Health ministry to examine E. Ontario’s ambulances

Ontario’s health ministry is examining Ottawa’s paramedic deployments out of concern that we’re not putting enough ambulances on the street.

“The ministry is actively engaged in discussions with relevant paramedic services and reviewing the deployment plans in the area in an effort to help find a balanced solution while ensuring all patients receive ambulance services in a timely fashion, based on the urgency of their need, regardless of municipal affiliation and jurisdiction,” the health ministry said in a statement Tuesday, responding to questions I put about the situation in eastern Ontario.

“Under the Ambulance Act, municipalities are responsible for ensuring the proper provision of land ambulance services in the municipality in accordance with the needs of persons in the municipality,” the health ministry said.

Which we pretty obviously are not doing.

The city’s neighbours have complained that Ottawa counts on them to send paramedics to emergencies inside its borders, taking advantage of a provincial law that says the nearest ambulance has to go to a medical call, regardless of which municipality it belongs to.

Ottawa’s paramedic chief and acting general manager of all emergency services, Anthony Di Monte — who works with the budget city council gives him — has admitted that ambulances assigned to rural Ottawa are constantly being drawn into the suburbs and downtown because that’s where most of the calls are. Then we call on the neighbouring counties to send help to places like West Carleton, Goulbourn and Cumberland.

Sometimes, a ministry investigation revealed early last week, we get desperate enough to summon ambulances from outlying counties to calls in downtown Ottawa. Over two weeks in November and December, our paramedic service says, we ran out of our own ambulances entirely 22 times.

(Di Monte says a $5.2-million boost to the paramedic service’s budget in 2017 should help a lot, though it’s playing catch-up to demand for services that have risen five or six per cent a year for years, as Ottawa’s population grows and ages.)

“Receiving ambulance services in a timely fashion, based on the urgency of their need, remains an important principle of land ambulance services in the province, in the interest of putting patients first,” the ministry’s statement said.

That’s called “seamlessness,” in the business. Sometimes you help us, sometimes we help you, and everybody gets the nearest available ambulance. But the table has been tilting in Ottawa’s favour. In the past year, the number of calls paramedics from counties like Renfrew, Lanark and Prescott-Russell answer in Ottawa has nearly doubled. Sometimes half their fleets are dealing with calls in Ottawa, their paramedic chiefs say. In no case are we sending more ambulances out of Ottawa than we’re asking a neighbour to send in.

Paramedic services are run by municipal governments — the city in Ottawa, the counties in the areas around it — but the provincial government pays half the costs and sets the ground rules for them. They have to produce deployment plans that indicate how many paramedics they’ll have out under what circumstances, where they’ll be, how they’ll respond on the fly to crises and changes in demand. If we’re constantly counting on others, something’s amiss.

In 2008, the province removed a regulation that let municipalities present each other with bills for paramedic services they’d rendered each year, spelling out a formula for how the costs were to be worked out and the terms under which the bills had to be paid. When the regulation was in force, we made long-term deals to settle up at the end of each year, but those expired at the end of 2015. Now, Renfrew or Leeds-Grenville or Prescott-Russell can send Ottawa a demand for money but Ottawa can ignore it.

The neighbour counties say Ottawa’s demand for their ambulances has increased since we stopped paying for them at the end of last year. Surprise. Di Monte says they should have planned for it.

“Cross-border billing continues to be a municipal choice; the ministry does not require municipalities to bill, participate in cross-border billing negotiations, nor approve any agreements reached between municipalities,” the ministry statement says.

So there’s no sign it’ll hand a hammer back to the municipalities whose ambulances get used and overused. There’s not much incentive for Ottawa to sign a payment agreement voluntarily. Indecent as it is, if Ottawa keeps demanding their help, they’ll have to keep supplying it.

Neighbour counties say Ottawa’s demand for their ambulances has increased since we stopped paying for them.