Military pushed to route N.L. marine medical calls to Rome
Defence Department opposed keeping marine medical service based in Canada
By Rob Antle, CBC News
Posted: Dec 4, 2012 4:32 AM ET
Last Updated: Dec 4, 2012 4:26 AM ET
Canada's military pressured coast guard officials in Newfoundland and Labrador in May into abandoning a plan to ensure that Canadian doctors would continue to handle marine medical emergency calls, CBC News has learned, but an emergency at sea days later prompted a change in policy.
Defence Department officials in Halifax had insisted that one procedure apply for the entire Atlantic region, in the wake of this spring's shuttering of the rescue sub-centre in St. John’s.
That decision led to emergency medical calls instead being routed to a free service in Rome.
Within days, a Newfoundland fishing captain received no medical advice for more than 10 hours after becoming ill at sea. Efforts by the crew to seek medical help were steered to Italy, where they confronted a language barrier.Defence Minister Peter MacKay's office took an interest in the marine medical calls issue the day before an emergency contract was signed with a Canadian provider of the service. (Sean Kilpatrick/Canadian Press)
Just before that incident, a military official was touting the “proven procedure with quality service” offered by the Italian non-profit, called CIRM Roma.
Defence staff had criticized Newfoundland coast guard employees for temporarily extending the contract to keep the service in Canada, according to internal military and coast guard correspondence obtained by CBC News under federal access to information laws.
The paper trail provides a behind the scenes look at events that ultimately led the prime minister to answer questions on the matter in Parliament.
As bad news was about to break, the federal government scrambled to put an “emergency contract” in place to pay Canadian doctors to provide coverage for the entire Atlantic region.
Temporary contract extension for Newfoundland
The St. John’s-based Maritime Rescue Sub-Centre closed in late April, victim of a wave of federal budget cuts.
Newfoundland coast guard officials temporarily extended the contract covering at-sea medical calls with Praxes, a Halifax-based company, as an interim measure.
Those consultations help determine how serious a medical situation is, and whether a crew member should be airlifted to hospital, for example.
But confusion almost immediately ensued.
With the St. John’s sub-centre closed, its former responsibilities were transferred to the Joint Rescue Co-ordination Centre in Halifax.
The JRCC’s procedure was to have calls made directly to the Queen Elizabeth II Hospital in Halifax, as part of an informal arrangement.
The Newfoundland region averages about 100 radio medical calls annually.
Internal federal documents indicate that JRCC officials did not notify doctors in Halifax about any increase in workload that would result from a new arrangement.
The doctors quickly balked.Dr. Sam Campbell is chief of the department of emergency medicine at the Queen Elizabeth II Hospital in Halifax. The hospital declined to take over handling marine medical calls. (CBC)
On May 4, Dr. Sam Campbell, chief of the QE2’s department of emergency medicine, informed the coast guard that the hospital would stop taking all marine medical calls.
“I have discussed this with Capital Health legal council and was told that we should not accept these calls at this stage,” Campbell wrote.
“She suggests that we refer these calls to 911. Failing this, I believe there are a number of companies that provide international medical advice.”
Coast guard officials in Newfoundland did not seem worried, as they had a contract extension with Praxes covering the next couple of months.
Military officials, however, were not pleased.
“The circumstance we are in is as a result of extending that contract,” Maj. Ali Laaouan wrote in a May 5 email to coast guard and defence officials.
“Roma is a proven procedure with quality service and never had any issues with them. Until we sort this out (hopefully this week) we will use them. The operation of JRCC is my responsibility on behalf of the admiral therefore I would appreciate that you let Harvey [Vardy, a top coast guard search and rescue official in Halifax] and myself deal with those decisions.”
Later that day, Ann-Margaret White, a senior coast guard official in Newfoundland, wrote back to Laaouan.
