After critical report, N.S. promises to fine ambulance company for poor service

A Nova Scotia Health Department official says the government will fine the province's ambulance service if it fails to meet performance standards for response times.

Craig Beaton, associate deputy health minister, made the comments Wednesday at a legislature hearing in response to last week's report by auditor general Kim Adair.

Adair said there was a lack of accountability in the ambulance service because no fines had been levied since the province's contract with Emergency Medical Care Inc. was renewed in 2021.

Beaton said his department is now accumulating system data that can help determine when poor ambulance performance can be attributed to the company.

"We are building our data capacity to independently look at that," he said. "It would be specific to the issue of the day, but if they are not meeting performance targets based on the contract then, yes, I would say there would be an opportunity to provide a fine to the company."

Beaton said the contract does set out exemptions for situations where the company can't meet response times because of things that are out of its control, such as weather.

'Absolutely a concern'

Adair's report said the contract establishes acceptable response times — the time from when a call is received to the ambulance's arrival — based on the priority of the call and the community from which it is placed.

Her report found the average wait time for an ambulance in 2022 rose to 25 minutes from 14 minutes.

Auditors based their findings on data collected up until December 2022.  

Beaton told the committee the situation had improved since then.

"Response times [are] absolutely a concern," Beaton told the committee.

"We have seen a reduction in the last number of months, albeit it's only a few minutes, but it does show a signal in the right direction."

When it comes to another significant problem, ambulance offload times at hospital emergency departments, Beaton suggested similar improvements. 

"We do know that in four regional sites that times have gone down over the last eight months since January," said Beaton.

Figures provided by the Health Department to the CBC, following the meeting, show ambulance offload times at the province's 10 busiest hospitals fluctuated from a low of 23 minutes in February at the Aberdeen Hospital in New Glasgow to 178 minutes, in January, at the Halifax Infirmary.

A comparison between offload times in January, compared to August did show average offload times had improved at hospitals in Truro, Yarmouth, Halifax and Amherst. But six other hospitals saw their offload times increase, from an extra three minutes at the Dartmouth General to 13 minutes at the Cape Breton Regional.

Adair said the poor response times were symptomatic of a system that had seen a 17 per cent escalation in 911 calls that required an ambulance over the last five years. Staff shortages that see available ambulances sit idle and temporary closures of emergency departments that divert patients to larger hospitals were also cited as factors.

Charbel Daniel, executive director of operations with Emergency Medical Care, told reporters outside the committee hearing that his company has no problem with penalties because it should be held accountable.

Tentative agreement reached

"We are not worried about penalties as long as the appropriate framework for that accountability is built in to properly measure," he said.

The report said that following two written warnings, the Health Department can impose a fine of $10,000 per month when a response time standard is not achieved. The fine can increase by $1,000 for every subsequent month the standard goes unmet.

Daniel also told the committee that a tentative agreement on a new three-year contract had been reached with the union for paramedics as a result of talks that began in June.

He told reporters following the hearing that the deal was reached Sept. 26 and is currently being voted on by members of the International Union of Operating Engineers, which represents the paramedics. The current deal expires Oct. 31, and the vote result for the new agreement is expected Friday, Daniel said.

The auditor general's report found that wages for Nova Scotia's paramedics in 2022 were comparable with those in the other three Atlantic provinces. The starting hourly wage of $26 for a primary care paramedic and $31.06 for an advanced care paramedic was second to Newfoundland and Labrador, which had the highest rates.

However, in an appearance before public accounts in February 2022, the union said it was losing trained paramedics to provinces such as Ontario, where the top annual salary at that time for a primary care paramedic was close to $81,000 compared to just over $63,000 in Nova Scotia.

While no one would discuss details of the tentative deal, Beaton was asked whether he thinks it will help retain paramedics for the health system.

"I think we've seen in other professions that compensation is a direct influencer in terms of retention so it is certainly one of the interests that we have," he said.