Family buries wrong body after blunder at HSC morgue

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This article was published 16/08/2024 (419 days ago), so information in it may no longer be current.

Manitoba’s health authority is looking for answers after separate incidents in which a man’s remains were released to the wrong family and two other bodies were incorrectly taken from a morgue to funeral homes.

“I am appalled. I am outraged, I am heartbroken, not only that this type of error could occur, but that it could be repeated,” Shared Health CEO Lanette Siragusa told a news conference Friday.

Siragusa said early results of an investigation have identified “concerning gaps” in processes in place to prevent such occurrences and an external audit will review Shared Health’s procedures for custody, identification and release of bodies in its care.

Health Sciences Centre received the body of 44-year-old Pimicikamak Cree Nation resident Keith Wilson on July 13. Following an autopsy, what was believed to be his remains were released to a funeral home on July 22.

Wilson was reported missing from Norway House Cree Nation on the morning of July 11. The next day, RCMP and community members found a body in the Jack River.

Irregularities were found in Shared Health’s records on Aug. 7 and, on Monday, the health authority advised Wilson’s family the wrong body had been released to a funeral home.

“I promise that we will do better.”–Lanette Siragusa, Shared Health CEO

The notification came after a burial in Norway House Cree Nation had taken place.

“Shared Health accepts full responsibility for this error,” Siragusa said. “I promise that we will do better.”

Pimicikamak Chief David Monias was shocked to hear about the incident and is waiting for a full investigation to be completed.

“It’s hard to deal with this kind of thing when you thought you had dealt with it. This reopens the wounds,” Monias said. “We want assurances that this is not going to happen to anybody else.”

Shared Health’s initial investigation identified two other recent “near-misses” in which bodies were incorrectly identified and sent to funeral homes before the errors were caught and the remains returned to HSC’s morgue.

Siragusa declined to provide further details of those incidents, citing privacy requirements under the Personal Health Information Act. However, she said she doesn’t believe the two bodies involved were related in any way.

All three blunders have been declared critical incidents.

“It is clear that human error played a role in this event,” Siragusa said. “However, it also signifies systemic failure that allowed it to be repeated again.”

Who has access to the morgue, how bodies are delivered and removed from the site and where the health authority failed to keep track of remains will be probed in the audit, she said.

Meantime, Shared Health has restricted morgue access to two employees; a large number of staff members connected to morgue services previously had access to the area.

The health authority is also doing a retrospective audit to see if any other bodies were released to the wrong families over the last month.

Siragusa said she wasn’t aware of any similar incidents occurring at the province’s largest hospital.

Monias said the wrong body was delivered to Norway House in a sealed casket and couldn’t be identified by Wilson’s family or other community members.

“I think that there would be very tight policies and procedures that need to be followed to make sure that there’s some quality assurance done (at the morgue),” he said.

“Losing a loved one is bad enough, but then to have the wrong body sent to you for burial is something that’s traumatic.”

“We want assurances that this is not going to happen to anybody else.”–David Monias, Pimicikamak chief

Monias said Wilson’s family should consider taking legal action against the health authority for the mistake.

“There’s funeral costs that they need to be reimbursed for, and to do the reburial and stuff like that has to be considered, as well,” he said.

Shared Health is arranging for the buried remains to be exhumed and for Wilson’s family to bury his body.

Manitoba Keewatinowi Okimakanak acting grand chief Angela Levasseur issued a news release Friday offering condolences on behalf of the 26 First Nations represented by the organization.

“Our hearts and prayers are with the Wilson family…. To now learn that they, in fact, buried someone else is hard to fathom,” Levasseur said in the release.

“The heartbreak that they must endure as they look to have their loved one returned is unimaginable. Steps need to be taken to ensure this doesn’t happen again.”

nicole.buffie@freepress.mb.ca