Updated: Tue Sep. 23 2008 11:12:47

ctvwinnipeg.ca

A man who was in the same hospital waiting room as Brian Sinclair says he told nurses and security workers he was concerned about Sinclair -- but says he was told they were too busy to check on him.

Brian Sinclair, 45, died while waiting 34 hours for care at the Health Sciences Centre in what some are now calling the worst emergency room failure in Manitoba's history.

The witness -- who spoke to CTV News on the condition his identity be withheld -- said he was in the waiting room Friday evening. Sinclair, who had previously had both his legs amputated, was sitting nearby in a wheelchair. He looked like he was sleeping.

The witness said when he returned to the waiting area the next night, the man was sitting in the exact same position and looked like he hadn't moved, so he decided he should tell someone.

"I don't think he's asleep, so we went to tell a nurse." said the witness, who was there with his wife. "The nurse said we'll go and check, [but] nobody ever went and checked on him. We waited another hour or so and we told another nurse twice to go and check." The witness said the nurse told him she was too busy and couldn't check right away.

The witness claims he told a security officer of the man's condition, but said the guard told him the case would be "too much paperwork."

Victim had kicked addictions: friend

Further details came to light on Tuesday about the story CTV News broke Monday night exclusively on CTV News at Six.

Friends of Brian Sinclair tell CTV News he was a former solvent abuser who had kicked his addictions.

"We haven't seen him in a year," said Joseph Severeight. "He quit using solvents and things like that. And that's how I knew him, he cleaned up his life."

Sinclair's brother, Bradley, said he didn't know his brother had gone to the emergency room and was told by social workers that Brian had died.

"I feel awful, but I'm going to pray for him," he said.

Sinclair arrived at the HSC on Friday, Sept. 20 at 3 p.m. He was finally attended to at 1 a.m. Sunday morning. The WRHA says the man was pronounced dead a short time later.

"For reasons we can't explain right now, he was never presented at the triage desk where we have triage nurses that assess someone's clinical situation," said the head of the Winnipeg Regional Health Authority Dr. Brock Wright.

Health officials are now confirming what CTV News reported Monday - that the man may have been sitting dead in the waiting room for several hours before anyone realized he had passed away.

"There is reason to believe at that point the patient had been dead for some time," said Wright. "We don't know how long, but it's likely the person had been deceased for a period of time."

The chief medical examiner has determined cause of death, but is still notifying family members. A critical incident review is now underway involving the Health Sciences Centre, its emergency department, and the WRHA.

Sinclair is seen on the hospital's security camera footage when he arrived at the department's main entrance Friday afternoon.

Sinclair seen in security camera footage

He is not in the footage the entire time, but health officials say they believe the man was in the waiting room for the full 34 hours. It's also believed the man interacted with aides and cleaning staff, but not medical staff.

"The challenge for us right now is to explain how it is somebody could be in the department for 34 hours and not have been brought forward to the triage desk area and be entered into the system," Wright said.

Wright said the system relies on people approaching the triage desk so that they can be placed in a cue based on the urgency of their medical needs. He said Sinclair was known to HSC staff, and said staff was surprised that Sinclair wouldn't have checked in at the triage desk.

The issue dominated question period at the Manitoba Legislature Tuesday, as Opposition Leader Hugh McFadyen demanded answers from Premier Gary Doer.

McFadyen called it the "worst emergency room failure in Manitoba history," and accused the minister of knowing about the case when she held a news conference on Monday to announce a new contract with doctors.

"Thirty four hours, no attention, known to the minister at a time when she's out boasting about her record in health care. I want to ask the premier if he thinks it's appropriate that the Minister of Health was in front of the media yesterday, boasting in this house, boasting before this story broke, a story she was aware of, that she had overseen the worst emergency room failure in Manitoba history."

"We're treating this as a very, very serious situation," responded Doer. "We are investigating what went tragically wrong. And we admit to the people of Manitoba that it went tragically wrong."

"Clearly that's a gap," said Wright. "It's never happened before. We're going to have to change our systems so it never happens again."

With a report from CTV's Kelly Dehn.

Please Add Comments(30)

RONALDO L. DACQUEL
We look for somebody to blame when incidents like this happen. Why can we not look for facts before presenting this to the public? I am extremely thankful to our Manitoba Health Care System if not, I would have not survived a fatal heart problem that would have cost me millions if treated elsewhere.

