Emergency Medical Services: Review examining “all aspects” of pre-hospital & inter-hospital EMS; SEMSA in lead role, health care council left out
At a news conference in
A health ministry news release said the review will be conducted in consultation with the ambulance industry and regional health authorities. Its recommendations will focus on pre-hospital and inter-hospital transfers, and will form the basis for a long-term plan to improve the province’s road ambulance services.
Don Cummings, an Edmonton-based consultant, has been appointed chair of the
McMorris was reported in The Leader-Post as saying the review may also look at the delivery model of emergency medical services. Road ambulance services are provided through the health regions, but about 40 operations are privately owned. Another 56 of the ambulance services are publicly owned, while 13 are non-profit. [
Records obtained from the health ministry under freedom of information legislation, however, suggest that everything will be examined.
The scope of the terms of reference for the review committee states in part: “The review and recommendations will…Include all aspects of pre-hospital and inter-hospital EMS (
The review committee will “provide recommendations for a strategic vision” and “will consider patient concerns with EMS and stakeholder views about the tools required to meet the strategic visions, including:
– patient access to service, cost to patients;
– human, capital/infrastructure and financial resources; and
– regulatory environment for
The review will be completed by March 31, 2009.
As for consultation the terms of reference state the review committee “may consult patients and/or families, stakeholders such as, but not limited to, the Saskatchewan Emergency Medical Services Association [SEMSA], Saskatchewan Association of Rural Municipalities, Saskatchewan Urban Municipalities Association, Saskatchewan Association of Health-Care Organizations, Saskatchewan Medical Association, Saskatchewan College of Paramedics, College of Physicians and Surgeons of Saskatchewan, the Saskatchewan Institute of Applied Sciences and Technology.
“The Committee will determine the means such consultation will take – focus groups, written submissions, etc. – but in so doing will not duplicate work that is already included in or underway through the Patient First Review.”
To date there don’t appear to be any labour groups involved in the discussions.
Contacted on Feb. 4, 2009, CUPE Health Care Council President Gordon Campbell said his organization had not received an invitation to participate.
The Health Care Council represents 12,500 health care providers. They include: special care aides, licensed practical nurses, food services workers, laundry, housekeeping and activity personnel, maintenance, clerical, medical diagnostic, therapeutic and recreational workers and medical technologists and technicians.
In 2000, the Council submitted a report to the Commission on Medicare headed by health consultant Ken Fyke called A Vision for Health Care: Building a Responsive Health Care System. One of the report’s recommendations was that “The government should create a provincially-coordinated and publicly-delivered ambulance emergency service.”
The Fyke commission report, released on Apr. 11, 2001, adopted several key recommendations from an
Although the union urged the government to implement the Fyke report, it was disappointed the commission didn’t call for a publicly owned and administered
“We shouldn’t allow private businesses to profit from medical emergencies,” said Steve Foley, the then president of the Health Care Council. “Private ambulance companies have no place in our public health system.” [EMS union seeks end to for-profit ambulance service: Group frustrated report didn’t recommend publicly-funded
The Saskatchewan Party government, on the other hand, seems eager to pursue more private involvement in the health system.
Last summer Health Minister Don McMorris confirmed that the government is open to looking at an increased private role in health care as part of its “patient-first review” of the health system. [McMorris looks at more private care (Leader-Post, July 26, 2008)]
In a June 27, 2008, letter to Saskatchewan Chamber of Commerce president Dale Lemke, McMorris said: “The private sector can and does deliver health services effectively within a publicly funded system. This is clearly the case with respect to ambulance and medical laboratory services. We will continue to examine whether there are benefits to further private delivery in publicly funded, publicly administered health services.”
McMorris was responding to a number of health care related policy resolutions that were passed at the Chamber’s annual general meeting in May 2008 and forwarded to him for consideration. One called on the government to “promote the establishment of a competitive environment for the provision of health care in
One thing the health minister neglected to mention at the Dec. 11 news conference was that the
According to a Dec. 2, 2008 briefing note prepared by the health ministry’s acute and emergency services branch, the inaugural meeting of the committee took place on Friday, Nov. 28, 2008 in
The document went on to say that, “Future meetings of the Committee are scheduled to take place bi-weekly from January to March with the location alternating between
Additional work of the committee detailed in the briefing note includes:
– Two key stakeholders of the review, SEMSA and the EMS Working Group, are planning separate meetings with the Committee Chair without the presence of other stakeholders including the ministry.
– During the afternoon of December 11, 2008, members of the SEMSA board will have a separate, private session with Mr. Cummings to highlight their viewpoints regarding the development of a strategic vision and prioritized recommendations within the Review.
– Members of the provincial EMS Working Group (consisting of senior-most managers from health regions that are responsible for
Finally, the document lists the seven members of the review committee that were appointed by the deputy minister of health (in consultation with stakeholders):
– Committee Chair (based of recommendation of SEMSA) – Don Cummings, Sierra Systems,
– Health Region Representatives (based on recommendation from health region CEOs) – Mike Redenbach, vice president of primary health care with the Regina Qu’Appelle Health Region, and Rod MacKenzie, manager of pre-hospital emergency medical services with the Saskatoon Health Region.
