Death of Indigenous woman who left ER without being treated leads to changes at MUHC

The McGill University Health Centre has changed its admitting policies following an internal investigation into why an Indigenous woman whose health insurance card had been stolen left the hospital after being informed she'd have to pay to see a doctor.

Kimberly Gloade, 43, walked out of the emergency room without having been seen in February 2016. She died at home a month later from cirrhosis of the liver.

In the wake of Gloade's death, the woman's family wanted to know why no one at the hospital made it clear to her that her inability to pay should not have stopped her from receiving medical care.

"It shouldn't have to be about money. It shouldn't have to be about what comes first before medical attention," said her mother, Donna Gloade.

The MUHC ordered an internal investigation in June 2017, after a coroner's report noted that although Gloade's cirrhosis may have been too advanced to prevent her death, she died without having a doctor explain what was happening to her body.

Dr. Ewa Sidorowicz, the MUHC's head of professional services, said the hospital's investigation was twofold: it looked into what happened that night in the emergency room, and then it reviewed processes for handling patients without medical insurance.

The investigation found that Gloade arrived at the emergency department at 7 p.m. on Feb. 6, 2016. Within 10 minutes, she was seen by a triage nurse and was ordered to undergo a series of tests.

Gloade then went to the registration desk, where patients must present their health insurance cards and are informed of any medical fees they might have to pay, if they are not insured.

Sidorowicz said the investigation was unable to retrace the details of what unfolded because "there is no memory of exactly what was said."

"Within 23 minutes of having actually arrived in the triage area, she chose — for reasons that I cannot explain to you — to leave the hospital," she said.

The investigation also found that Gloade had been seen at MUHC in the previous years "without any difficulty at all," said Sidorowicz.

Admission practices reviewed, training sessions given

Gloade's brief visit to the emergency room shed light on issues surrounding how staff process patients who, for one reason or another, do not have medical insurance and cannot pay.

The MUHC has since streamlined its billing practices. It also ensured that clerks and triage nurses are provided with a script so they can give standardized information for patients who don`t have insurance.

In August, it also gave training sessions to registration clerks and emergency department nurses to ensure all patients without medical insurance know they can still be treated even if they cannot pay.

"The message is, these patients need to be seen," said Sidorowicz.

"It's not the time to be discussing finances in terms of being able to pay or not. Yes, the patient needs to be instructed, but the patient's priority at that point is there is a perceived urgency, and they need to be dealt with."

If a patient wants to leave because there may be a payment, the clerk is instructed to send the patient back to the triage nurse to see if it is medically safe to do so, according to Sidorowicz.

The possibility that Gloade left because she either wasn't informed or she misunderstood that she was entitled to medical care is something that should never occur, she said.

"We have made sure that the processes were reviewed, that the training has occurred and that reminders are made to the staff about patients who come without coverage."

Cold comfort for family

Gloade, a Mi'kmaq originally from the Burnt Church First Nation in New Brunswick, had been homeless in the past and was dealing with addiction, especially with alcohol, according to her uncle.

But he said she had been seeking help and had moved into an apartment at the time she went to the MUHC.

Her family still believes that stigma and racism may have affected the way she was treated at the hospital.

"My daughter, she is an Aboriginal woman, and homeless on top of that, I am sure her appearance probably wasn't the best when she entered that hospital," said her mother. 

"Who she was and what life she led played a big role in why she never got the immediate attention that she needed."

However, Sidorowicz says that the investigation did not indicate there had been any discrimination, and she said MUHC staff has incredible respect for the Indigenous communities it serves.

"I certainly would hope that the message here is that they should not be worried or afraid to come to any of our sites for treatment," she said.

The changes at the MUHC are a step in the right direction, said Gloade's mother, but offer cold comfort to a family still struggling to heal.

"My daughter is never forgotten because she was a good person," she said.

"She had the biggest heart that anybody could have."