The mother of Heather Winterstein says she continues to suffer nightmares following a lengthy coroner’s inquest that examined the final hours leading up to her daughter’s death inside an Ontario hospital emergency room.

Francine Shimizu-Orgar described the emotional toll of watching surveillance footage and hearing testimony during the three-week inquest into the death of her 24-year-old daughter, who died from septic shock in 2021 after seeking treatment at a hospital in St. Catharines, Ontario.

Speaking after the proceedings concluded, Shimizu-Orgar said the images shown during the inquest continue to replay in her mind, including video footage reportedly showing Winterstein collapsing in the emergency department waiting area.

Despite the trauma, she said she felt it was important to witness every detail of what happened to her daughter and ensure the public understood the circumstances surrounding the case.

The inquest examined the medical treatment Winterstein received over two consecutive days after she arrived at the hospital suffering from severe body pain.

According to testimony presented during the hearings, Winterstein first visited the emergency department on Dec. 9, 2021. Medical notes from the attending physician reportedly referenced her history of anxiety and substance use, with her symptoms being partly attributed to “social issues.”

She was later discharged from the hospital with Tylenol and transportation assistance, while being advised to return if her condition became worse.

The following day, Winterstein returned to the hospital by ambulance while reportedly experiencing extreme pain and rapidly deteriorating health. The inquest heard evidence about delays in treatment and questions surrounding the emergency response she received.

The jury later concluded that delays in medical treatment contributed to Winterstein’s death and issued dozens of recommendations aimed at improving emergency department procedures, patient assessment practices, and healthcare responses involving Indigenous patients and vulnerable individuals.

The case has sparked broader conversations across Canada about healthcare equity, emergency room overcrowding, implicit bias in medical settings, and the treatment of Indigenous patients within the healthcare system.

Shimizu-Orgar said the emotional burden of the inquest remains overwhelming, but she hopes the findings and recommendations will lead to meaningful changes that could prevent similar tragedies in the future.

The hospital and healthcare officials involved in the proceedings have acknowledged the seriousness of the case, while recommendations from the inquest are expected to be reviewed by medical and government authorities.