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Hearst report blames EMS staff for tragic delay UPDATE 13 OCT

Paramedics waited idle in dying man's last moments. Read the report for yourself.

"HE DIED WITH HIS HEAD IN MY HANDS." Manuel Rodriguez sits in the hallway at 40 Alexander St where he and his roommate found Jim Hearst bleeding on the night of Jun 25. Credit: Micheal Pihach
The Ontario Ministry of Health and Long-Term Care released a scathing report into the death of gay man and Church-Wellesley village resident Jim Hearst, who died of a heart attack on Jun 25 while paramedics waited idle a block away from the scene.

The report singles out two dispatchers, two paramedics and a Toronto Emergency Medical Services (EMS) supervisor for not following proper policies and procedures. All five have been reprimanded by EMS with punishments ranging from 10- to 17- day suspensions, remedial training and a further six to 12 months of close on-the-job monitoring.

“I believe everyone involved in the process did not follow the policies and procedures,” said EMS chair Bruce Farr at an Oct 8 press conference. “Had they, we would not face the delays in response.”

The report says that 911 dispatchers did not collect all the information necessary to assess the situation properly. Paramedics were told that Hearst had suffered a laceration and might be drunk and so concluded that the scene might be dangerous to them and that Hearst’s condition wasn’t urgent. Instead of seeing for themselves, they parked their ambulance at Yonge and Alexander, out of sight of the building in which Hearst was dying, to wait for a police escort.

“If paramedics feel that there’s danger on the scene, they do not need to enter until police are there but they need to go to the scene and confirm,” said Farr. “They can’t wait down the street.”

Manuel Rodriguez, a resident of the building who attended to Hearst as he died, is pleased EMS management admits mistakes were made, but says he is frustrated that the paramedics responsible got off lightly.

“They should have been fired,” says Rodriguez. “Their punishment is basically a vacation. Do you think this is a price for a life?”

Hearst’s partner, Alejandro Ramirez, could not be reached for comment.

Hearst died just days into the city workers strike. Under an agreement with the city, paramedics agree to work at 75 percent normal capacity during a strike. But nothing in the health ministry report suggests there’s a connection between the strike and they delay in assisting Hearst.

“It just reconfirms what’s been reported all along,” says Mark Ferguson, president of CUPE Local 416, which represents EMS workers. “The labour disruption had nothing to do with this unfortunate incident.”

But Ferguson declined to comment further on the report or the penalties given to the EMS staffers saying he needs more time to review the findings.

A motion to declare EMS an essential service, which would remove paramedics’ right to strike altogether and replace it with a system of binding arbitration, is mired in bureaucracy.

Toronto city councillor Michael Walker (St Paul’s) led the move citing concerns for public safety. His motion to council notes that EMS response times slowed during the strike and that “when ambulance response times drop by 20 percent people die, and sadly, they did,” referring to Hearst.

“I don’t see it as any different than fire, any different than police,” says Walker. “We are very short [of paramedics] and we don’t have enough workers when there’s 100 percent on the road. That’s why it’s got to be declared an essential service. I don’t think public safety is something to be bargained.”

Support for Walker’s motion came from the Toronto Paramedics Association (TPA), which agreed that strike conditions put the public at risk. 

“Our focus is patient care. It’s more of a moral dilemma for us,” TPA spokesperson Roberta Scott told Xtra prior to the release of the report on Hearst’s death. “I don’t think anyone’s looking at the money. In general, we’re playing Russian roulette. We’d hate to see someone lose their life and that’s the reason we become essential. We want them to deal with this now.”

But those against the measure argue that such a true essential services designation becomes costly when arbitrators decide to compensate workers for the loss of their right to strike.

Councillor Kyle Rae (Toronto Centre-Rosedale), who wasn’t present at the council vote on the measure but says he would have voted to delay the motion, cautions that other services such as police and fire that have been deemed “essential” have seen wage and benefit hikes that strain the city budget.

“The problem for a city is in declaring it an essential service, is that then negotiations with the city rapidly become subject to arbitrators and they’re not sensitive to what a municipality can afford,” Rae said before the release of the Hearst report.

Ferguson objects to removing the EMS workers’ right to strike and downplays the danger to residents of having a quarter of the EMS staff off the job.

“We’re happy to know that citizens are protected by the agreement that’s in place,” says Ferguson.

While a spokesperson for the Mayor’s office says that there is “no timeline” to ensure there are always enough competent paramedics at work in Toronto, Walker maintains that essential services designation must be in place before the current labour contract expires in three years.

“I think we’re heading inevitably to another strike in two and a half years,” Walker says.

11 OCT 2009 – MATT MILLS – Toronto Emergency Medical Services (EMS) staff are to blame for the delay in attending to Jim Hearst on the night he died, says an Oct 8 report to the Ontario health ministry.

Hearst collapsed in the ground-floor hallway of the apartment building in which he lived at 40 Alexander St in Toronto’s Church and Wellesley neighbourhood the evening of Jun 25.

Despite several 911 calls it took emergency medical help almost three quarters of an hour to arrive at the scene. By then Hearst had died of a heart attack.

Read the entire report for yourself here.
And the accompanying recommendations here.
And a chronology of events

EMS chair Bruce Farr, who on Jul 14 told reporters that EMS was on scene nine minutes after the inital 911 call, said at an Oct 8 press conference that the city workers strike was not a factor in the delay. Farr indicated that he had taken steps to follow the recommendations in the report. There is no word yet on whether the Ontario Chief Coroner will investigate further.

Xtra will follow up with reaction to the health ministry report and further developments shortly. 

An excerpt from the conclusion of the report:

There was a preventable delay in ambulance response and the provision of patient care for this patient. From the time the first request for emergency ambulance service was received until an ambulance arrived on scene 38 minutes and 25 seconds had elapsed.

This delay was caused primarily by the inappropriate decision made by PCP 1 and PCP 2 [primary care paramedics assigned to the call] to park their ambulance (stage) away from the scene without obtaining sufficient information, either by assessing the scene or by requesting further information from the dispatcher.

EMD 1 [emergency medical dispatcher] contributed to this delay by not appropriately prioritizing this request and by failing to document pertinent information about the patient’s condition, clear scene information or that there were bystanders with the patient.

EMD 5 contributed to this delay by not upgrading the response priority on receipt of the second request for emergency ambulance service and by failing to document pertinent information about the patient’s condition, clear scene information or that there were bystanders with the patient.

Operations Supervisor 1 contributed to this delay by not attending the scene and by not reviewing the situation with PCP 1 and PCP 2 in order to determine the reasonableness of the decision to withhold patient care by staging until the arrival of the police.