Paramedic plan to put some patients in taxis still held up with ministry

A pilot program to use taxis instead of ambulances to transport some patients with less serious ailments in Ottawa has yet to get started, more than a month after its expected launch date.

The Safe Alternate Transportation pilot is awaiting approval from the provincial health ministry, which noted that the Ottawa Paramedic Service's initial application didn't actually mention its plan to use taxis.

The service's chief denied that was an oversight. Instead, he said the proposal has evolved.

It's intended to take pressure off paramedics who are spending hours waiting at emergency rooms before they can hand over patients.

Chief Pierre Poirier said that problem is getting worse. So far this year, delays have exceeded two hours and 42 minutes 10 per cent of the time.

Poirier said that's the most important factor in "level zero events," when there are no remaining ambulances to respond to incoming calls. That's happened more than 1,400 times so far this year.

Original launch date 'a little bit too optimistic'

In October, Poirier told councillors the taxi program would begin on Nov. 1. He acknowledged on Friday that his estimate was "a little bit too optimistic" and is now hoping to get approval before the end of the year.

"We're still working through the legal impacts of it," Poirier said. "I expect to have answers in the short term here with where we're at in terms of permission from the province."

He said paramedics currently have a duty to take patients to hospital when they ask to go and the minister will have to sign off on changing the language through the patient care model. That requires a legal review, according to Poirier.

The Ministry of Health did not immediately respond to a request for comment on Poirier's account of the discussions.

In an email to CBC last month, spokesperson Hannah Jensen said the service's original proposal gave "no detail on the alternative mode of transportation (i.e. taxis)."

She said the ministry's priority is to ensure the proposed changes maintain patient safety.

Poirier confirmed that the service did not mention taxis in its application last year. He said the initial program model would have seen paramedics consult with doctors when treating patients with low-acuity illnesses, then potentially cancel the call when warranted.

More complicated than expected

The idea of using taxis first arose over the summer and the service added it to its application to the ministry in September or October, he said. 

"We thought, since our program was so mature, that this would not be a complicated process," he said on Friday. "What we've uncovered is that it has been much more complicated than we expected."

Last month, he said delays in the pilot will add to delays in transferring patients, since those with the less serious conditions are often prioritized last at hospital. It's exactly those patients, with issues like twisted ankles or minor cuts, that the taxi pilot was meant to address.

Poirier said the pilot would transport a small number of those patients by taxi, though it could be expanded in the future.

River Coun. Riley Brockington, who chairs the city's emergency and protective services committee, said he had understood in October that the program was "more or less imminent." He said it's needed now.

"I hope this can be ironed out sooner rather than later," he said on Friday.

Brockington added that he's disappointed to see no progress with hospital offload delays, calling it a "top priority," but he's pleased the budget recommended to council on Friday will add 28 full-time-equivalent positions to the paramedic service.

Poirier is seeing some good news in recent statistics, even as offload delays creep up. While the service has found itself without ambulances more than 1,400 times, the total duration of those instances trending down from last year.

The percentage of patients the service is taking to hospital has also dropped slightly, according to Poirier.