The death of Brian Sinclair should be deemed a homicide due to the inaction of hospital staff, a lawyer for the Sinclair family said during closing submissions at an inquest in Winnipeg.
Vilko Zbogar told Judge Tim Preston on Thursday that failing to provide medical care to a sick person is akin to failing to provide the necessities of life.
"It should be considered a homicide because very clearly there were human factors that contributed to Brian Sinclair's death," Zbogar told reporters outside court.
The homeless, double-amputee was awaiting a minor procedure in a Winnipeg hospital emergency room in September 2008, but no one ever came to his assistance. He sat in his wheelchair for 34 hours until he was discovered dead.
Zbogar said the staff's failure to carry out their responsibilities, as well as their negative assumptions about Sinclair, led to the 45-year-old aboriginal man's death.
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An autopsy later determined Sinclair died of a treatable bladder infection. Police have already investigated the death but did not lay any criminal charges.
The inquest heard that nurses walked past Sinclair during his 34-hour wait and did nothing to help, even when he vomited on himself.
An internal report following his death found some staff thought Sinclair was drunk and was waiting for a ride or just needed a warm place to rest.
"We're talking about negative stereotyping — stereotyping that led to numerous assumptions being made, all of which significantly contributed to Mr. Sinclair's death," Murray Tratchenberg, another lawyer representing the family, told the inquest.
"It caused medical staff, who had the responsibility to intervene and provide Mr. Sinclair with the care he needed, not to do so."
Sandi Mowat, head of the union representing nurses, said what happened to Sinclair was a tragedy, not a homicide.
"No nurse would ever have wanted this to happen," she said outside court. "We're very hopeful that we're going to get recommendations to make sure nothing like this happens again."
Mowat added that while much of the "system breakdown" in Sinclair's case has been addressed, there is still an issue with patient flow in hospital emergency rooms.
A senior hospital official refused to respond to Zbogar's comments.
Arlene Wilgosh, CEO of the Winnipeg Regional Health Authority, said she's waiting for the judge's report, adding that staff regret what happened to Sinclair and have made changes to prevent another waiting room death.
"He should not have died in our facilities," she said.
"You cannot predict human behaviour, but we are putting in processes. We're educating our staff [and] continuing to support our staff. It would be our intention that that would not happen again."
Family deems inquest a disappointment
Closing submissions at the inquest, which has been looking into the circumstances surrounding Sinclair's death, took place on Thursday after about a year of proceedings.
The inquest saw surveillance footage of Sinclair’s visit to the ER that revealed he had vomited numerous times and still did not receive medical care.
'No nurse would ever have wanted this to happen.' - Sandi Mowat, Manitoba Nurses Union
Ultimately, an off-duty nurse found Sinclair dead in his wheelchair.
Preston is scheduled to submit his non-binding recommendations in December, but Sinclair's family has already called the proceedings a disappointment.
In February, they and their lawyers walked out of the inquest in protest, but all returned for final recommendations.
Family members said they wanted the inquest to look into racism and discrimination in the health-care system, but Preston said it was beyond the scope of the proceedings.
Health officials say they have made changes since Sinclair’s death — including redesigning the Health Sciences Centre emergency room.
Officials at the hospital have also testified that patients are better tracked when they arrive.
Call for public inquiry
The Sinclair lawyers along with lawyers with Aboriginal Legal Services of Toronto, which has standing at the inquest, are now calling for a public inquiry, saying it is needed to look at how aboriginal and marginalized people are treated in the health-care system.
"This inquest did not deal with the issues of systemic discrimination and assumption making and dismissive attitudes towards the public that came out very clearly in this inquest," Zbogar said outside court.
"The judge didn't think he had the capacity to deal with that issue in this process. He said it's not a public inquiry, so that's what we need."
Aboriginal Legal Services of Toronto lawyer Emily Hill said the inquest should have examined what role discrimination played in Sinclair's death.
She said his death isn't an isolated incident, just an extreme example of what aboriginal people experience daily.
Garth Smorang, lawyer for the Manitoba Nurses Union, did not address the call for an inquiry in his final submissions. But he did suggest Preston does not have the authority to rule Sinclair's death a homicide since a coroner has already called it "natural."
Instead, he recommended the judge address adequate nursing staff in emergency rooms, the availability of diagnostic equipment such as X-ray machines and increased use of electronic health charts.
Statement from Aboriginal Legal Services of Toronto
As the inquest into the death of Brian Sinclair formally concludes this week, Aboriginal Legal Services of Toronto (ALST) is looking elsewhere for solutions to the serious problems that aboriginal patients continue to face when they seek medical treatment.
"Inquests are supposed to answer the questions a community has about one of its members. In this case, questions about what role discrimination played in Brian Sinclair’s death have not been adequately addressed," said Emily Hill, senior staff lawyer at ALST, who had been attending the inquest until the agency withdrew from the proceedings in February of this year.
"Of course we will wait and see what recommendations are made in the final report, but based on the decisions about what evidence was called, we think a different process is needed to examine how Brian Sinclair’s death reflects the most extreme example of something that aboriginal people experience on a regular basis."
The family of Brian Sinclair has called for a public inquiry to examine racism in the health-care system.
"ALST supports the family’s call for a public inquiry. It is clear that Brian Sinclair is not an isolated case and that discrimination continues to have a negative effect on aboriginal and other marginalized people in the health-care setting,” said Christa Big Canoe, legal advocacy director of ALST.
"This problem needs to be fully explored so the medical system can begin addressing this problem. We look forward to continuing our work with the expert working group that was formed to address these very issues."