Responsibility and accountability

As Manitoba prepares to release a budget focused on health care, patient safety and nurse-to-patient ratios, the death of Stacey Ross remains a sobering backdrop. A woman who believed she was having a heart attack waited 11 hours in the emergency department of St. Boniface Hospital, the province’s only tertiary cardiac centre. Her family has called for a public inquiry. The province is considering an external review.

Those responses are appropriate. But if this moment is to produce meaningful reform, the conversation must extend beyond a single tragic case. It must examine how specialized cardiac care is organized in Manitoba and where ultimate responsibility resides.

St. Boniface functions, in practice, as Manitoba’s heart hospital. It is the only centre providing tertiary cardiac services for the province. Yet it does not operate under a clearly defined provincial program mandate in the way CancerCare Manitoba does for oncology. That distinction is not symbolic. A formal provincial mandate aligns authority, funding and accountability for outcomes in one place.

Cardiac care in Manitoba spans multiple layers. The provincial government sets policy and funding parameters. Shared Health carries province-wide service responsibilities. The Winnipeg Regional Health Authority oversees regional delivery. St. Boniface provides specialized cardiac infrastructure and clinical expertise.

Each entity has a defined role. The difficulty arises when no single authority carries end-to-end responsibility for cardiac outcomes across the full continuum of care.

Cardiac medicine is unforgiving of delay. Time-to-treatment is not an abstract metric; it is biologically determinative. Heart muscle lost to ischemia does not regenerate. When specialized care capacity is not explicitly designated and structurally protected, it can gradually be absorbed into broader institutional pressures. What begins as short-term contingency becomes routine practice.

The current debate over nurse-to-patient ratios, mandatory overtime and hospital safety designations is part of this same conversation. Ratios matter. Workforce stability matters. But staffing policies alone cannot resolve structural ambiguity. Frontline clinicians work within systems shaped by governance decisions. When lines of accountability are layered and diffuse, pressure settles at the bedside.

Fiduciary responsibility in health care runs in two directions: to patients who depend on timely, competent care and to professionals entitled to a safe and sustainable workplace. Clear mandate and aligned authority protect both.

It is tempting to frame the present crisis primarily as a funding shortfall. Resources are essential. Recruitment and retention are essential. But structure precedes performance. Without a clearly articulated provincial mandate for tertiary cardiac care, aligned governance authority and transparent reporting of outcomes, additional resources risk being dispersed rather than directed.

If an external review is to strengthen public confidence, its scope should extend beyond individual actions in a single case. It should examine whether Manitoba’s tertiary cardiac service is supported by: a clearly defined provincial mandate; governance alignment across provincial and regional bodies; protected tertiary capacity insulated from routine overflow pressures; and transparent reporting of time-to-definitive-care outcomes benchmarked nationally.

Reviews that focus narrowly on discrete events may establish facts but miss the structural conditions that shape them.

This is not about assigning blame. Governments change. Organizational charts evolve. Institutional arrangements persist. The enduring question is whether Manitoba’s only tertiary cardiac centre is organized so that responsibility for outcomes is unmistakable.

Budgets signal priorities. Governance determines whether those priorities translate into safer care.

Structures exist on paper. Patients experience care in real time.

Dr. Alan Menkis writes from Winnipeg