Gary
Nothing not much shocks me there anymore. They spend close to 100 million to build this new building, and they don't even make it winter proof. They had closed the adult emergency entrance because the cold was coming in, you would of thought they would of considered this when it was built, this is Winnipeg after all!

Joe Miguez
You would think as one of the highest taxed provinces we could improve our health care. I don't know where we went wrong, years ago we didn't have walkin clinics to help with the workload and you didn't have to wait as long at hospitals as you do now. The part that really bothers me is every political party blames each other, you all had a part in the degridation of the system so quit pointing fingers, drop the political barriers, work together and fix it. Try asking the people who do the job, they know a lot more than you where the problems are and they probably have ideas on how to fix it.

Larry Chapman
I am not surprised what happened, ER's are totally inept and irresponsible. I have had problems at 7 Oaks
Hosp. ER. No not because of lack of staff, there are more than enough triage and Rn's, it's a matter of ineffeciency
Yes Er's could use more doctors, but it's because administration is inept and so is Wpg. Regional Health.
Wpg. regional Health should not be run by govt. or doctors, but by a private company with doctors as consultants only. When you have doctors controlling the
medical system you get chaos!
I am sorry for that man and his family! Also what would have happened if the man was a white person? Probably gotten better service!

Robert Bamburak
Several years ago I went to HSC Emergency and registered at the triage desk at about 9 pm and waited to be called. I never was called and around 3 am I went up to find out the nurse/clerk had gone home and never passed my name onto the new clerk. I remember at the time remarking that I could have died by then and no one would have noticed. Thankfully I survived!

melissa Postma
The health care system does need to change before more tragedies like this one occur.
I can relate, I have gone to the emergency so many times to treat my asthma, many times I've told the triage nurses I was out of air and still made me wait a few hours. Problem is they're short of staff but worse of all, most don't care to bother.

I do feel for the family of Sinclair. best regards
Melissa Postma

Joanne
I don't feel that there has been enough changes made in hospitals if this kind of thing can happen in a Winnipeg hospital. Surely someone should check the waiting room now and then so that no one is left sitting there for that long a time whether he has checked in or not. You should feel safe in a hospital even if you did not report to triage. I know that nurses do the best they can but because I have nothing against the nurses or doctors but they should hire someone to keep an eye on the waiting rooms. In my estimation the waiting rooms are too far away from the triage desks so that they cannot see what is happening in them. They are definitely going to have to do something more in order to do a better job.

FEED-UP
Want to resolve this problem - get rid of all WRHA management staff that happen to be doctors. These morons are so out of touch with what we as regular citizens what and need they'll never get it right.

Appoint or elect citizens to the governing board of WRHA and get rid of the overpaid and old age doctors and human resource specialists along with their high paying Public relations officers

Alison
This incident is being blown way out of proportion. He was known to the staff and did not report in with any concerns. The only thing the hospital did wrong was provide shelter. Hospitals should not allow people to seek shelter, there are other places for that.

Anna Maria
Well, for one thing if stupid people who are NOT in a life and death situation, would stop clogging up ERs, then the doctors and nurses wouldn't be so tied up and therefore able to pay more attention to people entering the hospitals. People go to ERs for the stupidest things. Then you cry and act surprised when this stuff happens. Get a clue people. If you're not having a heart attack, bleeding to death, or otherwise having your life threatened, go somewhere else!

Paige
The sad thing is it is not just Wpg HSC that has a magor problem it is a provicial wide issue.In Brandon, I can count many times I sat with my child ( who had a fever of 104 sometimes 105 ) for hours and hours. Was given Tylenol and sent home. Also thanks to the nurses and Drs who assesed me as an over anxious pregnant woman, I went home in labor at 23 wks pregnant to return the next day 24 hours later by ambulance to lose my son.

All because no one wanted to take the time to diagnose me. She is worried, send her home. It is an attitude shared by many nurses and Drs. They are overworked, under paid and we just dont have adequet care and staff here. Our galliant politicians should focus on what can really help us and quit trying to outdo each other with all their hot air. Just watch them bash each other blaming each other for this. I agree it is all their doing, everyone of them!

