Al-Hasnawi barely had a pulse when he arrived at hospital, ER doc tells paramedic trial
Christine Rankin | CBC News | Posted: December 2, 2020 2:56 PM | Last Updated: December 2, 2020
Yosif Al-Hasnawi was shot and died 3 years ago today
When Dr. Andrew Healey went to take the pulse of Yosif Al-Hasnawi in the emergency department after he had been shot, he couldn't find one.
In an effort to save the teen's life, he opened up Al-Hasnawi's chest and found that his heart was empty.
Healey was one of the staff emergency physicians on duty at St. Joseph's Hospital on this day three years ago, when Al-Hasnawi was shot and died. He took the stand in superior court, virtually, from his home office on Wednesday.
Two former Hamilton paramedics, Christopher Marchant and Steven Snively, have been charged with failing to provide the necessaries of life for the 19-year-old.
The court has heard that the pair thought Al-Hasnawi had been shot with a BB gun. But he'd been shot with a .22-calibre gun, and the hollow point bullet pierced an artery and vein.
Healey said the emergency department was "quite busy" that night and was transitioning systems, which meant it took longer to see each patient. There were ample staff on duty to assist.
'I'm worried that this means he's dying'
The first "patch" call from the ambulance carrying Al-Hasnawi came into the hospital at 9:32 p.m.
Healey told the court that the information most critical to him was that a 19-year-old had been shot in the abdomen, had a high heart rate of 145 and was "extremely altered."
The heart rate, he said, was "very abnormal." Even without a penetrating wound, Healey said he would be concerned about the teen.
Though the call said Al-Hasnawi had been shot with a pellet gun, Healey said this wasn't "useful" information. The hospital was preparing for the "worst case" of a shooting victim who was possibly in a later stage of shock, he said.
By the second call at 9:37 p.m., Al-Hasnawi's heart rate had plummeted to 45 beats per minute.
"I'm worried that this means that he is dying," Healey told the court.
The teen wasn't responding with eyes or with words, and the only movement he made was withdrawing to pain, according to the call. His pulse was "thready," which Healey said means it could barely be felt.
Healey told his team of around seven to nine staff to focus on caring for Al-Hasnawi, and not about documenting everything in the new system.
No pulse
Footage played in court showed an ambulance pulling up outside the emergency department. A stretcher with Al-Hasnawi was unloaded from the back.
When the doctor tried to take Al-Hasnawi's pulse, he couldn't find one. The team of staff tried CPR, but blood came out from the wound with each compression.
A rapid ultrasound was taken of Al-Hasnawi's heart and right upper section of his abdomen. The abdomen showed dark fluid with white particulate matter, which Healey said was blood.
Low chance of survival
A thoracotomy to open the chest was the only option, he said, and the odds of surviving that with a penetrating abdomen trauma was "in the low single digit percentage survival rates."
It revealed Al-Hasnawi's heart and aorta was empty, he said. An incision was made on Al-Hasnawi's right side, and a tube was placed in, but there was no hemorrhage.
Healey had ordered blood, but it never came.
"Even if the blood had come at the earliest moment," he said, "I do not believe it would have changed his outcome."
It took about 23 minutes from the time paramedics arrived until they left for the hospital on Charlton Avenue. Al-Hasnawi was shot at 8:55 p.m., and pronounced dead at 9:58 p.m.
Evaluating the trauma
In cross-examination, Jeffrey Manishen of Hamilton, Marchant's defence lawyer, brought up a note that summarized a 2019 interview between police, the Crown, and Dr. Healey.
Based on Al-Hasnawi's vitals, Manishen said Healey was reported as saying the teen would have been in cardiac arrest at either hospital, St. Joe's or Hamilton General.
Based on Al-Hasnawi's vitals, Manishen said Healey was reported as saying the teen would have been in cardiac arrest at either hospital, St. Joe's or Hamilton General.
Healey said he doesn't recall if he said that.
When asked about Al-Hasnawi's injury, Healey said surgery, or at least radiology imagery, would have been needed to evaluate the depth of the wound and trauma inside his body. Pressing the abdomen wouldn't rule out the possibility of internal bleeding, he said, and abdominal distension as an examination has "poor reliability."
When Crown attorney Scott Patterson asked Healey where gun shot victims go for emergency treatment, Healey indicated that EMS transports them to Hamilton General. Both hospitals provide trauma services, but Hamilton General is the lead servicing Hamilton, according to the agreed statement of fact.
The court has heard that the paramedics reported the injury as a psychiatric emergency to the dispatcher. There was no information about emergency psychiatric treatment on the call to the hospital, Patterson noted.
Traces of methamphetamine
Nathalie Desrosiers, a toxicologist who now works for the Royal Canadian Mounted Police and previously for the Centre for Forensic Sciences, also testified on Wednesday.
A sample of Al-Hasnawi's femoral blood was analyzed at the Centre for Forensic Sciences, and "traces of methamphetamine were detected," she said.
A recreational dose of methamphetamine can be detected one to three days later, she said.
If a concentration is below the threshold to be forensically relevant, it's reported as traces, Desrosiers said. The amount would have been below 12.5 nanograms per milliliter, but above 6.25 nanograms per milliliters.
"It's not a lot," Desrosiers said.
Desrosiers said there are medicinal forms of methamphetamine available in the United States for the treatment of ADHD and weight loss. It's also available as an inhaler.
Canada does not have a medicinal form, she said, and the Canadian toxicology test doesn't differentiate between these forms.
Amount wouldn't show effects, toxicologist says
Manishen asked Desrosiers about the signs of a crash phase after using methamphetamine, which she noted as ranging from irritability to extreme tiredness. He also asked about tolerance, state of mind, and if purity of the methamphetamine would affect the dosage found. Desrosiers said it would.
He asked if three litres of saline that Dr. Healey's team introduced during their emergency care of Al-Hasnawi would affect the concentration, and Desrosiers said it wouldn't.
When asked by Justice Harrison Arrell, who will render a verdict for the five-week trial, if in her professional opinion, she thought the traces of methamphetamine would show no visible effects, Desrosiers said they wouldn't.
No other drugs were detected, which indicates to her that the methamphetamine wasn't cut with anything. There was no alcohol detected in Al-Hasnawi's blood or urine.
This is the trial's second week. The court recently heard from two family members — Yosif's father, Majed Al-Hasnawi, and Yosif's younger brother, Mahdi Al-Hasnawi.
Mahdi Al-Hasnawi talked about lifting his dying big brother off the sidewalk that night and struggling to get him to the stretcher. He did it, he told the court, because he thought the paramedics weren't "doing their job."
The father told the court how he tried to comfort his dying son.
Two police officers and a firefighter who were on the scene that night, and the man who called 911 at a nearby convenience store, have also testified.
Healy was a witness for the Crown. He testified previously in the trial of the person who shot Al-Hasnawi, Dale King.
King was acquitted last year of second-degree murder, and that case is being appealed.
The defence and Crown were also on Zoom on Wednesday, which was played on screens at a Hamilton courtroom for Justice Harrison Arrell and the public. The defendants were on Zoom as well, but not on video.
The trial is expected to last five weeks, and Justice Harrison Arrell will render a verdict. The Crown attorneys are Scott Patterson and Linda Shin.
Jeffrey Manishen of Hamilton represents Marchant, and Michael DelGobbo of St. Catharines represents Snively.