5. CORONER'S INQUEST CONCERNING
THE DEATH OF STÉPHANE MICHAUD
ENQUÊTE DU CORONER SUR LE DÉCÈS DE
STÉPHANE MICHAUD |
COMMITTEE
RECOMMENDATIONS
That Council approve that:
1.
The $225,000 required
to implement a Paramedic Airport Program be considered as part of the 2009
budget process; and
2.
The Ottawa Paramedic
Service enter into a contract with the International Airport Authority to
provide a 7 day per week, advanced care paramedic program per the Coroner’s
recommendation once funding and additional FTEs have been approved.
RECOMMENDATIONS
DU COMITÉ
Que
le Conseil approuve ce qui suit :
1.
Que la somme de 225 000 $
nécessaire à la mise sur pied d’un programme paramédic à l’aéroport soit prise
en compte dans le cadre du processus budgétaire de 2009;
2.
Que le Service paramédic d’Ottawa passe un contrat
avec l’Administration de l’aéroport international en vue de fournir un service
paramédic de soins avancés sept jours sur sept, conformément à la
recommandation du coroner, une fois le financement et les ETP supplémentaires
approuvés.
DOCUMENTATION
1.
Deputy City Manager, Community and Protection Services
Department report dated 7 March 2008
(ACS2008-CPS-OPS-0001).
Community and Protective Services Committee
Comité des services communautaires et de protection
and Council/ et au Conseil
Submitted by/Soumis par : Steve
Kanellakos, Deputy City Manager/Directeur municipal adjoint,
Community and Protective Services/Services communautaires et de
protection
Contact Person/Personne ressource : Anthony DiMonte, Chief, Ottawa
Paramedic Service
Ottawa
Paramedic Services/Services paramédic d'Ottawa
(613)
580-2424 x 22458, Anthony.DiMonte@Ottawa.ca
SUBJECT:
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OBJET :
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That
Community and Protective Services Committee recommend that Council approve
that:
1. The
$225,000 required to implement a Paramedic Airport Program be considered as
part of the 2009 budget process; and
2. The
Ottawa Paramedic Service enter into a contract with the International Airport
Authority to provide a 7 day per week, advanced care paramedic program per the
Coroner’s recommendation once funding and additional FTEs have been
approved.
Que le Comité des services communautaires
et de protection recommande au Conseil d’approuver ce qui suit :
1. Que la somme de
225 000 $ nécessaire à la mise sur pied d’un programme paramédic à
l’aéroport soit prise en compte dans le cadre du processus budgétaire de 2009;
2. Que le Service paramédic d’Ottawa passe un contrat avec l’Administration de l’aéroport international en vue de fournir un service paramédic de soins avancés sept jours sur sept, conformément à la recommandation du coroner, une fois le financement et les ETP supplémentaires approuvés.
On June 5th, 2005, 43-year-old Stéphane Michaud arrived at the Ottawa International Airport from Halifax. Shortly after his arrival, Mr. Michaud started to behave strangely, throwing himself on the ground and injuring himself by diving head first from a bench onto a floor. Police and Paramedics attended the incident. Mr. Michaud was transported to the Ottawa Hospital General Campus where he was pronounced dead by the Emergency Physician. A post-mortem examination was conducted on June 6th, which found the cause of death to be consistent with positional asphyxia.
Although technically, a coroner’s inquest into the death of Stéphane Michaud was called because he was in Police Custody at the time of his death, a number of issues needed to be examined.
The City received final recommendations, emanating from the coroner’s inquest, on December 17, 2007. In total, the jury made eleven (11) recommendations concerning the death of Stéphane Michaud six (6) of which were specifically directed to the Ottawa Paramedic Service.
The following report outlines the City’s response to the Coroner’s recommendations.
Le 5 juin 2005, monsieur Stéphane
Michaud, âgé de 43 ans, arriva à l’aéroport international d’Ottawa en
provenance d’Halifax. Peu après son arrivée, M. Michaud commença à se comporter
de manière étrange, se jetant au sol et se blessant en plongeant tête première
depuis un banc. Les services paramédic et de police assistèrent à l’incident.
