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Who’s watching the paramedics?

They’re performing more medical duties than ever before, but mistakes aren’t handled like those of doctors or nurses.
Feb. 16, 2016
By Michael Robinson

Ontario paramedics who make serious mistakes are disciplined behind closed doors and whatever sanctions they face are kept secret.

Toronto’s Paramedic Service received more than 360 complaints about patient care from 2009 to 2014. Of those, investigators concluded in 125 of the cases that a paramedic was at fault.

The incidents overall make up less than one per cent of all calls the service responds to each year.

Spokesperson Kim McKinnon said action is taken in “100 per cent of all cases” when an investigation finds a paramedic is at fault.

But the type of disciplinary action taken - ranging from written warnings to suspensions - is not available to the public. That information, McKinnon said, is “considered a confidential employment matter” and “private.”

Even some paramedics are pushing for change.

Geoff MacBride, president of the Ontario Paramedic Association, advocates for his profession to be regulated by a college of its own.

“We are not just ambulance drivers any more,” he said, adding paramedics have more medical responsibilities than they’ve ever had. “It is time for that skill set to get recognized.”

Michael Nolan, a former president of the Canadian Association of Paramedic Chiefs, said a professional college would instill the missing checks and balances. He says the current “patchwork” of legislation is neither consistent nor transparent.

“In the absence of a regulatory college structure, both the investigation and the evaluation which determines fault are up to the individual opinion of a doctor or employer,” Nolan said. “In many respects, there is no recourse by the paramedics or the public if they are dissatisfied with the outcome.”

Under the current system, he explained, paramedics found guilty of misconduct do not face public hearings and their names are not released, unless they end up in court.

Medical malpractice lawyer Amani Oakley, who has dealt with a case of paramedic negligence as part of her practice, said a College of Paramedics would increase accountability and public trust.

Contrary to other regulated healthcare professions, which post all disciplinary decisions online via a publicly available registry, there are no published records that identify paramedics who face disciplinary action.

“When you want to find out how many doctors are screwing up, you go to the College of Physicians, if you want to find out about nurses, you go to the College of Nurses,” she told the Star. “But where do you go when you want to find out the error rate or problems with paramedics?

“You would have to do it on a one-by-one basis, city by city, which is impossible.”

There are more than 20 other health regulatory colleges in Ontario, ranging from dentistry to traditional Chinese medicine and acupuncture.

Paramedics are already self-regulated in Alberta, Saskatchewan and New Brunswick. Nova Scotia announced a plan to establish a College of Paramedics late last year. The idea is still under consideration in Manitoba.

A damning 2011 report by the City of Toronto ombudsman said the service’s investigation of a sexual assault complaint “failed to investigate whether its own professional standards were breached” and “did not contain acceptable standards.”

But the full report remains secret. Neither the interim ombudsperson, Kwame Addo, nor his predecessor, Fiona Crean, will say what they found.

“We are not going to be reconsidering our decision to release the report at this time,” Addo said, instead referring the Star to a nine-paragraph summary in the taxpayer-funded office’s annual review.

Crean issued 16 recommendations to the organization after her investigation was concluded, but those are not public, either. Other than the four general improvements listed in the summary, Addo would not elaborate on the remaining 12, saying only that all were accepted and adopted.

The call for regulation is also in response to quasi-paramedic private transport companies, which are not registered with an ambulance service or licensed to perform medical acts by a doctor.

A Health Professions Regulatory Advisory Council (HPRAC) report recommended to the Ministry of Health and Long-Term Care in 2013 that self-regulation of paramedics “was not in the public interest.”

“Although paramedic practice entails a degree of risk of harm to the health and safety of the public, and the current oversight system is overly complex, the oversight system as a whole is sound and adequately addresses risk of harm to patients,” the council said.

In an emailed statement, Health Minister Dr. Eric Hoskins said paramedics are “an important, trusted part of our frontline healthcare in Ontario.

“It is important though that our government maintains the proper reporting mechanisms to ensure that highest level of care,” he said, adding the 2013 HPRAC report is currently under review.

“If updates to our complaints process are necessary we will make the appropriate changes.”

The decision of whether or not to move forward fell in Hoskins’ lap when he became health minister after the 2014 provincial election.

Some paramedic mistakes, outlined in disciplinary hearings:

Pierre Poirier, executive director of the paramedic association of Canada, is a former president of Alberta’s College of Paramedics, where he participated in disciplinary conduct and competency hearings. He outlined a few separate cases where paramedics made mistakes:

Paramedic with a drug addiction gave a patient saline and kept the opiate solution for personal use

Administered a drug that was outside the paramedic’s scope of practice

Withheld resuscitation by mistakenly assuming a patient was dead

Failed to appropriately assess a patient who appeared drunk but was actually a diabetic with low blood sugar.