Press Releases

Friday, December 12, 2014

Winnipeg Regional Health Authority accepts inquest report into the death of Mr. Brian Sinclair

The judicial inquest report into the death of Mr. Brian Sinclair and its recommendations will be accepted said Arlene Wilgosh, President and Chief Executive Officer of the Winnipeg Regional Health Authority.

"We accept the inquest report and its recommendations," said Ms. Wilgosh. "We will continue the work we are currently doing as directed by judge Preston, and will immediately begin assessing the best approach to implement his other recommendations. I also want to thank inquest judge Timothy Preston for his thorough assessment of the challenges facing our health system."

A judicial inquest into the death of Brian Sinclair was directed by the Chief Medical Examiner on January 10, 2009. The inquest commenced on August 6, 2013 and concluded on June 13, 2014 following a total of 40 hearing days in which 82 witnesses provided testimony.

"Mr. Sinclair's death was preventable," said Ms. Wilgosh. "He came to us seeking care, and we failed him. We certainly recognize that processes should have been in place to make certain that a person in need of care was triaged and thereafter received the care he needed."

"On behalf of the Winnipeg Regional Health Authority I would like to again apologize to Mr. Sinclair's family. We are very sorry we failed him."

In his report, the judge made 63 recommendations to address various issues he identified as contributing to Mr. Sinclair's death. A copy of the judge's report and recommendations are available for public review.

Download the report and recommendations

The Winnipeg Regional Health Authority and the Health Sciences Centre implemented several changes in 2009 to address issues identified immediately following Mr. Sinclair's death including:

  • Patients entering Health Sciences Centre's emergency room are now better identified and tracked;
  • Once in the waiting room, everyone there - patients, their family members and friends - are checked on regularly;
  • Roles and responsibilities of staff within the department have been further clarified;
  • Primary care clinics sending patients directly to an emergency department are expected to call ahead to let doctors and nurses know a patient is on their way; and
  • Physical upgrades to the Health Sciences Centre emergency department were also made, and can be viewed here.

Two internal reviews were conducted by the Winnipeg Regional Health Authority within the first two months following Mr. Sinclair's death. Details and recommendations of these reviews were publicly released in November 2008, and were submitted as part of the inquest.

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