On Wednesday, March 18, siblings Colleen Dyck and Daniel Fewster found themselves in front of news cameras again, drawing fresh attention to a policy initiative they call Debbie’s Law.
For this brother and sister, it felt like a step backward. Almost one year ago, Debbie’s Law passed second reading in the Manitoba Legislature—no small feat, they say, since only about four percent of new bills actually make it that far. It received a standing ovation.
Since then, though, the bill has gained no traction.
Fewster and Dyck have also made some startling new discoveries about the reality underlying Manitoba’s cardiac care system.
“There’s two things going on at the same time here,” Fewster says. “Debbie’s Law being rejected by the government, which is troublesome, and then the system being worse than we thought it was.”
The siblings helped draft Debbie’s Law with the help of SecondStreet.org, a public policy think tank. The bill was created a few months after Fewster and Dyck lost their 69-year-old mother to heart failure while she anxiously awaited a surgery date that never came.
With three blocked arteries, Debbie Fewster died eight weeks after being told she should wait a maximum of three weeks.
If legislated, Debbie’s Law would compel local health authorities to ensure that patients are informed when life-saving treatment cannot be provided within the medically recommended timeframe. Doctors and specialists would then be required to advise alternatives, such as out-of-province treatment.
Over the past months, the siblings have had more than one in-person meeting with Health Minister Uzoma Asagwara. They were also invited to meet directly with the administrators of the cardiac unit at St. Boniface Hospital, the team whose job it was to provide Debbie Fewster’s lifesaving treatment.
Here, they learned some shocking truths about human error, antiquated policy, and poorly functioning systems.
Debbie’s Case and Systemic Failure
While excessive surgical wait times are indeed a reality in Manitoba, it turns out that this wasn’t the cause of Debbie’s death.
In the end, the siblings were told, it was human error. A surgical booking form had been improperly filled out and misfiled, meaning that her file wasn’t flagged as urgent.
Although this is a shocking revelation, the duo are showing grace and acknowledging that hard-working, well-meaning medical staff can make mistakes that sometimes result in grave outcomes.
A lawsuit, Dyck says, wouldn’t solve the deeper issue.
It’s not the people that are the problem, she points out. It’s the policy and systems under which they must work, and only change at the governmental level can fix that.
For starters, the siblings say that the cardiac care system is missing key safety nets to catch and correct human error.
“The [cardiac administrators] were lamenting to us that they had to operate the cardiac unit on Excel spreadsheets,” Dyck says. “We were aghast at that. We said, ‘Surely there must be a better way. You can’t rely on an Excel spreadsheet to track all these patients in critical care. You could lose someone through the cracks so easily.’”
On top of that, Fewster and Dyck were told that at least one policy of the COVID-19 era, enacted as a direct response to the early months of the pandemic, remained in effect: a written directive suggesting that unless a patient’s heart condition is such that they require immediate hospital admission, a 180-day wait period for treatment is permissible.
Communication between health authorities is also a major concern. As a resident of the Southern Health-Sante Sud region, Debbie’s death would have been documented by them. The cardiac team at St. Boniface, though, weren’t made aware of Debbie’s passing and she remained on their list until Fewster and Dyck went public with their complaints.
Effect of Debbie’s Law
Following meetings with Minister Asagwara, a number of things have changed in the cardiac system, including a healthcare directive that is said to have gone out regarding patient care.
For the siblings, though, a directive isn’t enough. Unless Debbie’s Law passes into law, it won’t have its intended long-term effect and could be rejected by future governments.
More recently, Bill 27 was introduced in the Legislature, outlining amendments to patient care protocols, some of which Fewster and Dyck say echo conversations they’ve had with authorities.
One positive clause in Bill 27 relates to the responsibility of the system to provide patient advocates, bridging the chasm that exists between surgeon and client. Before, patients like Debbie Fewster had no direct way to get their questions answered or see where they stood on the wait list.
This model has been used by Cancer Care Manitoba for ages, Dyck says. She’s unclear why it hasn’t been adopted by all urgent care departments.
Despite having value, the siblings say that Bill 27 falls short.
First and foremost, there’s a need for candid conversations to take place between surgeon and patient about the true level of risk. This should be followed by a list of options to empower the patient, including information about other treatment centres that might be able to provide quicker response times.
Dyck and Fewster say that the practice of sending patients out-of-province for treatment used to be routine.
“The [government is] very resistant to anyone leaving Manitoba to get care,” Dyck says. “We’re wondering if they’re actually more concerned about protecting the system and protecting profits than actually protecting people.”
Another deficiency in Bill 27 is its lack of interest in tracking statistics and monitoring outcomes. For instance, the bill doesn’t require the healthcare system to monitor how many patients die before treatment can be provided, a key indicator that could prompt improvements.
Bill 27 also has a clause that precludes any need for administrative accountability.
“A failure to comply with this Act does not give rise to a cause of action or other claim or to a proceeding in any court or before any body or person having the power to make decisions under an enactment,” states the text of the bill.
What’s Next?
Dyck and Fewster are especially appreciative of Kathleen Cook, the Progressive Conservative healthcare critic, who has taken up the torch for their cause. They say it’s thanks to her outspoken endorsement in the Legislature that Debbie’s Law got as far as it did.
Once it was voted through second reading, Debbie’s Law went to committee for a chance at further review. According to Fewster, committee members have 100 days to speak to the bill and recommend amendments. If it isn’t debated and passed during that time, the bill dies and the process must begin again.
As of this March, Cook has renewed her push in the Legislature for Debbie’s Law to be considered. The siblings are now calling on the public’s help to keep this issue from dying a second death.
“If the province is going to have a monopoly on healthcare, then the standards for that healthcare have to be so high,” Fewster says. “If they’re going to force us to use their system, then they can’t have a broken system. That’s a violation of the social contract.”
According to MLA Ron Schuler, the very best way for the public to force change is to inundate the government with emails, letters, and phone calls.
“They track [these public communications] in the premier’s office,” says Schuler. “At some point in time they say, ‘It’s getting to be painful. We want to do it. Let’s put it through third reading and pass it.’ People getting engaged and lobbying their government officials has a huge impact.”
Dyck and Fewster are convinced that there are plenty of people out there who have been directly hurt by shortcomings in Manitoba’s medical system. Already hundreds have reached out to tell their stories and ask for advice.
“Canadians are among the most heavily taxed citizens in the developed world, and healthcare is central to that social contract,” Dyck has written on social media. “When patients die in waiting rooms, and cardiac units are reduced to tracking care on spreadsheets, that is not a medical failure, it is a government one. It is time to put people first and solve problems with urgency and competence, not allow them to be buried in slow, bloated bureaucracy. Government must do better.”