The family of a woman who lived with bipolar disorder and died after she wandered away from a Saskatchewan hospital last year is still searching for answers about how she was able to leave the facility without staff intervening.

Karen Ireland, 50, "always … put a smile on faces and was an all around happy being," said her son, Damon Ireland.

There are a lot of unanswered questions around the incident, the 33-year-old said.

"Where was the staff [at] that time?" he asked.

He believes his mother's death could easily have been prevented, and her family members are angry, he said.

"We want things to change so that it doesn't happen to any other family."

Karen Ireland was diagnosed with bipolar disorder more than two decades ago, and was frequently in and out of hospitals.

On the night of Nov. 22, 2022, she was in distress and admitted to the Southeast Integrated Care Centre in Moosomin, Sask., a small town just over 200 kilometres east of Regina, her family says.

The next day, she was reported missing.

"She may at times appear confused or agitated," RCMP wrote in a news release issued on the morning of Nov. 23, saying she had last been seen wearing only a hospital gown and pyjama pants, with no shoes.

Her body was found later that afternoon, less than a kilometre from the hospital. The temperature was around –2 C that morning, with a wind chill of –7.

RCMP said at that point foul play was not suspected. Damon Ireland says the coroner has told the family there were multiple signs that hypothermia was a factor in his mother's death.

Damon, who lives in Rocanville, Sask., says hospital staff should have been familiar with his mother's condition — she had been admitted to the hospital in Moosomin several times in the past — and taken precautions to make sure she wouldn't leave.

"We need all eyes on the deck at all times," he said. "It wasn't their first time dealing with her. It has been going on since 1996."

Better staff training in dealing with mental health "could have prevented the loss of my mom," he said.

He also said the family is still waiting for footage from security cameras to determine "if anyone actually went outside looking for her."

Some changes at the hospital have been promised to the family, Damon said, like installing more monitored cameras, more security measures like fencing, and a smoking area (the family was told Karen had stepped out for a cigarette).

Ruth Ireland Desjarlais, Karen's younger sister, says the family was told in discussions with the hospital staff that the cameras presently installed in the premises are not monitored.

"They say they will get more cameras, but there is no one monitoring it. What good is the camera? The discrepancy is a big flag," she said.

"They should consider getting security personnel and make positive proactive changes."

In a written statement Thursday afternoon, the Saskatchewan Health Authority said it will not comment on security activities nor individual camera placement at any of its sites, but it can "confirm security cameras are installed and operational in Moosomin."

Desjarlais, who lives in Port Moody, B.C., says there's a lack of accountability, which she believes is part of the delay in finding answers.

"She is gone. It has been made aware to our family that it has happened to other families, that it continues to happen," she said.

"Prevention is the only real thing we can grab on to at this time."

Review continuing: health authority

The Saskatchewan Health Authority said in a Tuesday email statement that it cannot provide any details about the case due to privacy legislation, but a review of the critical incident is continuing.

Critical incident reviews of incidents involving patients are launched "when there is an incident with serious harm (or death) or potential for serious harm (or death)" as set out in provincial guidelines, the statement said.

"The objective of the review is the prevention of future events," not to "assign blame or liability," the health authority said.

But Desjarlais says a lack hospital preparedness remains an issue. She raised concerns about whether there was a code yellow — an alert used by hospitals when a patient or a resident goes missing.

"If you are skipping the indoor search and going straight to the outdoor search, then you are not following the protocol," she said.

Desjarlais says the family was told that there was no code yellow issued the night her sister disappeared. However, the health authority said Thursday that a code yellow protocol was implemented.

Desjarlais also says Karen Ireland's family knew she was not well, but the hospital staff told them that their assessment said she "appeared healthy."

As well, she said Karen had a history of walking away from the hospital.

"Six years ago, she was forever walking out. Once she even ended up on a nearby property across the hospital in her hospital gown," said Desjarlais.

She believes hospital staff "neglected and failed Karen."

"They just don't have enough training."

Desjarlais said the hospital should have transferred her sister to a psychiatric practitioner if they did not have one on call that night. Her family says Karen required the specialized care of a mental health professional.

"In 2016, Karen was under the care of a psychiatrist trained in bipolar disorder, and that is what was needed that day."

Desjarlais said she often didn't know if her sister was in an active stage of her bipolar disorder, and if asked how she was, she would say she was fine. The hospital staff took her at her word, Desjarlais believes.

She said a few years ago, between Karen and her family, over 700 calls were made to the RCMP about her situation. Many people in the community knew she wasn't well, said Desjarlais.

The family is considering legal action and is currently seeking a pro bono lawyer with experience working in addictions and Indigenous women's mental health — since Ireland was Métis — to pursue accountability.

"It is the hospital's responsibility to care for their patient. If a patient is walking out of the hospital, then that falls on the hospital," Desjarlais said.

"In a perfect world, a mental health patient doesn't walk out of the hospital and freezes to death.

"There were a lot of factors to Karen not coming home back that day. We want a change."