M. Michaud fut transporté vers le campus général de l’Hôpital d’Ottawa, où son
décès fut constaté par le médecin urgentiste. Une autopsie pratiquée le 6 juin
a permis d’attribuer la cause du décès à une asphyxie positionnelle.
Bien que, techniquement, une enquête du coroner
sur le décès de Stéphane Michaud ait été demandée parce qu’il était sous garde
policière au moment des faits, un certain nombre de points devaient être
examinés.
La Ville a reçu le 17 décembre 2007 les
recommandations finales émanant de l’enquête du coroner. Au total, le jury a
fait onze (11) recommandations liées au décès de Stéphane Michaud, dont six (6)
concernent directement le Service paramédic d’Ottawa.
Le rapport qui suit expose les
grandes lignes de la réponse de la Ville aux recommandations du coroner.
At approximately 08:30 hours on June 5th, 2005, 43-year-old Stéphane Michaud arrived at the Ottawa International Airport from Halifax. At approximately 09:00 hours, Mr. Michaud started to behave strangely, throwing himself on the ground and injuring himself by diving head first from a bench onto a floor. It was later determined that Mr. Michaud suffered from a “Schizoaffective disorder with delusional features” and at the time of his death was not taking his prescribed mental health medication. When Mr. Michaud began diving from the bench he was restrained by nearby passengers and airport staff until the arrival of the Ottawa Police. He was then further restrained and handcuffed by police.
Paramedics arrived on scene at approximately 09:28 hours and commenced their assessment. The patient was eventually placed on a stretcher and restrained with multiple belts in a prone position, still handcuffed. Shortly after being injected with a sedative at approximately 09:51, Mr. Michaud appeared to calm down however a few minutes later was found to be in distress. With the assistance of the Ottawa Police, Paramedics attempted to resuscitate Mr. Michaud but their efforts failed. Mr. Michaud was transported to the Ottawa Hospital General Campus where he was pronounced dead by the Emergency Physician at 10:52 hours. A post-mortem examination was conducted on June 6th, which found the cause of death to be: consistent with positional asphyxia.
Although technically, a coroner’s inquest into the death of Stéphane Michaud was called because he was in Police Custody at the time of his death, a number of issues needed to be examined in particular whether positional asphyxia really occurs in restraints in the prone position, its association with excited delirium and what new methods have been devised since Mr. Michaud’s death to control individuals in that state of agitation. Other issues dealt with response time at the Airport by the Ottawa Paramedic Service, the use of chemical restraints as opposed to physical restraints and the difficulties in producing accurate timelines in these stressful situations.
The City received final recommendations, emanating from the coroner’s inquest, on December 17, 2007. In total, the jury made eleven (11) recommendations concerning the death of Stéphane Michaud (Document 1), six (6) of which were specifically directed to the Ottawa Paramedic Service.
The following recommendations are specifically addressed to the Ottawa Paramedic Service as well as the current status of the recommendation’s implementation.
Recommendation 3:
Status:
The Ottawa Paramedic Service supports this recommendation and additional staffing has been approved through the 2008 budget process. Thirty-eight (38) paramedics are in the process of being hired for 2008, with additional staff requirements identified for 2009 and 2010 to address growth and subsequent response times.
Recommendation 5:
The jury recommends that the
Ottawa Paramedic Service, the Ministry of Health and Long Term Care and the
Ottawa Base Hospital Program work together to find solutions that will allow
increased paramedic continuing medical education – including potentially one
further eight hour training day annually and/or alternative training delivery
methods without negatively affecting ambulance response times.
Status:
Ottawa Paramedic Service staff will coordinate a working group with the parties to review this recommendation and the possibilities for implementation including staffing requirements and cost.
Recommendation 6:
The jury recommends that the Ottawa Paramedic Service and the McDonald-Cartier International Airport Authority institute the placement of an Advance Care Paramedic, seven days a week, in the terminal building at the Ottawa International Airport.
