March 11, 2021
This speech can be read in the official record of the Nova Scotia Legislature, the Hansard, here.
SUSAN LEBLANC: I am glad to rise to speak to this critical issue, though of course saddened at the conditions which make it necessary and the fact that we even have to have this as an emergency debate. It’s not an exaggeration to say that paramedics have been sounding the alarm for years about this issue and so has our caucus.
First, it is important to put on the record some of the basics of the situation at hand. These are the things we know: paramedics are overworked and burning out. They spend hours waiting to offload patients at the hospital. They can work 16-hour shifts without eating. We have been hearing about the various tweaks that this government has been trying for years now, with little result.
The Code Critical issue is not just an ambulance or paramedic issue. It is a systemic, widespread health care system-wide problem that will not be solved by rearranging how our ambulance system works. We need widespread reinvestment in our entire provincial health network. Our system is taxed to the limit and the entire health care system and its backlogs are at the root of the #CodeCritical crisis and paramedics being unable to offload their patients at the hospitals.
Mr. Speaker, for years this government has refused to release a comprehensive report, paid for with $144,000 of public money, that analyzed the paramedic predicament. We know that this is called the Fitch Report. I will say off the bat that part of the campaign to have the Fitch report finally released by the government sent no fewer than 2,500 emails to me and to other members of this House to ask the government - to implore the government - to release the Fitch Report. The excuse that the government gave was that it could impact contract negotiations for our ambulance service provider, Emergency Medical Care Inc.
Finally, after those literally thousands of phone calls and emails from paramedics and their family members and average Nova Scotians who are concerned and, frankly, terrified at the state of our emergency health care system, the government finally decided to release the report years after it was completed.
Of course, upon its release we can see the real reason why it was hidden for so long. The report details the extreme conditions in our health care system that paramedics are faced with when they’re trying to do their job. The report states, “On average, EMC ambulances spend 1.5 hours offloading patients for Category 1 calls” or 3.25 hours measured at the 90th percentile. The International Union of Operating Engineers Local 727 president, Mike Nickerson, has said that he has heard of a paramedic waiting longer than 24 hours to offload a patient. Twenty-four hours to offload a patient. Let’s think for a moment about that patient and that paramedic. What an awful situation. When writing the report, Fitch found that nearly half of the paramedics’ time was spent driving people between different levels of hospital or nursing homes. Of those individuals being transferred between facilities, only two per cent required the skills of a paramedic or the equipment that is in one of the province’s 180 ambulances. Response times are routinely overshot in urban areas.
Fitch calculated the cost of offloading delays faced by paramedics but that important information was redacted. The public is not allowed to know, according to this government. The report also says that offload times appear to grow exponentially after 2018.
The government’s response to these challenges, which they have known about for years, was to issue a directive to the Nova Scotia Health Authority on offload times asking that they be limited to 30 minutes for emergency situations or 12 hours for transport. The former Minister of Health and Wellness tried the same thing in 2019. Offload times decreased for a period, but then increased after that again.
The government has said that it will be implementing 64 of the Fitch Report’s 68 recommendations, but it has not explained which four recommendations won’t be implemented. While I’m standing here, I would certainly urge the government not to implement the recommendation that suggests ambulance fees should be increased: “Review of patient transport fees which may lead to opportunities for increases, particularly as they apply to non-Canadian residents. Additionally, amounts unpaid by Canadian residents could be collected by other means, such as at the time of driver’s and other licence renewals.” I will remind the members of this House that ambulance fees can deter people from seeking medically necessary help.
I will also remind people about our caucus’s bill - which died on the Order Paper when the House was prorogued - to eliminate fees for medically necessary situations. That the government is leaving the door open to increased ambulance fees is, frankly, unacceptable.
No one has to search very far to find horrific stories of people who wait too long for an ambulance. People die while waiting for emergency help, as we tragically learned last month with the death of April George in Bass River. Even more people live in fear of what could happen to themselves, or a loved one, if an ambulance isn’t available to get to them. I know of a family member, for example, who when visiting the province to spend time here and decide whether they wanted to relocate back home here to Nova Scotia, were unfortunately in a car accident in Halifax. An ambulance took the passenger from the other vehicle to Emergency. Though she seemed fine, the paramedic on the scene said the daughter of the family should probably be seen, just in case, but there was not another ambulance to take her to the hospital. The family ended up deciding not to return to Nova Scotia. This experience was part of the decision.
As we find ourselves in a global health pandemic because of the COVID-19 virus, we know that paramedics are putting themselves and their families in harm’s way to take care of Nova Scotians during this pandemic. They will do so again should we experience another wave of the virus. Paramedics are still grappling with the same issues from before COVID-19 arrived, and some have intensified.
Like many things in our province - many systems in our government and in our province - COVID-19 has shed a light on the cracks and the chasms in those systems. This is definitely one of them. Paramedics are still working short and working extremely long shifts without breaks, being worn down, burnt out, and sometimes being assaulted at work. They now also have to contend with the risk of bringing COVID-19 home to their families. The stress is unimaginable, but IUOE 727’s request for temporary housing for paramedics during the pandemic, as was provided in Ontario, was not granted.
A scan of the #CodeCritical campaign shows dozens in the last few days in all corners of the province. Last month, after resuming the #CodeCritical campaign, paramedics reported more than 40 Code Criticals in five days across every health care zone in the province in which very few or no crews were available to respond to local emergencies.
We know the problems and we know the solutions. Frankly, our caucus has flooded this House with solutions to this very complex, multi-faceted health care crisis that is at the root of the Code Critical problem. We have introduced legislation that would build collaborative emergency care centres. We would keep community hospitals open in CBRM. We would allow physician assistants to work in the province and alleviate pressure in the system. We have introduced legislation that would require regular publishing on emergency room standards. We have committed to building a room for every resident and clearing the wait-list for long-term care that causes the extreme shortage of beds in our hospitals. We’re calling for emergency mental health response teams that would work to alleviate the burden placed on paramedics by mental health calls. We are waiting for these to be taken up by this government. We are proposing ideas, but Nova Scotians can’t wait much longer.