Heather Winterstein did not exhibit typical signs of sepsis, a life-threatening condition, during her hospital visit in St. Catharines, Ont., the day before her unfortunate passing, according to an emergency medical specialist testifying at the coroner’s inquest for the 24-year-old woman.
Detecting the severe bacterial infection response that claimed Winterstein’s life on December 10, 2021, is crucial but challenging, as there is no definitive method for diagnosing the condition, as explained by Dr. Ron McMillan, an expert from McMaster University who reviewed Winterstein’s medical records and post-mortem examination report.
Dr. McMillan supported many of the decisions made by emergency physician Dr. Emad Nour, who treated Winterstein the day before her death, despite her complaints of body pain, particularly in her right leg. Nour conducted an examination for signs of infection but ultimately concluded that she did not have one.
The ongoing inquest, initiated in 2024 and conducted virtually, features 22 witnesses set to testify over a 13-day period. The purpose of such inquests is to inform the public about the circumstances surrounding a death, without assigning blame, guilt, or innocence. Winterstein’s family and community organizations have raised concerns about potential discrimination and racism influencing her treatment.
Dr. McMillan noted that Winterstein’s vital signs during the triage assessment were mostly normal, with only a slightly elevated pulse rate. Nour decided against repeating the vitals or ordering bloodwork, instead advising Winterstein to return if her symptoms worsened after receiving Tylenol.
The following day, Winterstein returned to the hospital after collapsing at home, where resuscitation attempts were unsuccessful. McMillan defended Nour’s clinical decisions, emphasizing the absence of identifiable infection sources and the need for clinical evidence before prescribing antibiotics to prevent antibiotic resistance.
McMillan also supported Nour’s choice not to repeat vital sign assessments, highlighting the potential rapid progression to severe conditions like septic shock. Despite the availability of screening tools for sepsis, Winterstein’s case did not meet the criteria due to her lack of infection signs, underscoring the importance of clinical judgment in patient assessment.
Regarding Nour’s notation of “social issues” in Winterstein’s medical record, McMillan explained that it is a common practice when a definitive diagnosis is unclear, especially in emergency departments, where psychosocial factors can manifest as physical symptoms.