Status:
Staff have discussed the implementation of an airport program, 7 days per week at the airport to facilitate timely medical intervention. Staff have discussed a program and the potential to have the Airport Authority pay 50% of the associated cost. In order to provide 20 hours of service per day, 7 days per week, the Paramedic Service would be required to hire 10 additional paramedics at an approximate cost of $900K per year. However, the costs will be offset by revenue as the Airport will fund $450,000 or 50%. The remaining $450,000 will be funded by the Province ($225,000) through the City’s current level of Provincial funding and the City would be required to pay ($225,000). Council authority is required to implement the program.
Recommendation 8:
The jury recommends that the Ottawa Paramedic Service, in conjunction with the Ministry of Health and Long-Term Care, explore the feasibility of any technological solutions that would assist in a field environment with improving the accuracy and the recordings of times on Ambulance Call Reports. This would include a mechanism to monitor scene-time and alert paramedics when a specified amount of time has passed.
Status:
Staff are currently establishing a working group that will include staff from the City’s Information Technology Branch, Paramedics and Ministry of Health and Long Term Care to explore opportunities to implement a solution to improve the accuracy and recordings of time on Ambulance Call Reports.
Recommendation 9:
The jury recommends that
efforts be made to find solutions that will improve patient transfer from
paramedics to staff at emergency rooms in the Ottawa area hospitals.
Status:
A motion was adopted at Council during the 2008 budget deliberations “that a steering committee be established to develop an innovative plan to address hospital wait times in Ottawa. One of the first solutions to address in 2008 is the feasibility of using other health care practitioners to support emergency departments.” A Steering committee with Terms of Reference is currently being established that will request that the existing Champlain Emergency Service Network Operational Committee discuss and develop a plan to address the hospital wait times in Ottawa
The Government of Ontario has indicated that this is its number one priority and has named Dr. Alan Hudson as the lead to resolve this provincial health problem. Any local solutions that may be explored must take into account the provincial health initiative, as this is a provincial health responsibility and is being led by the government of Ontario.
Recommendation 10:
The jury recommends that a policy be implemented that forbids first responders who are attending to a medical emergency from putting a patient in the prone position particularly with patients exhibiting the set of symptoms commonly referred to as excited delirium.
Status:
Policies within the Ottawa Paramedic Service have already been changed and instituted. Likewise, other emergency responders are delivering the new training to their front line staff.
Although the final recommendations from the coroner concerning the death of Stéphane Michaud were only received in December of 2007 – 2 ½ years after his death, Ottawa Paramedic Service have already begun developing solutions to address issues identified through this incident. Ottawa Paramedic Service continues to report to Council annually with recommendations to ensure staffing addresses growth and subsequent response time issues. They continue to revise and implement training as appropriate and with the help of Council continue to participate on committees to address lengthening hospital wait times. By working with their emergency partners, the Ottawa Base Hospital and the Ministry of Health and Long Term Care, Ottawa Paramedic Service continues to strive for excellence and to provide the best possible service to the citizens and visitors of Ottawa.
N/A
Funding the recommendations of the Coroner’s report is provided within the 2008 Paramedic Service Operating Budget, except for Recommendation #6. The Paramedic Service is to provide a dedicated Advanced Care Paramedic Airport Program, which will result in an additional 10 FTEs and $900,000 in gross operating expenditures. However, the costs will be offset by revenue, as the Airport will fund $450,000 or 50%. The remaining $450,000 will be funded by the Province ($225,000) through the City’s current level of Provincial funding and the City ($225,000). The City’s portion will be put forward as a pressure as part of the 2009 operating budget.
Document 1: Verdict of Coroner’s Jury (Previously distributed
and held on file)
CITY STRATEGIC DIRECTIONS
Currently
the City receives funding from the province at 50% and the City should maximize
the opportunity to access the provincial funding. Likewise, the Paramedic Service has an opportunity to access
funding from the Airport Authority to address the Coroner’s
recommendation. This would support the
strategic direction to “[d]eliver agreed-to level of service at the lowest
possible cost”.
The Community and Protective Services and Ottawa Paramedic Services will implement any direction received from Council.