While confirming that it won't allow medical assistance in dying on site, St. Boniface Hospital has lifted its policy requiring patients to leave the facility to be assessed for the service.

Under its old rules, patients at St. Boniface Hospital hoping to access medical assistance in dying had to be transferred off site for the assessments, which are required by Manitoba law and conducted by a medical team from the Winnipeg Regional Health Authority.

One patient died as a result of one such transfer, according to a St. Boniface Hospital internal memo dated March 1 that was provided to CBC News.

The patient received an initial assessment at the hospital, but had to leave for the second assessment. To accommodate the receiving site, staff changed his treatment and medication before the transfer.

"The patient's condition deteriorated during transfer. The patient arrived in great physical distress," the memo reads.

"The staff at the receiving facility had volunteered to assist during assessment to support the conversation and were not prepared or equipped to manage the patient's symptoms."

The patient died a few hours after arriving at the receiving site. The memo describes the moral distress of staff members who had helped him with his transfer and says a crisis intervention team was called in to help them work through it.

Assessments allowed on-site

St. Boniface president Dr. Bruce Roe told CBC News the incident and others described in the memo happened when the hospital and its board were still developing its policy on medically assisted dying.

Since medically assisted death became legal in Canada on June 17, 2016, Roe said around 50 patients at the hospital have contacted Winnipeg's MAID team and two have been transferred out to receive the service at other hospitals.

The hospital's new policy, brought in on June 12, allows the team to assess patients on site, but the hospital is still working on improving transfers of palliative patients, said Tom Carson, the newly appointed board chair for the hospital

"There's an interesting question when you think about the whole question of transport [of palliative patients.] … If people are looking to die at home, they're probably already in the hospital and need a transfer home to be able to accomplish that," Carson said.

Carson was appointed earlier this week following the resignation of Murray Kilfoyle. Kilfoyle stepped down after he said the hospital's sole member, the Catholic Health Corp. of Manitoba, intervened to prevent medically assisted dying in the hospital by adding 10 new members to St. Boniface Hospital's board at once. 

In a letter of resignation provided to CBC News, Kilfoyle cited dangerous transfers of care as one of his concerns.

"I see no way to reconcile my patient-centric MAID views with those of CHCM and any ability to influence St. Boniface Hospital policy has been eliminated with the new board composition.

"I will be unable to support a policy I believe allows for the undeniable reality of transfers of care that harm patients."

Board expanded to avoid medically-assisted dying

In November 2016, St. Boniface and Concordia Hospital in Winnipeg said they would not participate in the practice. Both hospitals are faith-based.

On May 29, the board of directors at St. Boniface voted to amend that policy, allowing the practice in "rare circumstances."

But the next day, the Catholic Health Corp. of Manitoba — the sole member of St. Boniface Hospital — held a special meeting. The corporation appointed 10 new members to the St. Boniface board of directors and requested a re-vote including the new members.

That vote took place on June 12, when the newly composed board voted to reinstate the ban on medically assisted death and simultaneously brought in the new policy allowing patients to be assessed for the service on-site.

Catholic Health CEO Daniel Lussier told CBC News the corporation's No. 1 job is to ensure the hospital is guided by values and principles, and appointing new board members is within its rights.

Lussier could not recall another time when 10 board members were approved all at once.

"In my experience with the corporation to date, no, but again, this was important conversations and [an] important moment for us to figure out what would be a responsible decision based on our role that we've been entrusted in terms of ensuring the values and principles can continue to guide the faith-based organization," he said.

Lussier said the 10 new members are also seated on Catholic Health's own board.

"I think this board will be quite good at functioning together moving forward. I don't have any concerns in that way," Lussier said.

With files from Kelly Malone