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Mayor Jackson's Letter to BC Emergency Health Services Re: Delta Fire & Emergency Services EMR Licensing and Practice

Jul 14, 2015

The following letter from Mayor Lois E. Jackson was written in response to the letter dated June 18, 2015 from Carl Roy, President of BC Emergency Health Services, indicating that BCEHS will take legal action to halt Delta firefighters from practising at the Emergency Medical Responder level they are licensed to:

Dear Wynne Powell, Chair, and Carl Roy, President, BC Emergency Health Services:

To follow up on your letters of June 12 and June 18, and the meeting at Delta Municipal Hall on the morning of June 25, 2015 attended by yourselves, myself, our CAO, George V. Harvie, our Fire Chief, Dan Copeland, and my executive assistant, Dona Packer, I can confirm that we have obtained legal advice from two outside law firms regarding your objections to Delta’s firefighters administering EMR level service to patients within our community. Both of these law firms have provided opinions that we can undertake this level of service with or without BCEHS approval. We have also discussed the issues raised in your letters at an Executive Meeting of Municipal Council on July 13, 2015 and I have been authorized to issue this response.

Quite frankly, given the history of BCEHS encouragement and participation in this project, the support of the Minister, Terry Lake, and the fact that we have done everything asked of us by BCEHS throughout the process, we are at a loss to understand what has changed to justify this about face by BCEHS. In September, 2014 we had mutually agreed on the terms of a First Responder and BC Emergency Health Service Collaboration and Indemnity Agreement and an Amending Agreement for a three year pilot program, which agreements were prepared by your lawyers. We even agreed on the wording of a press release to announce the implementation of the program, subject only to what was explained to us by BCEHS negotiators as a rubber stamp approval by your Board. As we both know, that approval was not forthcoming, for reasons that have not been made clear to us and that we suspect had nothing to do with patient safety concerns.

BCEHS has now embarked on a completely different tack, alleging that it has concerns about patient safety if the EMR level of service is provided by our firefighters. These are the same firefighters who have been successfully trained to the EMR level and subsequently evaluated by BC Ambulance Service paramedics and licensed by the Emergency Medical Assistants Licensing Board to provide EMR level of service. It is our understanding that a similar program was successfully undertaken in Prince George, which, unlike Delta, has a regional hospital and nowhere near the traffic congestion of our municipality, and is continuing to operate today. 

We therefore cannot understand the concern and how Delta’s firefighters should be considered by BCEHS to be any different than Prince George firefighters and no longer capable of providing the services contemplated in the agreements negotiated in September 2014. Delta’s population is located in 3 distinct regions, intersected by Highways 99 and 91, which are heavily affected by traffic congestion and can often be a nightmare, not to mention the challenges posed by the Alex Fraser Bridge and Highway 10 and soon to be scheduled traffic closures on the Pattullo Bridge.  Approximately, 75% of our ambulance trips leave Delta to take patients to hospitals in Surrey, Vancouver or New Westminster.

It simply makes sense as the right thing to do to provide this level of service to our residents at municipal cost in the face of increasing challenges for Provincially funded ambulance services. I remind you that this is an ancillary service to support and supplement the paramedics, but only until an ambulance arrives, if it arrives at all.  Our firefighters will not be transporting any patients to hospital and we are not providing a competing emergency service, we are supplementing and supporting the ambulance service, so that working together, the first responders and the ambulance service can achieve better patient experiences and more efficiently utilize the resources we have at our disposal, all of which are funded by taxpayers.

Our firefighters are not providing a higher level of medical service than any other person licensed at the EMR level, including civilians, ski patrol, search and rescue and lifeguards, so the BCEHS concerns need to be reconsidered. This is hardly the case of a rogue municipality taking unilateral actions without prior direct collaboration with BCEHS on the issues, and we take exception to BCEHS portraying it as such to its staff and other stakeholders, as well as waging a campaign in the local newspaper against Delta. We have gone to some effort internally to avoid this becoming an issue that gets debated in the media, but BCEHS has taken that step and we will respond if necessary.

As to the four categories of issues you mentioned in your letter of June 12, we have the following responses:

1. Medical oversight of first responders.

Delta firefighters are only providing ancillary health services until the ambulance arrives. Delta Firefighters have always been under the scrutiny of BCEHS medical oversight, currently Dr. William Dick, and in addition have employed their own medical oversight physician, Dr. Allan Holmes.  BCEHS is fully aware that the firefighters have been providing EMA FR level of care to date without dedicated emergency physician support. If a matter is so serious as to require a phone call to the emergency physician on call, an ambulance should have been dispatched to the incident already. As to your point that insurance may not be available to patients under the BCEHS health care protection plan, this is completely spurious, as Delta firefighters are covered by appropriate insurance for this level of care.

2. Legal authority for Delta to provide health care services on behalf of the Province.

We respectfully disagree with your challenge of Delta’s legal authority to provide ancillary services.  The services Delta firefighters are providing are specifically provided for under the Emergency Health Services Act, but are not included in the services which require BCEHS approval. We have legal opinions that section 8 of the Community Charter provides Delta with sufficiently broad powers to provide these services as municipal services (s. 8(3)(a)) and that there is no conflict with Provincial legislation with regard to health.

3. Safeguards to enable review of care provided by first responders.

Once again, we must disagree with your interpretation, where you state that Delta is not entitled to the protection afforded by section 51 reviews under the Evidence Act. This is not correct. Changes to section 51 that came into force on April 1, 2013 added “emergency medical assistants”, as defined in the Emergency Health Services Act, to the list of health care professionals referred to in section 51 who cannot be forced or allowed to testify regarding a proceeding of a committee or evidence used by the committee. As we understand it, Delta firefighters providing EMA FR or EMR level care are licensed by the Emergency Medical Assistance Licensing Board and thus fall within the definition of “emergency medical assistants” under the Emergency Health Services Act.

4. Legal certainty for patients regarding insurance coverage and liability.

We find your point about the possibility of confusion in adverse outcomes as to which caregiver group to pursue legally or which policy of insurance will respond to be completely without merit. There are frequently multiple defendants and multiple insurers involved in personal injury actions. Twisting this argument into an increased potential for prolonged litigation ultimately penalizing patients, is absolutely unsupported by anything but your speculation.

To summarize, the issue of Delta firefighters being able to provide the EMR level of care to supplement and support the ambulance paramedics in advance of their arrival is a matter of pressing concern for our Council and our residents. If, as threatened, BCEHS intends to use taxpayer funds to bring a court application to stop Delta firefighters from providing this much needed service, it will speak volumes about whether patient care is the real issue.

Yours truly,

Lois E. Jackson