Peer worker was told Ontario hospital ER too busy to 'deal with' woman who later died of sepsis, inquest hears

A papers is shown expression the triage nurse came come out on Dec. 10 and told Cronkwright to evidence Winterstein at i point that she'd have to wait five or six hours.

"I thought it was very insensitive," he says. 

Cronkwright says he had real concerns about Winterstein's condition.

Asked if he was worried about how she was perceived by medical staff, he says he did on Dec. 9.

On Dec. 10, he said it was clear Winterstein needed medical attention urgently.

"This young lady should have been in a bed. I don't think she should have been in the waiting room. She's too sick."

He said he wished he'd pushed medical staff on that.

"I could have advocated better," he said, his voice breaking. "I could have been more forceful."

Cronkwright says he returned to the hospital later on Dec. 10 to see Winterstein. 

"She was on the floor and she was kicking her feet. The floor is cold and dirty, so I asked one of the security staff to help me get her up off the floor" and return her to her wheelchair. A paramedic might also have helped, he says.

A video shown at the inquiry shows Cronkwright approaching Winterstein on the floor, then walking to get security to help him. He is also shown bringing her a clean blanket, and putting the blanket over her, after she was back in her wheelchair.

He says he remembers being angry that she was placed facing the wall in her wheelchair.

Another video is shown of Cronkwright about to leave his shift.

"I hate this part. I wished her well," he says, his voice breaking. 

“She was a very sick girl.

"Her colour was terrible," Cronkwright says. "She was in so much pain. 

"I remember how sweet this young lady was. She was a sweet young girl. It reminded me of my three daughters. It was tough to leave her."

A video is shown of Cronkwright pushing Winterstein in a wheelchair to get her to the bus stop.

He says he left her in a bus shelter.

"I was concerned about how she was going to get on the bus and how she was going to get off the bus."

Cronkwright saw Winterstein again on Dec. 10, 2021, going through the waiting room. 

"She seemed very grey; she seemed to be struggling with movement," he says.

Cronkwright says she was in pain. "She just seemed like she was struggling."

Cronkwright says Winterstein told him she couldn’t stand up. 

"She was speaking very quietly. She didn't look like she had a lot of strength."

A form that Cronkwright filled out related to the interaction and shown at the inquiry mentioned lower back pain and fentanyl withdrawal. 

From his experience, he says, Winterstein didn't seem to have the symptoms of fentanyl withdrawal such as agitation and sweating. "She was calm."

He planned to refer her to an emergency shelter, detox and Quest's Urgent Service Access Team.

In another consent form document signed by Cronkwright and Winterstein, she signed her name with just initials. He says she was having difficulty holding a pen.

"The nurse said, 'She's been discharged and you need to take her to the bus stop.'" 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 Vivian Sim 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.

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