'Roma is a proven procedure with quality service and never had any issues with them.'—Maj. Ali Laaouan
“Ali, I respect the role of the SAR authority and, as I’ve said previously, your remarkable work in leading this,” White noted.
“If you can spare some time on Monday, we can discuss the context and why utilizing the alternate provider unexpectedly, at this time, was not the preferred course.”
Laaouan quickly wrote back to stress that the contract with Praxes for Newfoundland was “extended without our knowledge” and did not follow the procedure set down for the rest of the region.
He indicated that allowing Newfoundland to continue using Praxes until June would result in procedures being changed again in two months time.
“Changing policy and procedures all the time is not ideal,” Laaouan wrote. “It is much preferable to set out a procedure that will be in place and proven for a long time.”
Laaouan stressed that the services offered by Roma “will be available after June and are a proven agency.”
By May 7, two days later, Newfoundland coast guard officials had acquiesced.
Laaouan wrote his senior officer in Halifax, Capt. Doug Young, with the news.
“Sir, after a long discussion and persistence, CG has now advised their MCTS in Nfld to use Roma if QE2 is not available. 1 Procedure.”
Military saw trouble on the horizon
Later that day, Capt. Doug Young indicated the decision was the correct one, but warned his colleagues of trouble looming.
“The thing that has bothered me all day is that at some point in the next few days, someone in NL is going to state that we are not using Canadian doctors to provide aero-medical services,” Young wrote in an email to senior defence officials.
“Although the fact is the provincial doctors have refused to provide the service (it is offshore after all) and we need to have a standardized procedure in the region. It is too risky to use one system in NL and a different one everywhere else. But as we have seen in other high profile SAR issues, rational thinking doesn’t apply.”
'It is too risky to use one system in NL and a different one everywhere else. But as we have seen in other high profile SAR issues, rational thinking doesn’t apply.'—Capt. Doug Young
Young presciently noted that “there may be a another media storm coming,” and blamed the refusal of doctors to help.
The military’s public affairs officials prepared responses for the media inquiries they expected to come.
It didn’t take long for that to happen.
The next evening, May 8, word came through about an “issue” with a radio medical call from Newfoundland that funnelled through to Rome. The office of Defence Minister Peter MacKay began to take an interest.
That “issue” involved the Sherry Ann Chris.
The fishing vessel was in waters more than 130 kilometres northeast of Twillingate, off Newfoundland’s northeast coast, when skipper Ronald Rideout took ill. He had dizzy spells, hot flashes and briefly lost his vision.
Shang Rideout, one of three brothers aboard the ship, called the coast guard’s marine communications and traffic centre in St. Anthony, on Newfoundland’s Northern Peninsula. It patched him through to a doctor more than 5,000 kilometres away, in Italy.
The call did not go well.
The doctor did not know where Twillingate was — or Newfoundland, for that matter.Shang Rideout was patched through to a doctor in Rome while making a call seeking medical assistance off Twillingate in May. (CBC)
“When he asked me what country, I was like, ‘Oh my God, what am I into?’" Rideout told CBC News at the time. "I wasn’t getting no sense from him at all from that point on.”
It took the Sherry Ann Chris 10 hours to make it back to port. After that unsatisfactory Italian encounter, no one aboard spoke to another doctor to assess the situation.
Ronald Rideout was fine, as it turned out, and he later went to hospital for testing.
CIRM Roma is a not-for-profit organization offering only basic services for free to international ships, its president confirmed to CBC News.
The Canadian Coast Guard and Department of Fisheries and Oceans ultimately answered CBC inquiries about the new procedure.
There was no mention of the military’s role in the decision that ultimately saw Newfoundland calls directed to Rome, instead of availing of the contract extension with Praxes.
By 6 p.m. on May 9 — as CBC News was airing its story on Shang and Ronald Rideout, and the Sherry Ann Chris — Ottawa reached a deal with Praxes.
The “emergency contract” extended service to the entire Atlantic region, not just Newfoundland.
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