Manitoba doctor had no choice, sent man to hospital waiting room where he died

WINNIPEG – A doctor says she had no choice but to send a man with a blocked catheter to a hospital emergency room where he died during a 34-hour wait for care.

Marnie Waters told an inquest Monday into Brian Sinclair’s death that she examined the double-amputee on Sept. 19, 2008. Sinclair had wheeled himself to a community clinic from a Winnipeg homeless shelter, where he was volunteering, because he hadn’t urinated in 24 hours, she said.

The doctor said she examined the 45-year-old and found his catheter was blocked.

“He was calm and showing no signs of emotional or physical distress,” she told the inquest. “His responses were basic but they were audible. They were intelligible. They made sense to me.”

Waters said she determined Sinclair needed his catheter changed but the nurse working with her said she couldn’t do it at the downtown practice. The nurse told her Sinclair was soiled and needed “a general clean” before a new catheter could be inserted in a sterile manner, Waters said.

The clinic didn’t have a lift that would have been needed to get Sinclair out of his wheelchair to perform the procedure. Sinclair also needed lab work done relatively quickly and the clinic’s lab was closed that Friday, Waters said.

She and the nurse decided “the safest and best place for Brian” was the emergency department at the Health Sciences Centre, she said, so the nurse arranged for a taxi for Sinclair, while the doctor wrote a letter outlining his condition.

Waters said she told Sinclair to hand the letter to someone at the hospital triage desk and “it will help you to be seen quickly.”

“He said, OK doc.”

Sinclair went to the emergency room. Video from a surveillance camera shows him speaking to a triage aide before wheeling himself into the waiting room.

He sat there for 34 hours, vomiting several times as his condition deteriorated, before he was discovered dead. By that time, rigor mortis had set in. Sinclair died from a treatable infection caused by the blocked catheter.

He was considered mentally incapacitated and was under the care of the public trustee, but Waters said his chart was incomplete and didn’t include that information. She said she didn’t call the emergency room to let them know Sinclair was coming because his vital signs were stable and the treatment he required was simple.

“In Brian’s case, his medical concern and needs were clearcut. He had a blocked catheter. It needed to be changed,” she testified. “I felt he was capable of handing over a medical letter and telling triage his history when asked.”

The clinic co-ordinator called Waters at home on Sept. 22 to say Sinclair had died in the waiting room.

“It was a very emotional piece of news,” she said. “Thinking about it is difficult.”

Sending Sinclair by ambulance to the hospital wasn’t an option since his condition wasn’t urgent, said Waters, who added he didn’t seem to have any family to take him or advocate on his behalf.

Since Sinclair’s death, it’s now clinic practice to call the emergency department and write a letter for any patient who is transferred to a hospital.