– Ministry of Health Representatives (selected by Deputy Minister) – Duncan Fisher, special advisor to the deputy minister of Saskatchewan Health, and Patrick O’Byrne, director of community hospitals and emergency services, acute and emergency services branch with Saskatchewan Health; and,
– SEMSA Representatives (selected by SEMSA Board) – Ron Dufresne, president of SEMSA, from
The recommendation to appoint Cummings as the review committee chair is outlined in a short briefing note dated Oct. 28, 2008: “Mr. Cummings is well known in both the Health and EMS community and was instrumental in the development of the Emergency Services Chiefs of Canada [EMSCC] report The Future of EMS in Canada: Defining the New Road Ahead and the Provincial Ambulance Strategy report for Alberta Health and Wellness and the Provincial Health Services Plan for the Health Boards of Alberta.”
The Future of EMS in
The EMSCC envisions EMS “as a mobile health care service” and believes “that the future of EMS in
Page eight of the report explains some of this stating: “
One of the report’s six key strategic directions is that, “A more comprehensive and inclusive approach, focused on mobilized health care in addition to traditional emergency services, is required.”
On Aug. 28, 2008, Health Minister Don McMorris announced the launch of a mobile health unit, or “health bus,” to provide primary care to residents in
According to a Dec. 18, 2008, email from the communications and media relations branch of Saskatchewan Health, between Aug. 29 and Nov. 19 the health bus served 794 clients.
The health bus project is a partnership between the Ministry of Health, Saskatoon Health Region and M.D. Ambulance, a private company.
It should be noted that M.D. Ambulance president and CEO Dave Dutchak is the Saskatchewan Chamber of Commerce’s immediate past-president and a contributor to the Saskatchewan Party. Dutchak also serves on the SEMSA and EMSCC boards and was one of nineteen individuals interviewed for The Future of EMS in Canada report.
EMS Review Committee member Trevor Dutchak is the CEO of Parkland Ambulance Care Ltd. in
At a news conference in
Hermanson said a Saskatchewan Party government would not rule out private MRI clinics and would review support services.
Dave Dutchak, the then president of SEMSA, said he was glad to hear emergency services will be a priority for the Saskatchewan Party. [
A few days later on Oct. 29, 2003, SEMSA held a news conference in
“We are facing serious issues that require government leadership and participation to solve,” Dutchak said.
Following the press conference SEMSA delivered a two-page document entitled Proposal for Partnership to the
“We’ve been successful in having the Saskatchewan Party sign this document. It just provides a framework for how we’re going to work together to reconcile issues,” SEMSA executive director Shirley Antonini said. [
The close working relationship between all those involved still seems strong today.
A Sept. 9, 2008, briefing note estimated the cost of the
The document also indicates that: “There is a consensus among the Ministry, the RHA’s and Saskatchewan Emergency Medical Services Association on a number of
Exactly what these issues are is unclear because the ministry severed that section of the report.
However, the record does say that the ministry “continues to work with SEMSA and health regions in pursuit of change to the regulatory environment affecting EMS including development of a template service contract for
Today SEMSA represents 83 out of 109 ambulance services within the
“The SEMSA Board has requested the provincial govenrment [sic] to agree to an EMS Review for some time and the opportuity [sic] is now upon us. Now, it’s time to hear directly from the membership,” a posting on the SEMSA website states.
If anything is certain about the
UPDATE: On Dec. 12, 2008, a request was made to Saskatchewan Health for a list of stakeholders that the EMS Review Committee would be consulting with as part of the review process. The ministry responded that the list was “under development” and would “be available at a later time.” Subsequent requests for the information were made on Jan. 31 and Feb. 2, 2009.
On Feb. 17, the ministry advised that “the EMS Review Committee has corresponded with the following stakeholders” to date:
Federation of Saskatchewan Indian Nations
Saskatchewan College of Paramedics
Saskatchewan Institute of Applied Sciences and Technology
College of Physicians and Surgeons of Saskatchewan
Saskatchewan Registered Nurses Association
Saskatchewan Association of Licensed Practical Nurses
Saskatchewan Association of Rural Municipalities
Saskatchewan Urban Municipalities Association
Saskatchewan Office of the Fire Commissioner
Saskatchewan Association of Fire Chiefs
Saskatchewan Professional Fire Fighters Association
Health Sciences Association of Saskatchewan
Canadian Union of Public Employees (Saskatchewan)
Service Employees International Union
Saskatchewan Government Employees Union
Saskatchewan Police Commission
The ministry also said, “In addition to the health regions and members of SEMSA, there will also be an invitation to members of the public and other interested organizations for submissions as part of the consultation process.”
It remains unclear which organizations, if any, have had face-to-face meetings with the review committee.