Anastassia Waddell won’t ever know exactly what caused her husband’s death. Her requests for an autopsy were denied by the B.C. Coroners Service.

Drew Madsen, her husband and partner of 27 years, had a seizure on March 11. After coming out of it, he told her he had a headache and wanted to take a nap. He never woke up.

He died in the early hours of March 12, 2024

“He didn’t make any noise,” she recalled. “I knew he was gone, and I knew it was too late to do CPR — because you can’t CPR your way out of brain death.”

Madsen is believed to have died of SUDEP, or sudden unexpected death in epilepsy. There’s no known cause for SUDEP, and the body of research is limited, with many labs seeking brain donations from deceased patients in hopes of advancing what is known about it.

Waddell wanted to donate Madsen’s brain to research. She says she tried to co-ordinate the donation in the hours following his death, but requests for an autopsy so tissue could be removed and sent to a lab were eventually denied by the B.C. Coroners Service (BCCS).

“I could not understand why they would say no to that,” she said. “It’s a fatal medical event that bears research, and the idea of them just flat out refusing to fund an autopsy at all seems insane to me.”

B.C. has one of the lowest autopsy rates in the country. Its declining autopsy numbers have drawn heavy criticism from pathologists who say the province could be missing out on critical public health information while families are left without answers as to how their loved ones have died.

The coroners service has previously said that mounting overdose deaths affect autopsy rate statistics in B.C. as the vast majority of overdose deaths don’t receive an autopsy.

The BCCS would not comment on Madsen’s death as its still being investigated, but in an emailed statement it said medically related deaths in homes don’t meet its investigative mandate.

Not all deaths qualify for an autopsy under the Coroners Act, although autopsies for unknown medical deaths can be requested by families, according to HealthLink B.C. The BCCS said those autopsies wouldn’t fall within its jurisdiction.

Drew’s story

Madsen was diagnosed with epilepsy when he was 24. Waddell says they struggled to navigate through B.C.’s health-care system as doctors failed to identify exactly what part of his brain was causing his seizures.

“It was just MRIs and CT scans and a constant readjustment to his medication. He was on over 20 different medications. Nothing seemed to work, and as the years went by, his seizures just kept getting worse,” said Waddell.

However, during a stay at the Seizure Investigation Unit at Vancouver General Hospital, doctors were able to pinpoint and trace the issue to his temporal lobe. A follow-up scan at a centre in Victoria was able to isolate the problem area. Madsen was a candidate for brain surgery.

“They told us it was something they could operate on, and he had a really good chance of being seizure-free for the rest of his life,” said Waddell.

But on March 11, he had a seizure. Once he was lucid, Waddell gave him his medication, as she usually did.

“He told me he had a really bad headache behind his left eye, which is what happened a lot when he had cluster seizures,” she said. “He told me that he loved me, and then he went to sleep.”

Waddell says she went to wake him up for dinner, but he wanted to keep napping. Later that night, she went back into the bedroom to give him his medication.

“When I went in to give him his bedtime dose, he was already dead,” she said.

Autopsy denied

Waddell said she called Madsen’s specialist moments after she discovered he was dead, who advised her to request an investigative autopsy so his tissue samples could be sent to the North American SUDEP Registry. Waddell says the specialist faxed an autopsy request to the hospital that day.

She said she also requested the autopsy of the coroner who visited her home, as well as a coroner at the hospital, who then told her the request had to come in directly from his family doctor. After some back and forth with the doctor’s office, Waddell said the request was sent on March 22,2024.

She says she was later advised by a funeral director who was in contact with the Nanaimo Regional General Hospital that an autopsy would be done on March 27. However, she said on March 28, her family doctor told her that the coroner’s service deemed the autopsy unnecessary.

While it didn’t comment on Waddell’s case specifically, the BCCS said it considers SUDEP a natural cause of death.

“Instances in which the decedent dies at home and is under the care of a physician or nurse practitioner do not meet the reporting criteria for a coroner’s investigation,” wrote BCCS spokesperson Ryan Panton in an emailed statement.

The BCCS only donates tissue samples from autopsies if an autopsy was already being done for investigative purposes.

Waddell believes since her husband’s death was sudden and unexpected, it should have been investigated.

“I haven’t felt such rage in a long time,” she said. “It feels like a giant gaping hole in our system that makes no sense to me.”