The recent deaths of two Winnipeg men who were found outdoors after being sent home from hospital by taxi has Manitoba's health minister promising new rules to make sure discharged patients are transported home safely.
The Winnipeg Regional Health Authority (WRHA) confirmed Friday it is investigating a second death involving a man who had been discharged from Grace Hospital in late December.
News of the case came after CBC News reported that 78-year-old David Silver died on his front porch after being sent home from Grace Hospital in a taxi on Dec. 31.
The WRHA said both men's cases meet the requirements for officials to launch critical incident investigations.
Silver was taken by ambulance to the hospital on Dec. 30 suffering from stomach pain, nausea and a headache.
His family told CBC News that doctors told him he had gallstones and kidney stones and the problem wasn’t serious enough for him to be admitted to the hospital.
At 1 a.m. on Dec. 31, they told Silver they were sending him home. He was given a cab slip and sent home in his pyjamas and slippers, according to family members, even though the temperature at the time was –37 C without the wind chill.
On the way to his door, Silver collapsed and died. He wasn’t found until about 14 hours later, when his caregiver arrived to find him frozen in the snow.
His family said Silver didn’t die from freezing to death, but of a heart attack or some kind of a heart-related issue.
Man found on sidewalk
The WRHA says in the second case, a man was discharged from Grace Hospital and driven by taxi to a residence on Arlington Street.
'It's common sense to make sure that the person gets to the door in a safe manner.' - Erin Selby, health minister
Less than an hour later, a passerby called 911 after seeing a man lying on the sidewalk outside the home.
"Our understanding was that he was alive when he exited the taxi," Arlene Wilgosh, the WRHA's president and chief executive officer, told reporters on Friday.
"And it is our understanding as well that he was deceased when emergency personnel arrived," said Lori Lamont, the health authority's chief nursing officer and vice-president of interprofessional practice.
Shawn Zemla, who lives in the building next door to the man's home, said he woke up one morning and heard a woman screaming.
Zemla said he saw a man lying on the pavement outside his building, as passersby and emergency responders tried to revive him.
"I ran outside and I grabbed as many blankets as I could and I covered him up," he told CBC News.
"We couldn't get him on his back because he was really heavy-set, so it took us quite a while to get him from being face-first in the snow."
The man, who had been in the hospital's emergency room for about 24 hours and was thoroughly examined, died of an underlying medical condition, according to the health authority.
The health authority did not release any details about the man, such as his name or age.
As for when the second death occurred, a WRHA spokesperson would only say an incident took place "where a gentleman left Grace Hospital at 8:20 a.m. within approximately a one-day range of the incident with Mr. Silver."
Overnight low temperatures in Winnipeg at the time were between –33 C and –38 C without the wind chill.
The WRHA says taxicabs are commonly used to transport patients home from hospitals in the city, but it did not have specific numbers.
Wilgosh said the WRHA will meet with the provincial Taxicab Board next week to develop a plan to ensure discharged patients get inside their homes. As well, officials are reviewing the discharge protocols in both cases.
"One key point that I wanted to leave with you is one of the similarities of these cases [is] that they do both involve transportation by a taxi cab," she said.
Health minister wants onus on cab drivers
On Friday, Manitoba Health Minister Erin Selby said the onus should be on taxi drivers to ensure patients being driven home by cab get inside their homes safely.
"I think it's clear that when a patient is discharged from hospital and returned by taxi that that should include making sure that patient gets through the front door safely," she told reporters.
Selby said Manitoba Health is drafting a protocol to be sent to all regional health authorities.
"People on the front line make the decision of what is the best way to discharge people … in many cases it is a cab," she said.
"In the case somebody be discharged from a taxi, we are going to expect — and it will be mandatory — that the taxi cab driver ensure the person make it to the front door safely," she added.
"It's common sense to make sure that the person gets to the door in a safe manner."
No one from Winnipeg's main taxi companies, or the Taxicab Board, has responded to requests from CBC News for comment.
'It's still happening'
The WRHA's current guidelines do not require cab drivers to escort patients to the door, but officials said cab drivers typically do watch for patients to get inside or help them.
The health authority revised its safe discharge policy after Heather Brenan died under similar circumstances in January 2012.
- Woman's death probed by health officials
- Inquest called into death of woman after hospital discharge
Brenan, 68, was sent home in a taxi from the Seven Oaks Hospital emergency room. She collapsed on her doorstep and died from blood clots in her lower legs.
An inquest has been called into Brenan's death, but no date has been set yet.
Her daughter, Dana Brenan, says while the WRHA's policy may have been revised, it appears that no one has made sure protocols are being followed.
"Clearly there's been no change, that it's still happening," she said.
"Yes, it's a different hospital than in my mother's case, but this is obviously a city-wide policy."
On Friday, officials said they are looking into whether the WRHA's discharge policy should be changed for the period between November and April because of the cold winter weather.