Quadriplegic Quebec man chooses assisted dying after 4-day ER stay leaves horrific bedsore

On a Thursday in January, Normand Meunier arrived at the hospital in Saint-Jérôme, Que., with a respiratory virus. Weeks later, he would emerge with a severe bedsore that would eventually lead him to seek medical assistance in dying (MAID).

Meunier, 66, had been a truck driver before a spinal cord injury in 2022 left his arms and legs paralyzed.

Before being admitted to an intensive care bed for his third respiratory virus in three months this winter, Meunier was stuck on a stretcher in the emergency room for four days.

His partner, Sylvie Brosseau, says without having access to a special mattress, Meunier developed a major pressure sore on his buttocks that eventually worsened to the point where bone and muscle were exposed and visible — making his recovery and prognosis bleak.

"Ninety-five hours on a stretcher, unacceptable," Brosseau told Radio-Canada in an interview.

"Every time we go to the hospital, it's my duty to tell them that Normand is quadriplegic and needs an alternating pressure mattress … I don't understand how this can happen, because a mattress is the most basic thing."

Brosseau says although she advocated for her partner, she was told the special bed had to be ordered.

'I don't want to be a burden': Meunier

Without access to a mattress that shifts pressure points to prevent the formation of bedsores, a patient's position must be changed frequently, says Jean-Pierre Beauchemin, a retired geriatrician and professor at Université Laval's faculty of medicine.

"When you're lying down, always in the same position, there's hyper-pressure between the bone and the skin," said Beauchemin.

"A pressure sore can open in less than 24 hours, and then take a very long time to close."

The buttocks, heels, elbows and knees are particularly vulnerable.

A rotation schedule every two hours is generally necessary for a person confined to bed, according to a Quebec Health Ministry reference sheet.

Meunier had previously suffered other bedsores, notably on his heel, but nothing as disabling as the pressure sore he developed after his hospitalisation in Saint-Jérôme.

Speaking with Radio-Canada the day before his death, Meunier said he preferred putting an end to his physical and psychological suffering by opting for a medically assisted death.

He was told the sore — a gaping hole a few centimetres in diameter — would, at best, take several months to heal, according to the experts they consulted.

According to his partner, he underwent two debridements in one month — a treatment in which dead or infected tissue is scraped from wounds to help them get better.

"I don't want to be a burden. At any rate, the medical opinions say I won't be a burden for long; as the old folks say, it's better to kick the can," said Meunier.

He died at home on March 29.

'A case of disbelief,' says advocate

"That whole story is a crying shame," said Steven Laperrière, the director general of the Regroupement des activistes pour l'inclusion au Québec (RAPLIQ), which supports people with disabilities.

"It's really a case of disbelief … What are we doing in order to help disabled persons or sick people to live in dignity prior to dying in dignity?"

He says the health-care institution was "negligent to say the least" and that getting a proper mattress is not like "trying to get a space shuttle into orbit."

"It's pretty basic … Nobody will convince me that within a few hours the proper mattress could not have been found," said Laperrière.

"To me, that's totally a lack of professionalism," said Laperrière, who says Meunier "would probably still be alive today" if staff had "been really professional about it."

145 alternating pressure mattresses available, says health authority

In an email to CBC, management at the local health authority, CISSS des Laurentides, said it is taking Meunier's case "very seriously."

"An internal investigation is underway to shed light on the events," read the statement.

The health authority confirmed it has 450 therapeutic mattresses, including 145 with alternating pressure, in its facilities (including hospitals and long-term care facilities) and that equipment is available if staff request it, according to Radio-Canada.

But adapted mattresses and beds are not found in ERs, says Steve Desjardins, director of nursing at the CISSS des Laurentides.

"An emergency room is not an appropriate place for this type of mattress, because beds aren't used in an emergency room, they're stretchers [and] there isn't really a mattress adapted [to be put on] a stretcher," said Desjardins.

"An emergency room is a riskier place for a fragile person. That's why, if necessary, we're going to work actively to give them access to a bed in an inpatient unit."

'Deeply troubling,' says professor in health law

Trudo Lemmens says this case is "an illustration of problems in our health-care system."

The Scholl Chair in Health Law and Policy at the University of Toronto says people who are already vulnerable are left feeling like more of a burden in the system.

"Then the system responds by saying: 'well, you have access to medical assistance and dying,'" said Lemmens.

"Medical assistance in dying is more easily available and on a more regular basis than some of the most basic care."

He says he is increasingly hearing stories of people who are struggling in the system and turn to MAID.

"It's deeply troubling," he says.

Along with Brosseau, Moelle épinière et motricité Québec (MÉMO-Qc), an advocacy group for people with disabilities, is now demanding the Quebec government launch an independent inquest into Meunier's death. They believe the health authority's internal investigation is insufficient.

Walter Zelaya, the head of MÉMO-Qc, said the investigation could be done by any agency outside the CISSS, like a coroner or another commission. 

"For years, on many occasions, MÉMO-Qc has expressed to the various authorities in the health network the major shortcomings in several regions of Quebec," it said in a news release.

"It is regrettable that a death has to occur and be publicized by the media for the health authorities to listen." 

They are also requesting a meeting with Christian Dubé, Quebec's health minister, to address the circumstances and lack of care that led to Meunier's eventual death, which "unfortunately, far too many people with disabilities face." 

Dubé told reporters Friday that he will wait for the report from the CISSS investigation before deciding if an independent inquest is necessary.

"We can say it's the exception, but it's unacceptable what happened," he said.