By Frances Barrick and Jeff Outhit
Waterloo Region Record
WATERLOO, Canada — A damning report says local paramedics failed to consistently follow patient-care standards and led to the departure of three staff members, including the director.
But authorities stress they have no evidence of any patient being harmed as a result of paramedics failing to follow regulations.
“There is no evidence of harm, but we can’t be 100 per cent sure of that. We only know what we have the evidence for,” Dr. Liana Nolan, regional medical officer of health told reporters Friday.
The report led to 26 of Waterloo Region’s 171 paramedics being disciplined, including the firing of two and the departure of ambulance chief John Prno. The ambulance service is administered by the region.
A provincial ministry review of 562 of the highest level of emergency ambulance calls from January to August of last year found that in many cases paramedics failed to administer oxygen when required by patients’ condition, failed to do spinal immobilization and failed to follow other procedures.
Officials said paramedics were lax in documenting patient care, such as not noting a patient’s vital signs or reasons for walking a patient to a stretcher. False information was also documented on more than half of the ambulance calls.
“The bottom line is the paramedics were exercising discretion when they shouldn’t have” and no one was saying this was wrong, Nolan said.
“They weren’t intentionally trying to harm people,” she said.
Nolan said the problem came to light last July when an ambulance supervisor noticed an ambulance on a Code 4 - the most serious and urgent emergency call - drive through an intersection without activating lights and sirens, which is required under both the Ambulance Act and Highway Traffic Act.
An internal investigation was immediately launched and what it revealed was a broader problem and the Ministry of Health was contacted, Nolan said.
“We have taken this very seriously,” she said.
About 15 per cent of the department’s unionized paramedics were disciplined, including eight who were given written notices, 16 suspended and two fired.
Apart from Prno, no other manager left the service as a result of this report, said Regional Chair Ken Seiling.
Prno declined comment Friday.
Nolan said the problem probably started with one or two paramedics and when their behaviour was not corrected, it spread to other paramedics. She said this behaviour started sometime after September 2010 when the service received a three-year accreditation.
“Some paramedics inappropriately used discretion where discretion is not to be used. They weren’t consistently meeting the standards, but there were a lot who were,” she said.
“However, that’s not good enough. We want to shoot for 100 per cent compliance with all regulations and standards. And there was a lack of management checks and balances to detect this inconsistency,” she said. “What has transpired shouldn’t be a reflection on all paramedics,” Seiling added.
Nolan said that the region takes responsibility for not having a system in place to ensure compliance with ambulance regulations.
The region appointed Arthur Graham, an ambulance manager from Toronto, as interim regional ambulance director until Sept. 20.
A search has been started to find a permanent replacement for Prno.
Nolan said ambulance staff and management received training to ensure all legislated standards are consistently met and the region is developing a monitoring system to ensure future compliance.
“We need to be more proactive,” she said.
Mike Murray, the region’s chief administrative officer, said the problem highlighted the fact that no ambulance service in Ontario has a system to track use of ambulance warning signals, something he said the ministry is studying. The regional service will be the first in Ontario to have a tracking system, he said.
Coun. Sean Strickland, who chairs regional council’s community services committee that oversees emergency medical services, said this has been a “pretty rough patch” for the service.
“As we move forward, we’re going to do whatever we can to ensure that the consistency and quality of patient care continues,” Strickland said.
The report will be discussed by regional councillors on Tuesday.