Earlier care could have saved Indigenous woman who died in St. Catharines hospital, expert says

Health care workers at a St. Catharines hospital had as many as three chances to save Heather Winterstein according to an expert witness at an inquest into the 24-year-old Indigenous woman’s death.

The infectious disease specialist saying earlier treatment could have saved her life.

When Winterstein arrived at the emergency department of Niagara Health’s St. Catharines hospital on December 9, 2021, she didn’t exhibit all the typical signs of sepsis.

She had gone in for severe back pain, and was sent home with Tylenol, and told to return if her symptoms got worse.

But, according to expert testimony on Monday, that was the first and best chance that health care workers had to prevent her death.

“I think there’s been potential at each of the interactions in the healthcare system,” says Dr. Dominik Mertz an infectious disease specialist with McMaster University. “I suspect the diagnosis could have been made, and could have changed the outcome”

Winterstein returned to the emergency room the next day, where she collapsed in the waiting room and died of sepsis.

Her death is at the centre of an inquest this month, as a jury looks to make recommendations to prevent similar deaths in the future.

Dr. Mertz says sepsis is a deadly and quick-moving bodily response to infection — in which patients can go from infection to septic shock in just 24 to 48 hours.

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There are a set of tests paramedics and triage nurses use to determine if a patient may have an infection — which expect to catch between 80 and 90 percent of cases.

But as a counsel representing the doctors who treated Winterstein pointed out, she didn’t exhibit enough symptoms to warrant immediate blood work under those tests.

“The issue with the screening tool, like all screening tools, is that they’re imperfect,” Dr. Mertz told the jury, adding that, with the benefit of hindsight, he would have found it reasonable to order preliminary blood work for the young woman, something that he believes could have identified the sepsis early and saved her life.

Since Winterstein’s death in December 2021, Niagara Health has changed how it handles sepsis cases, writing in an email that it includes: “Updated clinical directives, automated alerts to help identify patients at risk, enhanced surveillance and staff education,” as well as upgrades to its emergency room and triage-trained nursing staff.

Dr. Mertz said under the new model, patients are treated for infection if they exhibit just one of the main symptoms and are at high risk — like being an intravenous drug user, as Winterstein was.

He told the jury today, this new model “would have picked [Winterstein] up as a higher risk at both of those interactions, and potentially would have prevented what happened.”

The inquest is expected to last another five days, and will hear from 22 witnesses throughout its course.

The jury will then provide recommendations to prevent future deaths.

Niagara Health says it can’t comment on the on-going inquest.

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