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Rob Sinclair (left) , cousin of Brian Sinclair, a homeless man who died after a 34-hour wait in an emergency ward, and Vilko Zbogar, Toronto-based lawyer for the Sinclair family, are shown outside the Winnipeg Law Courts, Tuesday, Nov.17, 2009.Mike Deal/The Canadian Press

A homeless man who died during a 34-hour wait in a hospital emergency room could have been dead for hours before his body was discovered, Manitoba's medical examiner said Wednesday.

Thambirajah Balachandra told the inquest into Brian Sinclair's death that rigor mortis had begun to set in when the double-amputee was declared dead on Sept. 21, 2008.

Security footage showed Mr. Sinclair moved his head around 5 p.m., 22 hours after he first arrived at Winnipeg's Health Sciences Centre emergency room, Dr. Balachandra said. Mr. Sinclair didn't appear to move again and was declared dead just before midnight.

It's likely Mr. Sinclair had been dead "for a couple of hours" before being found, Dr. Balachandra said. Rigor mortis, the stiffening of the body after death, usually takes some 12 hours to fully set in, but Dr. Balachandra said fever or seizure can hasten the onset.

Mr. Sinclair died after being referred to the hospital by a clinic doctor because he hadn't urinated in 24 hours.

Mr. Sinclair was seen on the video approaching a triage aide when he first arrived in the emergency department and then sitting in his wheelchair in the waiting room. Someone approached a security guard 34 hours later with concerns about Mr. Sinclair's condition and he was pronounced dead.

The 45-year-old died of an infection from a blocked catheter that spread into the bloodstream and caused him to go into shock, Dr. Balachandra said.

Mr. Sinclair vomited on himself while waiting, a sign he was likely going into shock, Dr. Balachandra said.

At that point, Dr. Balachandra said, someone should have checked his pulse and talked to him, asking him why he was vomiting and whether he needed help or a drink of water.

Had he been seen by a doctor, Sinclair would have needed about 30 minutes of medical treatment, which likely would have prevented his death, Balachandra said. He added that Sinclair needed to have his pulse and blood pressure checked, his catheter changed and antibiotics prescribed.

Following the death, the medical examiner's office heard from people who were in the waiting room with Sinclair, Balachandra said. One woman suggested medical staff didn't show much interest in the well-being of patients waiting to be seen.

"She was concerned about the attitude of staff and the unwillingness to recognize the need to respond to people in the waiting room," he said.

While Sinclair's family has suggested Sinclair being aboriginal and marginalized played a role in his death, Balachandra said this could have happened to anyone.

Emily Hill, a lawyer for Aboriginal Legal Services of Toronto, which has standing at the inquest, suggested to Balachandra that staff might discriminate based on their own biases. Sinclair had a history of solvent abuse and Hill suggested some medical staff might prioritize him differently because his health issues might be seen as self-inflicted.

Balachandra rejected that, saying medical staff put aside any biases and treat patients according to the severity of their condition.

"If Snow White had gone there, she would have got the same treatment under the same circumstances," he said. "Brian Sinclair or Snow White — it's the same."

Balachandra said he called the inquest because Sinclair's death is a sign that emergency room procedures and wait times need to be examined.

"There is something wrong somewhere," said Balachandra. "It's nobody's fault but the system has to be rejigged."

The inquest continues this month and is to resume in October.