‘Shocking slap in the face’: Coroner denies investigation request into Filipino mother’s death

The Quebec coroner’s office has rejected a request by Candida Macarine’s family to reopen the investigation into the 86-year-old woman’s death.

BACKGROUND: Montreal family unsatisfied with coroner’s report into death of 86-year-old Filipino mother in hospital

“This is a slap to our face and a slap in the face of the truth,” said her daughter Gilda Macarine.

Macarine was found dead on the floor of Lakeshore General Hospital on Feb. 27, 2021, one day after being admitted to the hospital due to respiratory distress.

The family was initially told Macarine had died of a cardiac arrest, only finding out more details through a news report more than a week later.

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Nearly 19 months later, a three-page report by coroner Amélie Lavigne said Macarine likely died naturally of a heart attack. It stopped short of alleging neglect by staff.

Macarine’s children asked the Quebec’s chief coroner last month to investigate further after accessing the hospital records that were examined by Lavigne. The family said Lavigne failed to correctly look at all the medical information at her disposal.

RELATED:

• Family wants new investigation into Filipino mother’s death after accessing hospital records (Oct. 25, 2022)
• ‘What really happened’: Family remains in the dark about grandmother’s death; report expected soon (Mar. 1, 2022)
• Family of Filipino woman found dead on hospital floor says it still doesn’t have answers (April 22, 2021)

That request was denied in a letter dated Nov. 17.

“Received almost 10 days ago, the negative response by the Coroner’s office’s is seen as a deliberate attempt to turn a blind eye to disturbing evidence of negligence in care,” the Centre for Research-Action on Race Relations (CRARR) said in a statement.

Statement from Quebec coroner’s office 

In a statement to CityNews, the Quebec coroner’s office said it believed Lavigne’s report was completed with “rigour and professionalism.”

“In a context of continuous improvement of the quality of care, it was recommended that actions be put in place to ensure rigorous monitoring of the visual and audio alerts of the telemetry system,” read the statement. “The Coroner’s analysis reviewed the complete medical management of the deceased and the Coroner’s Office is of the opinion that the circumstances leading to the death were established in accordance with the requirements of the Act governing us.

“As a result of the concerns expressed by the family, the Coroner took care to conduct a complete review of her investigation. Following all these steps, there is no need to reopen the file.”

‘Our mother and our family deserve justice’

The family says it will now file official complaints and take legal action to shed light on the circumstances of her death.

“Our mother and our family deserve justice, and the coroner’s office failed us,” said Gilda, wearing her other’s sweater and holding back tears.

Despite the coroner’s claim, the Macarine family says they found many flaws in the initial report, including:

• Failure to note Macarine required reassessment every 15 minutes, which was reportedly not done;
• Failure to examine the placement of their mother in a bed located away from the nursing station;
• Failure to mention blood test results showing critical high levels of acidity, which should have seen her moved to the ICU, they say

“That nobody saw and heard the alarms of the machines, especially she when she fell on the floor. How did she fall on the floor if the bed had railings? The coroner did not address that,” said Fo Niemi of CRARR.

“Why did it become an issue as to whether being a Filipino background matters in this case? Because we found out in the attending doctor’s note at the beginning when the first doctor look at her, described her as speaking English nor French. And that’s not true. Mrs. Macarena spoke English. She just did not have her listening device on.”

More complaints coming

CRARR will help the family file complaints against the attending doctors with the College of Physicians, and against the attending nurses with the Order of nurses.

The family also examining legal options like a judicial review of the coroner’s decision and a civil lawsuit against the Lakeshore General Hospital and involved personnel.

“Doing this, on my part, it’s not only for my mom, but for all the victims, because there’s a lot of victims of this negligence,” said Gilda Macarine.