Grieving mother searches for answers in daughter’s death

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This article was published 17/07/2023 (821 days ago), so information in it may no longer be current.

The mother of Talina Rampersad-Husack will mark the anniversary of her 14-year-old daughter’s death with a Hindu ritual and by placing flowers in the Red River.

“What could we have done to save her? What should have been done to save her? I have no answers,” said Naline Rampersad, who cannot understand how her seemingly healthy child unexpectedly died in the ICU at Children’s Hospital one year ago today. She was admitted because she had difficulty breathing.

The hospital discovered days after she died that the girl had a rare autoimmune disorder, but didn’t tell her parents until nearly a year later at a meeting to summarize a “critical incident” review of what went wrong.

“They admitted that they knew this after she died, and no one bothered to contact me until I went to the hospital on June 9 for the critical incident report,” said Rampersad.

Provincial legislation requires health-care organizations to disclose when a critical incident occurs to patients or their families, including all facts as they become known.

“They said I fell through the cracks,” said Rampersad.

The hospital’s child health leadership team told her Talina had antineutrophilic cytoplasmic antibody (ANCA) vasculitis, a rare autoimmune condition characterized by inflammation and damage to small blood vessels that can mimic pneumonia.

“What they said to me was that this usually happens to people in their 40s and somehow she contracted it. How did she contract it? Why did she contract it? It’s not genetic, according to them,” but that’s little comfort, said Rampersad, whose son has just turned 14.

“I am now scared to death about him contracting the same thing.”

Rampersad said she’s still waiting to see it confirmed in Talina’s autopsy report, which she was told could take a year.

When completed by the chief medical examiner, final autopsy reports are typically shared with the primary care physician, a Shared Health spokesperson said Friday.

“In this instance, our provincial specialty lead for child health has offered to personally review the final autopsy report with the family when it becomes available.”

On July 13, 2022, the normally vibrant teen was having trouble breathing and taken to urgent care at Victoria General Hospital. She was transferred to Children’s Hospital that day and received supplemental oxygen. Her condition worsened.

On July 17, she was transferred to the pediatric ICU, where she died.

A source in the hospital familiar with the case previously told the Free Press more diagnostic procedures should have been performed on the girl, who was initially diagnosed with pneumonia in both lungs, and she should’ve been transferred to the ICU sooner.

The pediatric intensive care unit where Talina was treated had increased patient numbers at the time, Shared Health said earlier.

Her death was the subject of a critical incident review, which is conducted when serious harm has come to a patient in the health-care system that cannot be attributed to an underlying health condition or inherent risk in the health services provided. The purpose is not to assign individual blame but to determine the facts and look at what can be done differently to improve the health care provided.

While the critical incident report is not made available to the affected patients or families, they receive a brief summary of what went wrong and recommendations to reduce the chances of a similar event from happening.

In Talina’s case, it said her undiagnosed vasculitis was so rare it would not have been considered as part of the differential diagnosis. In a June 16, 2023, letter to Rampersad, the summary also identified gaps in the documentation and monitoring of her fluids, particularly with respect to her urine output. “Such information may have led to earlier consideration of alternative differential diagnosis,” it said.

It recommended the child health program provide education to physicians regarding rare presentations of pneumonia and that it develop and implement a guiding document defining how to appropriately measure, document and monitor accurate fluid intake and output as per physicians orders.

“We acknowledge and apologize for the harm Talina experienced while in our care,” the letter said.

The apology and summary don’t satisfy the grieving mom.

“How does a healthy, vibrant, beautiful girl manage to die in the HSC? What happened when? What’s supposed to happen? What didn’t happen? is on my mind every single day,” said Rampersad.

carol.sanders@freepress.mb.ca