Seniors' advocate issues warning after latest report on critical incidents in Manitoba health-care

Seven out of 11 deaths detailed in Manitoba's latest report on critical incidents in the health-care system happened because of delays in care, and one advocate warns the worst is yet to come.

7 of 11 deaths detailed in report from early days of COVID were due to delays in care

Major critical incidents reported to the province in spring of 2020 include deaths, injury and more medical interventions due to delays in care. (Evan Mitsui/CBC)

Seven out of 11 deaths detailed in Manitoba's latest report on critical incidents in the health-care system happened because of delays in care, and one advocate warns the worst is yet to come.

Released every three months by Manitoba Health, critical incident reports reflect "serious and unintended harm" experienced by individuals accessing health services. 

In the most recent report, one patient died after a complex surgery due to a delay in recognition and response to a major health complication. 

Another with a serious medical condition died after delays in the recognition and response to a serious complication. 

A patient who needed an urgent medical procedure wasn't able to get it in time and died while waiting. 

Those deaths are among 42 unintended critical cases highlighted in the latest posted report between April and June of 2020, during the early months of the pandemic.

"I just know that these things are going to multiply. As long as the health-care system is at its breaking point, they will continue," said seniors' advocate Trish Rawsthorne, a former nurse. 

Manitoba's health-care system is under heavy strain, with patients being transferred out of Winnipeg to other parts of Manitoba for care, a critical nursing shortage and ICUs hovering near capacity. Rawsthorne said the documented harms to patients reflect the under-resourcing of the entire system.

"It is a little reminiscent of what happened in long-term care when they had so few staffing," she added.

An outbreak was declared at the Maples care home Oct. 20, 2020, and didn't end until Jan. 12, 2021. In that time, 74 staff and 157 residents tested positive for COVID-19 and 56 people died.

Other incidents detailed in the report include someone who died by suicide while receiving health care.Two residents within a facility died after choking. A patient needed to come back to hospital so that a surgical item left in their body after surgery could be retrieved.

Several patients had complications after surgery that required more medical interventions, many had wounds or ulcers that did not receive the proper care and worsened, and some experienced deterioration of their medical conditions because of a delay or missed opportunity for care. One patient had to have a limb amputated because of worsening of their wounds. 

Rawsthorne notes seniors seem to be disproportionately affected in the report, which may have been compounded by visitors' restrictions during COVID-19. She worries it will also be seniors who are more likely to be selected for transfer to other facilities in the province for care as well.

"People that will be expended are those people who have contributed to the community and to the welfare of the province of Manitoba but are not seen as productive and ageism creeps in there and they have no other choices."

Rawsthorne is urging the province to call in military support before the looming surge of Omicron overwhelms the system completely. 

The two-page quarterly report from Manitoba Health provides few details about the incidents but classifies them all as either major or fatal. As a result, they were reported to the Minister of Health as critical incidents.

A spokesperson for the province said critical incident reporting is done to look at what can be done differently and what improvements can be made to the way health-care providers work to help prevent future incidents from occurring. 

The reviews don't take the place of a regulatory investigation, which may occur after or at the same time as the review.


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