Paramedic suspended after taking a stand for workplace safety

If a paramedic makes a medical error after working more than 16 hours in a 24-hour period, who shoulders the blame?

Image courtesy of Hal Newman.

Yesterday, Christian Dubé, the Minister of Health stood up in the National Assembly and couldn’t even bring himself to use the word ‘paramedic’, preferring instead to use the archaic and insulting term ‘ambulancier.’ 

As if paramedics are somehow physically attached to the vehicles themselves.

Dubé went on to claim that his government has invested “important sums” of money into changing paramedics’ shift schedules when any monies invested represent a fraction of the dollars being committed to improve access to private healthcare — and which, in reality, did nothing to improve ambulance coverage.

We shouldn’t be surprised.

The CAQ has not only tolerated but has encouraged the privatization of healthcare in Quebec and an accompanying lack of transparency when it comes to workers’ rights that, while not appearing in profit and loss statements, is part of the real cost of healthcare for profit. 

Until quite recently, the 400 paramedics of the Coopérative des techniciens ambulanciers de la Montérégie (CETAM) would have, no doubt, been ready and willing to extol upon the virtues of being members of a for-profit cooperative. 

However, something has changed in an organization where paramedics each own a stake in the company and where democratic rule is supposed to be the bedrock foundation of the organization. 

‘One member, one vote’ has somehow morphed into a Lord of the Flies scenario wherein a powerful administration uses suspensions as punishment in response to anything perceived as being out of line with the cooperative’s values.

In 2021, there were a few suspensions of paramedics who may or may not have run afoul of the rules. The total number of days spent by all paramedics on suspension added up to 11. In 2022, the total number of days spent on suspension was 90. Forty days spent on regular (or classic) suspension and 50 days spent on suspension pending investigation. 

The regular suspensions were one or two day punishments intended to spark reflection on the part of the employee. What was new and menacing were suspensions pending investigations, a practice my sources claim was in response to even a whisper of a potential problem — founded or not.  And these suspensions pending investigation weren’t measured in days. We are talking about suspensions lasting weeks.

Somehow, in the midst of a critical shortage of paramedics and after a prolonged labour conflict finally came to an end, CETAM had decided that suspending paramedics was a good strategy. 

Which brings us to 2023. In the first five weeks since New Year’s Day, CETAM already sentenced paramedics to 20 days of classic suspensions and an astounding 40 days of suspensions pending investigations. That’s right. More days of suspension have been meted out than days of the year thus far.

“We’re worried. It’s intense,” said Mathieu Lacombe, Vice-President, Information & Mobilisation for the Syndicat des paramédics et du pr/hospitalier de la Montérégie - CSN. “We’ve seen suspensions used as a form of punishment by other ambulance companies but seeing it being used with such frequency by a cooperative is something new–and very disconcerting.”

“There are dramatic impacts for paramedics who are placed on suspension. Seldom do they emerge unscathed. Many reconsider their future in the profession while others are changed forever by the experience. There are important mental stressors that come with a suspension pending investigation,” said Lacombe.

As one paramedic told me, “Once a paramedic is placed on suspension, the weeks of mental torture begin. They’re crippled with anxiety not knowing what’s going to happen to them. Are they going to be fired? Will they be served with a huge suspension? How do I explain this to my significant others?

“To their colleagues who are asking how come they’re not at work? Am I going to have to remortgage the house? How am I going to get through the year if I lose a full month of pay?”

***

We have talked about this before here in The Rover.

Quebec’s network of ambulances is funded entirely by the state but is mostly operated by private companies. That means of the 6000 paramedics in Quebec, 5000 of them work for private enterprises.  

Québec spends more than $659 million on contracts with these ambulance providers. Of that nearly $500 million goes to private companies. Private organizations who are accountable to themselves and to their shareholders. 

Private companies whose employees are governed by a collective agreement negotiated with the government, the companies, and the unions. However, the vagaries of each of these companies’ human resources policies are as tightly held as their financial information. Which is to say, held extremely close to the chest. 

And that’s why this story is so important. If the future of Quebec’s emergency prehospital care system continues to be tied to the profit margins generated by the majority of these ambulance companies (one of them, Dessercom, is a non-profit corporation), what happens to the rights of the workers — in this case, the paramedics?   

Paramedic shortages are inexorably linked to a refusal to recognize the true value of paramedics. 

“I love my job, I love my colleagues. The conditions have become difficult and inhumane in recent years.”

—Suspended paramedic

So we don't pay them enough, we don't show appreciation or respect, we don't allow them to have schedules that balance work and life, we don't provide enough mental health support, we don't pay them or even allow them to take time off for professional development, and we don't provide enough lateral or vertical movement to allow them to be a paramedic throughout their careers and be satisfied they've done it all.

We demand that they sacrifice their mind (PTSD) and bodies for the rigours of the job and when they do we reward them by finding excuses to push them out of their jobs, out of the organizations they work for, or the profession itself.

We force them to work until they're 65 before they can retire while their counterparts in law enforcement and the fire service are entitled to retire after 25 years of service.

We take them for granted. We treat them like numbers. We don't leverage the full range of their knowledge, wisdom, skills and experience. We under-estimate the deep attachment they have for the communities and the people they serve.

And then we wonder why so many of them are rethinking their career path or leaving the profession altogether.      

***

On Christmas Day 2022, a paramedic working for CETAM began his shift at 11 o’clock in the morning.

It was a 10-hour shift that was supposed to end at 9 o’clock in the evening. It was a busy shift and the weather was extremely challenging with high winds and blowing snow.  

