Assumptions: When Narrative Influences Facts

There is a particular kind of evidence that does not arrive as a single moment. It builds instead through repetition. Through small decisions that begin to feel familiar. Through language that starts to settle into place. By the end of the afternoon, what emerges is not confusion. It is a pattern.

And today, that pattern had a centre.

Assumption.

The paramedic who responded to Heather Winterstein on December 10 was clear in his account. When he arrived, he did not believe she was seriously ill. That conclusion was formed quickly, and importantly, it was formed before a full set of vital signs had been taken. It was based on what he saw, what he was told, and how she presented in that moment. She was sitting. She was speaking. She was able, at least in part, to answer questions. From that, a judgment followed.

She was not acute.

That judgment shaped everything that came next.

Despite dispatch information that she had fallen and was unable to move, no stretcher was brought into the home. No stair chair was used. No spinal precautions were applied, even though the governing standard, read plainly in the hearing, required exactly that for a patient with a fall and back pain. Instead, Heather was asked to stand. She was helped to her feet. She was guided down a narrow staircase, slowly, unsteadily, and in visible discomfort.

The explanation offered was that the space was tight, that equipment might not have fit, that safety had to be considered. These are not unreasonable concerns on their own. But they exist alongside something else that is harder to ignore. The decision not to use available equipment had already been made before those stairs were ever tested. It had been made when her condition was first judged to be manageable.

What followed outside the home did not disrupt that assessment. She walked, with assistance, to the ambulance. She was placed not on a stretcher, but in a jump seat. Again, this was framed as her choice, and that may be true in a narrow sense. But choice, in a medical setting, is rarely neutral. It is shaped by what is offered, by what is encouraged, and by what is understood to be necessary.

What was not understood, or not accepted, was that she might require more.

It was only once she was in the ambulance that the first full set of vital signs was taken. That is when the picture began to shift. Her heart rate was markedly elevated. Not slightly. Not marginally. Elevated in a way that the paramedic himself described as concerning and without clear explanation. That should have been a turning point. In some respects, it was. The destination hospital was changed. The possibility of withdrawal was raised.

And that is where another pattern begins to take shape.

Because once drug use entered the narrative, it did not remain neutral information. It became a lens. The pain she described, which had already been present, was now understood as potentially consistent with withdrawal. The elevated heart rate, which had no explanation moments before, now had one readily available. The discomfort, the restlessness, the generalized distress, all of it could be interpreted through that frame.

Not definitively. But enough.

Enough to make it make sense.

Enough to keep the earlier assumptions intact.

The problem is not that withdrawal was considered. It is that it appears to have settled too easily into place. It did not expand the scope of concern. It narrowed it. It offered an explanation that required less urgency, less intervention, and less escalation than the alternative.

And the alternative, which would have required asking what else could cause this presentation, did not take hold.

The evidence continued. At the hospital, video footage showed Heather exiting the ambulance. The paramedic did not recall anything unusual about this moment. The video suggests otherwise. It raises the possibility that she did not stand to exit, but instead lowered herself, slowly and awkwardly, out of the vehicle. That detail may seem small, but it is not. It speaks to function. To strength. To what her body was actually capable of doing in that moment.

And again, no one appears to have stopped.

She was placed in a wheelchair. She was brought into the emergency department. A report was given. It included her symptoms, her recent hospital visit, and the possibility of withdrawal. It included that she was tachycardic. It did not include any urgency attached to that information. It did not include the variability in her vital signs. It did not include any indication that her condition might be deteriorating.

She was directed to the waiting room.

There is a moment in the testimony that is easy to overlook. The paramedic described leaving her there. A blanket was offered. Food was provided. He wished her well and told her to alert staff if anything changed. It is standard practice. It is routine. It is what happens every day in emergency departments across this province.

But it lands differently here.

Because by that point, she had already told multiple people that she was getting worse. She had already been to the hospital the day before. She had already called for help. And she had now been assessed, moved, transported, and placed in a waiting room without ever receiving what most would recognize as a thorough or careful examination.

No one person made a catastrophic decision.

That is not what this evidence shows.

What it shows instead is a series of smaller decisions, each one defensible on its own, each one grounded in experience, training, or judgment, but all of them shaped by the same underlying belief.

That she was not as sick as she said she was.

That belief did not come out of nowhere. It was built from her presentation, from the absence of obvious signs, and, increasingly, from the knowledge that she used drugs. It is not stated outright. It rarely is. But it is present in the way options were framed, in the way care was delivered, and in the way concern was calibrated.

It is present in what was not done.

What remains, at the end of this day, is not a single failure that can be isolated and corrected. It is something more uncomfortable than that. It is the recognition that a person can move through multiple layers of care, from home to ambulance to hospital, and at each step, be seen, assessed, and still not fully recognized.

Not because no one was looking.

But because what they were prepared to see had already been decided.

And by the time that changes, it is often too late.