Indigenous woman had body pain for 6 days before collapsing in hospital ER wait room, Ontario inquest told

"The nurse said, 'She's been dismissed and you demand to use up her to the jalopy block.'" Cronkwright testifies. 

"She [Winterstein] was not doing well. I didn't think she should be going to the bus."

He says he asked the nurse why Winterstein wasn't given a taxi pass. The nurse said "'that's the decision we made.'"

He says his first impression of Winterstein was complaining a lot about the pain in her back and leg. "She did not look well." 

He says he asked her if she wanted to go to detox.

"I never left her side."

He says he was concerned she might have been a victim of human trafficking, but she said she wasn't.

"Her hair was not well kept.… Her clothing was messy."

Cronkwright says nursing staff will often tell peer support navigators what patients' chief complaints are, but not share their medical records. 

One of the flags that may lead to a referral from a nurse is NFI (no fixed address) notations, he says. 

That, addictions or mental health are also factors that bring in navigators to help patients, he says.

"We are their friend in the ER who understands what they're going through."

Inquest lawyer Christina Varrette asks him if he was in contact with Winterstein on Dec. 9, 2021. 

He says he was. 

A nurse contacted him and brought him to triage, where Winterstein was in a wheelchair.

"This nurse did state she [Winterstein] was a heroin addict. She said she wasn't going to deal with this patient. The ER was way too busy."

He says he saw Winterstein post-discharge rather than post-triage as was the usual way. He was supposed to take her to the bus stop.

Cronkwright says peer support navigators help people, such as those with addictions and who may have housing instability, when they come into the hospital emergency department for care.

That could mean supplying people with food, clothes and help, and referring them to community agencies, he says.

Cronkwright says he's a former "homeless drug addict."

Part of what Niagara HELPS does is train people with life experience and put them in the emergency department to aid others, he says.

The hearing has resumed with Scott Cronkwright, a peer support navigator, speaking on how he and the organization he was with help people who need housing help.

Cronkwright recently left his role with Niagara HELPS, or Homelessness Emergency Liaison and Peer Support, a partnership between Niagara Health and Quest Community Health Centre.

Dupuis is back testifying to answer any questions from the jurors.

One juror asks Dupuis if she recalls how many people were in the ER wait room on the day she was working. 

Dupuis says she doesn’t recall how many patients were in line to be seen.

The juror also asks the triage nurse how she’d rate her stress level at that time. 

"I was quite stressed," Dupuis answers. 

With no further questions from the jury, a lunch break is called.

Dupuis is now being questioned by Natai Shelsen, lawyer for the Winterstein family.

Shelsen asks Dupuis about what kind of questions she would have asked Winterstein during her assessment.

Shelsen notes that previous evidence showed there was roughly an equal number of patients waiting to be assessed in the waiting room on both Dec. 9 and Dec. 10, 2021, yet Dupuis was able to do a full assessment of Winterstein, including speaking to her. 

The inquiry previously heard that another triage nurse, who assessed Winterstein on her Dec. 10 visit, didn't speak to her and only glanced at her for two or three seconds.

The proceedings are on a short break for the jurors to determine if they have any questions for Dupuis.

Dupuis says she learned of Winterstein's death in a meeting at the hospital. 

"People were reflecting on how the system was working at the time.

"I remember being incredibly confused," she says of the meeting. "I didn't know why I was there."

Varrette asks her if she was aware that Winterstein was Indigenous.

"No, I wasn't aware," says Dupuis, adding she was made aware of Winterstein’s background in that meeting.

The triage nurse is asked if she would have done anything differently if she had the chance. 

"I don't think it's fair for me to say I would do something differently," Dupuis answers.

She also offers her condolences to Winterstein's family.

"Patient deaths are incredibly hard on all of us. I'm hoping we can have some good that comes from this."

Dupuis is asked about how she comes up with a Canadian Triage and Acuity Scale (CTAS) score. That scale has a scoring system, from one, the most serious level, to five, the least serious. 

Dupuis gave Winterstein a score of three.

The triage notes point to "moderate pain" of a score of four to seven on a scale of one to 10, with 10 being the most severe pain.

Winterstein was assigned to what's known as the rapid assessment zone in the emergency department. 

Dupuis says patients can remain in the paramedic bay or the waiting room while waiting.

The jury hears Winterstein was sent to the waiting room. 

Dupuis is asked by Varrette if patients are reassessed in the waiting room. She says she doesn't recall reassessing Winterstein.

In the objective notes section, chronicling the nurse's observations, it says Winterstein is in a wheelchair with her head down and the patient "appears unkempt." 

Winterstein is "easily roused," the notes say. She’s also able to move all her limbs independently.

Varrette asks if it's typical to test for mobility if the patient is in a wheelchair. Dupuis says she doesn't recall if she saw Winterstein out of the wheelchair.

A triage assessment typically lasts about five minutes, including taking vital signs and taking the report from paramedics, says Dupuis.

After the break, Kendra-Lee Dupuis, a triage nurse who was working in the ER when Winterstein was there on Dec. 9, 2021, returns to testify.

Inquiry lawyer Christina Varrette asks Dupuis about her subjective notes, in which information gleaned from Winterstein is entered.

The notes mention Winterstein's "body pain" and that she has pain all over, especially in her right leg. 

Winterstein reported the pain had been going on for about six days.

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