“We only stopped to eat. We returned to our station after a transfer to Laval in the middle of the snowstorm.” By then, the team of paramedics were on overtime. When they finally ended their shift, it was 10:35 at night. “I was exhausted by the time I got home,” said the paramedic who has requested to remain anonymous.

Knowing he was scheduled to work again at 6 o’clock in the morning on December 26th, the paramedic realized he would violate the rule in the collective agreement that a paramedic cannot work more than 16 hours in a 24 hour period. 

“I went home. I re-read the collective agreement to be sure. I was worried about what would happen if I worked more than 16 hours and ended up making a medical error or got into an accident on the road,” the paramedic said. 

“So I contacted three of my superiors (one by Messenger and the other two via official email addresses) to let them know that I’d start my shift at 06:35 in the morning in order not to violate the 16-hour rule. I was replaced in the morning and there was no interruption in service. There isn’t any type of rule for this situation at CETAM,” the paramedic said. 

The paramedic started his shift at 06:35 in the morning on December 26th. It was a 12-hour shift that was supposed to end at 6 o’clock in the evening. “It was busy like the day before,” said the paramedic. 

His next scheduled shift was on January 2nd. Everything seemed to be normal. No supervisors had met with him or discussed what had happened on December 25th. 

However, on December 29th, he received an email informing him that he had been suspended, with pay, for an undetermined period of time pending an investigation. The paramedic was told that he should be sure he would be available for the investigation when it would be held.

The letter (which I reviewed) does not state a reason for the suspension or the investigation. That’s interesting because, according to the collective agreement between the paramedics and CETAM (which, as a cooperative, is owned by the very paramedics who work for the company) a suspension must provide the reasons for the suspension. 

“I’ve been a paramedic for more than 13 years. I became a paramedic by a combination of circumstances,” the source said. “I was studying at university, but I wanted something concrete, and I wanted a job where I would make a difference. I like adrenaline, managing difficult situations, and supporting my peers. 

“I love my job, I love my colleagues. The conditions have become difficult and inhumane in recent years. People are tired, physically and mentally injured, worn out. It is difficult to live and to see. Being a paramedic is what we do every day. The way everyday life treats us is another thing. We can be against the way we are treated and managed and still love our job. It's heartbreaking, but it's the sad reality for many paramedics,” he said.

When CETAM’s new schedule was posted, the paramedic discovered his suspension had been extended until January 23 without any notice or explanations.

And that’s where this story, already convoluted, takes an even more surreal twist. 

The paramedic was informed by his union representative that CETAM no longer wanted the paramedic to attend a gala dinner he had been invited to as a 13-year-veteran of the service.

He showed me the invitation:

“If you received this email, it’s because you are on a very select list of invitees to the First Editions of the Festins des 10 ans. This new recognition was created to thank our members with 10 years of service. The first edition also includes those with 11, 12 and 13 years of service who will be honoured during an evening of haute cuisine on January 19, 2023. Congratulations for all your years of service, you make the difference in the lives of many people !”

A 13-year career as a paramedic with the same organization is increasingly rare in the dog’s breakfast that is Québec’s emergency prehospital care system. The average career expectancy among new paramedics has been estimated to be about 5 years. Or about the time required to make it halfway up the archaic pay scale that tops out in territory making Québec’s paramedics among the lowest paid in Canada.

“I could hardly believe it. After having acted in good faith to the best of my knowledge, respecting the law and the collective agreement,” the paramedic said. 

“We have so little recognition in the industry. It was the first time that we had organized something like this. My wife wanted to go there with me: she is also a paramedic. We got to know each other through work, and have been going through the hardships of the profession together for almost 13 years.”

“I was angry, my wife too. She was devastated. She didn't go alone: it was a moment that we wanted to experience together. They took this experience, this celebration away.”

“We had a lot of support from our peers in private. Coincidentally, some younger co-workers were having a quiet night out at a bar the night before the recognition party, and invited the two of us. It did us good. Basically, that's what real recognition is. Respect, humanity, sharing good times. I would like to thank them: it is these kinds of small gestures that make the difference in a system emptied of all its empathy,” the paramedic said.

I reached out to CETAM with questions concerning the suspension, the gala, a social media post about the suspension and the cooperative’s human resources policies. This is the reply I received.

“CETAM will never comment on a personal file and will certainly never identify a sanctioned worker or in the process of being sanctioned. It is certainly not the practice of CETAM to punish a worker for fun or for trivialities, it would be against the fundamental values of the organization. The approach is for acknowledgment of errors with, as needed and depending on the error, corrective action that encourages awareness and correction. It does not please any CETAM manager to impose sanctions. 

“For the management and all of its team, it always remains an unpleasant experience but, when applied, necessary. While sanctioned workers can sometimes (whether out of disappointment, anger or sadness) resort to social networks to give colour to the facts, a colour that often scandalizes, the reality is that the story has more than one side. CETAM does not sanction without reason! Finally, workers who feel aggrieved are encouraged to use union remedies that are rightfully available to them and are also encouraged to seek the support of the Employee Assistance Program. 

“CETAM will not comment further on this.”

The paramedic remains off the job and is now on medical leave.   

As for what the future holds for him:

“I still believe our job deserves to be known. I still hope things can change, but it's harder than ever. I have been questioning myself lately. Do I deserve better than this ? Have I already given enough ? I went back to school last fall. I'll see what awaits me after all this turmoil calms down and when my bachelor’s degree is over. I have a lot of personal projects – a couple of big dreams that I’m chasing. As of now, I am still a paramedic.”

I asked him why he chose to work for a cooperative when he started out. 

“I chose a co-op because I believed we could change things for the better. For ourselves and for the population. Looks like I was wrong in both cases.”