Doctored response times? Self-reported private ambulance data taken with 'a very large grain of salt'
Understaffing issues highlighted in Happy Valley-Goose Bay
A CBC investigation into understaffing by a private ambulance operator in Labrador has uncovered province-wide problems including a flawed self-reporting system and greater contract non-compliance.
The self-reporting system involves private ambulance employees recording their own response time data which is used to calculate pay and ensure the company is meeting the time targets outlined in its contract.
Accuracy questioned
In internal documents obtained by CBC, the accuracy of that, self-reported data is called into question.
"I can run reports from [the data] to give me a snapshot of operator activity," Wayne Young, with the Department of Health's air and road ambulance division explained to another government official via email.
"However, I take the data recorded and shown with a very large grain of salt as it is self-reported by the operator."
Discrepancy in data and family's memory of fatal accident
On the night of Nov. 13, 2015, the self-reported private ambulance data for a vehicle-pedestrian collision in Happy Valley-Goose Bay shows, by provincial standards, an acceptable response time.
However, family members of the woman who died in hospital recalls a much longer timeframe and questions whether their loved one's outcome would have been different with a quicker response time.
Dee Wells, 61, was hit on Hamilton River Road, 3.5 k.m. from the hospital.
An ambulance was immediately called, according to the family.
"The RCMP arrived five minutes following the phone call," daughter Robyn Wells told CBC's Labrador Morning in May when CBC first shared stories of ambulance response times in Happy Valley-Goose Bay.
"However, the ambulance took about 30 minutes to arrive on scene."
Self-reported data by Labrador Ambulance Services Ltd. recorded a much shorter response time.
According to the spreadsheet obtained by CBC, the emergency call for Dee Wells came in at 21:31.
One minute later, the ambulance was en route and, according to self-reported data, paramedics were at Wells' side at 21:35 — four minutes after the dispatch call was received.
I really have to wonder what would have happened had the ambulance arrived more quickly.- Robyn Wells
Robyn Wells wasn't with her mother at the time of her accident, but has since learned the details from her father, who told her the wait was half an hour and her mother was, at first, coherent.
"I know my father told me it felt like a lifetime having to watch his wife and my mom suffer for that long," she said.
"I really have to wonder what would have happened had the ambulance arrived more quickly."
"I'll spend the rest of my life asking myself that question. I'll always wonder could my children have known their grandmother or could my parents have seen their 50th wedding anniversary if the response time had been faster."
Understaffing
Labrador Ambulance Services Ltd., the private ambulance operator that responded to Wells, hasn't answered CBC's repeated requests for comment.
According to internal documents, the operator has also been lax in responding with the Department of Health and its employer, Labrador-Grenfell Health.
In an official notice delivered to the company's owner, Kelli Freake, on March 1, 2016, the regional director of population health, ambulatory care and paramedicine had made three verbal requests and written two emails asking for staffing information.
The director outlined a 10-day deadline which was ignored.
Labrador Ambulance Services Ltd. responds
In early May, CBC began publishing stories which Freake was asked to respond to.
In the case of Louie Montague, 81, who was made to wait an hour outside in late November 2016 after suffering a stroke and falling down a set of stairs, Freake admitted to being understaffed.
She said four back-to-back calls came in that day, three in a "very short time frame."
"Labrador Ambulance Services took direction from the ER department regarding the order based on the acuity of each call," she wrote in an email to the Department of Health.
Only one ambulance staffed, not two
Since the incident with Montague, Freake said the company is "in the process of still hiring new staff to fulfil the obligations of 2 fully staffed machines 24/7."
According to the contract, Labrador Ambulance Services Ltd., is required to have two ambulances with two attendants including a primary care paramedic "ready to respond within 10 minutes (90 per cent of the time) 24 hours a day/7 days a week."
We need to have a discussion on the recapture of wage funding not used.- Wayne Young
The company receives $235,000 a year for its first ambulance and $202,000 a year for the second in addition to a mileage subsidy and patient fees.
The company is also provided wages for its employees — four full-time salaries per ambulance, a total of eight salaries — in the $20 an hour range at 40 hours a week.
Despite not having two ambulances staffed at all times, it appears the company was being paid the employee salaries for the second emergency vehicle as if it were staffed.
"We need to have a discussion on the recapture of wage funding not used," Young said in an internal email.
Chute times a reality across province
The time between the ambulance receiving a call and staff being on their way is called chute time.
Private ambulance operators are contractually required to hit a chute time of less than 10 minutes, 90 per cent of the time.
But that isn't happening in all areas of the province.
According to data compiled by the provincial government and retrieved through Access to Information, from Apr. 1 to Dec. 31, 2016, 92.3 per cent of the 17,924 emergency calls received by private ambulance operators had an acceptable chute time of under 10 minutes.
"The average ambulance operator self-reported response times are within standard," Young, the government official who is skeptical of the current reporting system, said in another internal email. "Surprise!"
Of the 49 private ambulance operators analysed, 11 don't hit the 10-minute chute time.
For example, Young's Ambulance Service in Spaniards Bay misses the 10-minute standard 60.6 per cent of the time.
Medics with Jackson's Arm Ambulance Service take more than 10 minutes to get going 47.9 per cent of the time.
Labrador Ambulance Services, the operator CBC initially began looking into, meets the 10-minute standard 90.7 per cent of the time.
All these figures are according to self-reported data.
Contract up for renewal
It depends on the region, but in Happy Valley-Goose Bay's case, medics aren't always stationed with the ambulance.
The emergency vehicle waits in a bay at the end of town and when a call comes in, medics drive to it and then leave for the emergency.
The responding medics record the time the call came in, when they arrive at the bay and when they leave for the scene.
The private ambulance contract is currently up for renewal.
The self-reporting process is under investigation.
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