LoJay
Our NDP gov't promised to get rid of hallway medicine. This poor man didn't even make it to a hallway. I don't think that race is the issue here as alot of us have personal stories we can relate. Living in a rural area we often have our clinic shut down due to no Dr. being available (there should be 4 because of the population). When we do get one most of the time you can't understand a word they say as they are imported for about 6 months then disappear. Yes, remember the good old days when you could see a Dr. within a few days instead of a month. If huge changes are made to the system due to this fellow's death hopefully it will comfort the family to know he left something good & positive behind & all of Manitoba has him to thank for it.

Heartbroken Nurse
I'm disgusted with this. I hear a lot of people taking it to the government levels now, and certainly this is necessary to some extent. But lets face facts. The so called "TEAM" of health care "Professionals" on duty for the TWO DAYS that this man Sat ignored and uncared for, ARE COMPLETELY TO BLAME for this horrific incident. I am a NURSE in this city, and I have seen first hand the negligence, judgment and cruelty that sometimes occurs as a result of burned out, over entitled hospital staff that have come to work for nothing more then their pay cheque. How can I say such things, being in health care myself? Because I have also been on the receiving end of it all, and I have observed gossipy staff huddled around their nursing stations speaking in voices audible to those waiting for treatment. I have heard inappropriate and callous remarks made, and have been told how "BUSY" everyone is. I realize there are issues with our system as a whole, but if staff have time to sit on their A$$ES talking trash about the patients they don't enjoy very much, then they sure as hell should not be grumbling for higher wages and juicier contracts! Get to work! Do your Jobs! Or get out of the profession. The housekeeping staff did a better job tending this poor soul as he sat there breathing his last breaths! I'm just disgusted and ashamed to call myself a part of this "team" of self servers right now. :(

Mike singh
City collects high taxes, why not make a good hospital? Like hire good amounts of staff and make more rooms... I really think this short staff term should be fixed, like if you're really ill you would want help asap, not 4 hrs later! And as far as I know everyone has a right to proper healthcare!! Good day Canadians

jeff b
The reality is that the hospital staff would've likely been all too familiar with this male, like many that are in the hospital day after day. seeing someone who is classified as less fortunate is a common occurrance in er's and this is no different. they are brought there, most times to sober up due to their intoxication and are left there, not at the fault of the "system", but due to the politics and legal ramifications to having them intoxicated in public. the system needs to get them out of the waiting rooms, into something resembling a main street project wing of the hospital and be treated or released. often times they are threatening or dangerous and should not be out with the public anyways. not too often is there not someone at an er waiting room that is not there for this reason and these people are common visitors to er's. while this is a horrible situation, the staff are not to blame in my opinion, but rather the response times and wasted dollars renovating hospitals instead of actually improving the quality and efficiency of the work they do. the politics of hallway medicine have people thinking that it is the most important issue, when in reality it is the lack of true service provided by the health care system. that would help fix the problem. people in the situation this male found himself in, with an addiction, need to be treated. not fed, sobered and kicked out the door. for a change, instead of taking the government to task, i would love to hear the pc's come up with some solutions and work with the ndp's to help improve things. not the time for i told you so's, but solutions.

Jay
The blame should lay squarely on the Winnipeg Regional Health Authority. I do not understand how such an inept "corporation" continues to run wasting millions of our hard earned tax dollars while our health care system spirals toward ruin.

I say we should blame fire Gary Doer! He never did deliver on his health care promises.

Nicole Milani
I knew wait times where bad but this is ridiculous!I really hope this won't happen again.

Michelle
In our family we have a rule. If one of us gets sick and needs to go to the ER, we never, ever, let them go and stay alone. Hospitals DO NOT care for patients. Family cares for patients and part of that care is to ensure that hospital staff do what is required of them. Too many bad experiences in hospitals have led to the need for the family rule.

Andrew
I still believe in the public health care system... Sadly tragics like this happens these were human mistakes, not the system. Privatization isn't the answer to fix the problem. Look at the U.S, almost 50 million people don't have health-care. And for someone that has asthma, they'll get denied health-insurance because its a pre-existing condition... A for-profit system would mean LESS treatment for everybody.

