Dr. Marc Del Bigio wrote an email suggesting that double-amputee Brian Sinclair's chronic solvent abuse caused the health problems that brought him to the emergency room of Winnipeg's Health Sciences Centre in September 2008, the inquest into Sinclair's death heard Thursday.
Sinclair died from a treatable infection caused by a blocked catheter. There is "no question something went amiss at HSC emergency," Del Bigio wrote in the email to the province's medical examiner and CEO of the Winnipeg Regional Health Authority.
But after reviewing thousands of pages of Sinclair's medical history, Del Bigio said the hospital was not solely responsible for Sinclair's death.
"We should not lose sight of the fact that this man's problems were self-inflicted," Del Bigio wrote in June 2009. "His cognitive disability and neurogenic bladder were the consequence of decades of solvent/inhalant abuse. Societal blame can only go so far. At some level individuals must accept responsibility."
The inquest has already heard how the 45-year-old had visited a health clinic because he hadn't urinated in 24 hours. The doctor referred him to the hospital and put him in a taxi with a letter in his pocket for medical staff.
Sinclair was seen wheeling himself up to the triage area, speaking to an aide and then waiting in the emergency department for 34 hours. During that time, he vomited on himself and sat without moving for hours before a concerned patient approached security.
The medical examiner said Sinclair had probably been dead for hours before he was discovered.
Sinclair had suffered severe brain damage due to sniffing glue and other solvents, Del Bigio said. Given his mental state, Del Bigio said Sinclair shouldn't have been sent by taxi to the emergency room.
"Mr. Sinclair was declared mentally incompetent years earlier," Del Bigio wrote in his email.
"Having witnessed dementing in both my grandfathers, I can assure you that a demented individual should not be sent in a taxicab unaccompanied to hospital and be expected to successfully navigate the admissions process."
When questioned about the email, Del Bigio said he was writing it as a health advocate rather than a neuropathologist.
"I'm within my bounds ... to make some commentary," he said under questioning by the lawyer representing physicians who treated Sinclair. "Perhaps my wording was not optimal."
He said he wrote it at a time when the general medical consensus was that addiction is a choice, not a disease.
Sniffing toxic substances caused so much damage to Sinclair's brain and spinal cord that he was no longer able to empty his bladder and required a catheter, Del Bigio said.
"I don't know what led him into this substance abuse habit that ultimately led to his death," Del Bigio said under examination. "I don't think Mr. Sinclair chose to destroy his brain and spinal cord. The substance he abused did destroy his brain and spinal cord."
People who are solvent abusers are more likely to die young, he added.
"At some level, people have to recognize that what they do can lead to bad outcomes," Del Bigio said.
Under questioning from Sinclair's family lawyer, Del Bigio said most solvent addicts die from toxicity or a fatal fall rather than during a 34-hour wait for care in an emergency room. He admitted he was not an expert in solvent addiction or how such an addiction can be related to family breakup or poverty.
Regardless of personal history, Del Bigio agreed Sinclair was entitled to the same treatment as anyone else in an emergency room.
"I never meant to and I'm not seeking to blame Mr. Sinclair," Del Bigio said. "When we're trying to investigate how did he die or why did he die under these circumstances, I don't think it's fair to simply say he didn't have his catheter changed because he got missed in emergency and that's the end of it."
Manitoba's medical examiner, Thambirajah Balachandra, has testified that if Sinclair had been seen by a doctor, his treatment would have taken about half-an-hour. He needed his catheter changed and antibiotics prescribed to fight the infection that had spread to his bloodstream, Balachandra said.
The inquest is scheduled to sit for the month of August and is set to resume in October.