A coroner's jury in Ontario is weighing critical questions about how a 24-year-old Indigenous woman died after visiting a hospital emergency department twice over two days, only to collapse while waiting for medical care.
Heather Winterstein sought emergency assistance at St. Catharines hospital in December 2021 while experiencing severe body pain. She returned the following day and collapsed in the ER on December 10, 2021, while still awaiting physician assessment. Medical examiners determined she died of sepsis.
After a comprehensive inquest that began March 30, the jury is now deliberating on the manner of death — weighing findings of natural causes, accident, homicide, suicide, or undetermined causes. The case has intensified scrutiny around potential systemic barriers in Canadian healthcare.
Family Argues Systemic Failure
Winterstein's family and legal representatives, along with the Niagara Region Native Centre, presented closing arguments calling for a homicide finding. They argue that healthcare system failures and institutional biases may have contributed to her death.
Legal counsel for the family highlighted that Winterstein faced multiple risk factors for healthcare bias. "Heather was a patient with several features that put her at risk of bias and stereotypes: she was an Indigenous woman, she had a substance use disorder, she was perceived to be homeless, she has a mental health history," explained Rachael Gardner, the family's lawyer.
Dr. Suzanne Shoush, an expert in healthcare bias, testified during the inquest that anti-Indigenous racism is embedded within Canada's health systems, and biases related to housing instability, substance use, and mental health significantly impact patient care and outcomes.
Hospital and EMS Dispute Homicide Claim
Both Niagara Health (which operates the hospital, now renamed Marotta Family Hospital) and Niagara Emergency Medical Services rejected the homicide argument in their closing submissions.
"This jury has heard no evidence whatsoever to support the notion of any intentional act by any person or any system which caused this death," stated Kate Crawford, counsel for Niagara Health.
Daina Search, representing Niagara EMS, argued the evidence "simply and categorically cannot support a finding of homicide," urging jurors instead to find that Winterstein's death resulted from natural causes.
Questions of Care and Protocol
Search noted that when paramedics learned Winterstein had previously used fentanyl and might be experiencing withdrawal, they elevated the severity rating of her condition and transported her to the hospital rather than to an urgent-care facility—a decision that suggests concern for her wellbeing.
The paramedic who responded to her father's 911 call believed Winterstein was white and not Indigenous, according to testimony, though this raised questions about whether unconscious bias affected assessment protocols.
The jury's deliberations will determine not only the manner of death but may also produce recommendations designed to prevent similar tragedies within Ontario's healthcare system. While coroner's juries cannot assign legal blame, their findings and recommendations carry significant weight in shaping future healthcare policy and practice.
This story was adapted from reporting by CBC Health.