Waiting 18 months so far for knee surgery, in pain
Ronaldo... congrats on surviving YOUR heart attack... but that illustrates EXACTLY what is wrong with the system.
EVERYONE deserves treatment as great as you recieved. Until then, I will consider the system a complete failure. Millions without a family doctor, suffering from whatever issues they have... too fed up with sitting in a waiting room for hours and hours and hours and hours. Waiting years on a surgery "waiting list" (I'm on that list, 18 months now)... the list goes on and on...
I give the health care system in this country a complete and utter failing F.

Nothing new with the ERs
There should be better monitoring of the waiting rooms. Twice or more a shift someone from the triage desk should check in on the waiting room and ensure everyone on their list is sitting in the waiting room and everyone is accounted for. This is a huge disaster on top of everything because the nurses were told about this individual and still did not take 5 minutes to check! Unbelievable.
I've had bad experiences at Concordia and so has my spouse. He went in there with chest pains and couldn't breathe and actually collapsed at the triage desk. What did they do? The nurse and security guard helped him up and put him a chair in the waiting room! He is a white middle class buisness owner and he did not get special treatment, just the opposite of what he should have for someone having a heart attack! So it's not necessary the race thing, it's ignorance all the way around with the ERs.
I understand they are understaffed and over worked, but aren't we all. If the doctors and nurses can't manage the overload of a ER they should go and work in a private clinic then.

K. Guimond
This goes to show Winnipeg that Health Sciences Centre is still a butcher shop. They don't care as long as the nurses and doctors all get paid, never mind the general public.

doug
ERs are for health care, not a place to warm up. There should more fac. for the less fortunate.

Shawna
This is also a small town issue too. I live in a small rural manitoba town, and it is like pulling teeth to get into seeing a doctor. You might sit there for a good 5 hours before they even call a doctor. Our Healthcare system is SAD SAD SAD.

Charley Rose
*hugs* to the Heartbroken Nurse and thank you! I'm sure most nurses in this province do their job, like yourself, with compassion and efficiency. I too have been to this ER and have seen first hand what you speak of. The gossipping and poor manners some of the staff members display is just .... scary. What exactly did this poor man die of anyway? It would have taken a staff member a whole minute to assess him quickly and make sure he had been seen at Triage, but they chose to ignore him instead. Shame on you! And have you ever heard of multi-tasking? Many people who hold jobs these days are familiar with this skill, perhaps ER staff should receive some additional training in this field. I don't know, but I can't see how this should have happened if they knew their job and responsibilities. And where's the compassion? Maybe they are in the wrong line of work.

Nan McB
Andrew, I was waiting to find out how many comments it would take before someone dragged the US in here somehow. Congrats! It always happens.

We get what we deserve
Seems to me that we get what we deserve.

How many times over the years has people in the Province voted for the NDP government???

What we get for our stupidity is the highest taxes in Canada, almost the lowest paid medicial staff in Canada, and here's the NDP's greatest contribution - one of the largest and most expensive management structures in the country to run WRHA.

Want change - then quit voting in the NDP party!!

And before you try to belittle me for my comments - Remember when Pope John visited and held mass in Birds Hill park? Remember that a member of the NDP party suffered a heart attach at the mass?

Remember that he was air lifted to Seven Oaks hospital as it was the only one with a heli-pad?

Did the NDP then open that heli-pad to all citizens fo Manitoba???
The answer was NO - so shut up

Mark
I am grateful that we have a public health care system but I know also know that some of the doctors don't care about us too. My friend went to the hospital over a year ago complaning about chest pain and sore arm. The doctor said that it was a cold and sent him home. Later that same night he died from heart failure. He also had some heart problems in the past, but the doctor didn't even look at the files.

Gerard Lavallee
The excuse has being to busy is not nice. They just do not care. Put in their eight hours and go home. A few years ago, I spent over 10 hours one time at the ER, I had to go home without seeing anyone, just too busy.

Michelle
What happened at the HSC in Wpg is not acceptable. Mr. Dacquel, I am happy to see that you are ok, it is good to hear good stories about our healthcare system. As for Alison's comment, it doesn't matter if you are known or not known to the hospital or you checked in or not someone should have noticed Mr. Sinclair sitting there. My condolences to Mr. Sinclair's family. This should not have happened and I hope it does not happen again.