used to identify you or be published.

  • Cancel

Having problems with the form?

Contact Us Directly
  • Print

You can comment on most stories on winnipegfreepress.com. You can also agree or disagree with other comments. All you need to do is be a Winnipeg Free Press print or e-edition subscriber to join the conversation and give your feedback.

You can comment on most stories on winnipegfreepress.com. You can also agree or disagree with other comments. All you need to do is be a Winnipeg Free Press print or e-edition subscriber to join the conversation and give your feedback.

Have Your Say

New to commenting? Check out our Frequently Asked Questions.

Have Your Say

Comments are open to Winnipeg Free Press print or e-edition subscribers only. why?

Have Your Say

Comments are open to Winnipeg Free Press Subscribers only. why?

The Winnipeg Free Press does not necessarily endorse any of the views posted. By submitting your comment, you agree to our Terms and Conditions. These terms were revised effective April 16, 2010.

letters

Make text: Larger | Smaller

LATEST VIDEO

Wasylycia-Leis wants to create aboriginal accord

View more like this

Photo Store Gallery

  • A Canada Goose cools off in a water pond Monday afternoon at Brookside Cemetary- See Bryksa’s Goose a day Challenge– Day 27-June 25, 2012   (JOE BRYKSA / WINNIPEG FREE PRESS)
  • A Great Horned Owl that was caught up in some soccer nets in Shamrock Park in Southdale on November 16th was rehabilitated and returned to the the city park behind Shamrock School and released this afternoon. Sequence of the release. December 4, 2012  BORIS MINKEVICH / WINNIPEG FREE PRESS

View More Gallery Photos

Poll

Should the federal government be able to censor how Ottawa is portrayed in the CMHR?

View Results

Ads by Google