Wayne Didkowski told an inquest into the death of Heather Brenan that he made arrangements for the 68-year-old to go home when a doctor at Winnipeg's Seven Oaks Hospital decided she was well enough late one evening in January 2012.
He said Brenan was worried she didn't have her keys or a ride home, but he assured her she would be sent in a cab and a friend would be there waiting for her with the keys.
Didkowski said he spoke to Brenan's friend and arranged for her to meet Brenan at her house. Although the hospital had a "bed crunch" at the time, he said he had no qualms about discharging Brenan and didn't raise any concerns with the doctor in charge.
"I had ensured there was a safe discharge in place for her," he testified Tuesday.
The next time he saw Brenan she was in the resuscitation room in the emergency department. She had collapsed on her doorstep and was rushed back to Seven Oaks, where she died when an undetected blood clot moved to her lungs.
Months later, two other patients were put in cabs by a different hospital and died outside their homes. The health authority said at the time that there was no systemic problem and an internal investigation found the hospital did nothing wrong.
The Winnipeg Regional Health Authority has suggested no one could have predicted Brenan's death and it probably would have occurred whether or not she was in hospital.
The inquest was called to look into Brenan's death and to "examine hospital policy regarding the discharge of patients at night, particularly those who are elderly, frail and who reside alone." It is also to determine whether a shortage of acute-care beds might have been a factor in Brenan's death.
Brenan had been sent to the Seven Oaks emergency department because she had lost 40 pounds and couldn't swallow.
Two nurses testified that hours before she was discharged, Brenan was too ill to undergo diagnostic testing.
Arvadell Egesz, a nurse who escorted Brenan to another hospital for an endoscopy, told the inquest the test was called off because Brenan was having trouble breathing. Egesz said she did not see Brenan stand on her own for the seven hours she was with her that day.
Egesz remembered Brenan as a "very nice lady, very talkative" on her way to the procedure. But she was groggy and sleeping on the trip back to Seven Oaks, where she had been for three days, the nurse said.
Dana Brenan said her mother never should have been sent home.
"She was seriously ill. Nobody ever saw her moving."
Brenan said her mother was unsteady on her feet when she returned to Seven Oaks after the failed procedure.
"But they still sent her home. Alone," she said. "She was just pushed aside because she didn't complain and probably because she was so ill that she really wasn't able to state her case."
Claudine Knockaert, the nurse in charge of the emergency department that day, said it was understood Brenan would be released once the endoscopy was done.
Brenan arrived back at the emergency department after the failed procedure during the evening shift change. Knockaert said the report she passed to the incoming charge nurse was not as "thorough" as she would have liked, especially given how long Brenan had been in the ER.
The inquest is scheduled to sit until mid-June.