As COVID-19 deaths soar, nurse investigators at Manitoba's medical examiner's office are warning that they face a "desperate need" for resources.
Crushing caseloads and staff shortages are driving them towards burnout, a situation that runs the risk of bodies being left to languish in morgues and families left waiting for communication.
The news puts a spotlight on another grim facet of a province struggling to bear the weight of the pandemic.
Last week, a group of investigators at the medical examiner's office sent a letter to the Manitoba Government and General Employees Union. In a copy of the letter obtained by the Free Press, the investigators wrote that they are facing "overwhelming and unsustainable working conditions" due to an increase in reportable deaths.
While these challenges are not new, the letter stated, they've been "exponentially exacerbated" by COVID-19.
"This is yet another government workplace that is struggling due to a lack of resources," MGEU president Michelle Gawronsky said in a statement to the Free Press. "The government needs to give the employer what they need to staff up the unit in order for them to keep up with the demands this pandemic has placed on them."
According to the letter, a reasonable workload for an individual nurse investigator would be 500 cases a year. This year, each investigator working in the unit had surpassed that figure by September — before the surging COVID-19 deaths of recent weeks, all of which require an official investigation before the body can be released.
The letter states there are currently five full-time nurse investigators working in the office. A normal complement is eight, but by mid-2020 high staff turnover had already left them short-handed. Three open positions remain unfilled, and since an open posting closed in August, no new hires have been made.
"This is yet another government workplace that is struggling due to a lack of resources. The government needs to give the employer what they need to staff up the unit in order for them to keep up with the demands this pandemic has placed on them." — MGEU president Michelle Gawronsky
"This is simply unacceptable during a global health crisis," the letter stated.
In a statement to the Free Press Monday, a spokesperson for Manitoba Justice acknowledged that the file review process has been impacted by "the significant increase in cases due to the COVID-19 pandemic," and said that the province is actively recruiting to fill three vacant positions in the area.
The spokesperson also wrote that there are currently eight investigators and six administrative staff in the medical examiner's office, and that "under normal circumstances, this would be sufficient" to meet the need.
The letter to MGEU states that there are only five investigators currently working. It is signed by four of the five.
According to the letter, the staff shortage was further exacerbated when the province also required that each nurse investigator take one week off, unpaid, during the pandemic, due to being considered non-essential workers. Staff isolating while awaiting COVID-19 tests due to symptoms has also depleted capacity.
In addition to their daily caseload, at least one investigator must be on-call 24 hours a day, seven days a week. Due to the demands of the position, investigators are required to be nurses with experience in emergency or acute care who have extensive medical knowledge.
"It was predicted since the onset of the pandemic that there would be a second wave. We knew this was coming, however the Government of Manitoba to date has yet to provide our office with additional supports or made reasonable attempts to fill the longstanding (investigator) vacancies on a timely basis."
"It was predicted since the onset of the pandemic that there would be a second wave," the letter stated. "We knew this was coming, however the Government of Manitoba to date has yet to provide our office with additional supports or made reasonable attempts to fill the longstanding (investigator) vacancies on a timely basis."
The Office of the Chief Medical Examiner works under the auspices of the Manitoba Justice. It is responsible for investigating any death that is reportable under the provincial Fatalities Act, including deaths due to suicide and accident, violence, negligence, communicable disease — such as COVID-19 — and all deaths of children.
The long list of deaths the office must investigate also includes those in personal-care homes and correctional institutions, deaths within 24 hours of being admitted to hospital or while recovering from surgery, any unexplained death and any death linked to a workplace, among others.
Some cases require autopsies to determine or confirm a cause of death. Others require staff making on-site visits. But all reportable deaths must be processed by the office before the body can be released to next of kin. Staff remain in regular contact with families of the deceased, offering updates and support through the process.
With staff now struggling to keep up, the letter warned, it will be families that suffer the worst impacts.
"We feel the quality of our work is at risk of being compromised or rushed," the letter stated. "We also recognize the detrimental impact this has on the families we serve who are grieving and in great need of our support — we are simply not able to provide the quality of care that they deserve during their time of tragedy and loss."
There are other potential risks should nurse investigators become further overwhelmed, the letter went on to explain.
They include hospital morgues being filled past capacity with bodies waiting long periods of time to be processed. And law enforcement could be unable to move human remains from a site in a reasonable time, as certain situations require an investigator's authorization before bodies can be moved.
"Our current staffing situation is untenable and requires immediate attention as well as prompt action to ensure that we can continue providing the quality service that Manitobans expect," the letter stated.
Melissa Martin reports and opines for the Winnipeg Free Press.