Why the conviction of two Hamilton paramedics in the death of Youssef Al-Hasnawi may change healthcare

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In Canada’s first law, two Paramedics found guilty For their role in the death of 19-year-old Hamilton. Now, emergency responders are wondering how this precedent might change the way they do their jobs.

An Ontario Superior Court judge on Tuesday indicted Stephen Snivally and Christopher Marchant for failing to provide life’s necessities for El Hasnawy, who was shot and later died in hospital.

Paramedic and attorney John Schumann says paramedics have followed the trial and conviction with great interest.

“From the paramedics’ point of view, if we do anything wrong now, will we be held accountable? And if we have a bad day, and our judgment is off, will we be charged?” said Schumann, who specializes in family law, education law and children’s rights in Toronto.

Judge calls death a ‘tragic case’

On December 2, 2017, Al-Hasnawi was outside a mosque with one of his brothers and others. The shooting took place after he intervened when he saw two people leading an old man. Dale King, who shot Hasnawi, was acquitted last year of second-degree murder in a decision now subject to appeal.

Snafly, 55, and Marchant, 32, testified at their trial that they believed the 19-year-old was shot from a BB pistol. But they were wrong – it was a 22-caliber pistol, and the teen died of internal bleeding about an hour later.

“To say this is a tragic case would be an understatement,” Judge Harrison Ariel said in his ruling.

The judge ruled that there was a “notable departure” from how a properly trained paramedic should respond.

Ariel explained that paramedics did not recognize the penetrating wound and took part in dangerous elevators to transport Al-Hasnawi from the sidewalk.

They also delayed leaving the scene down the street from the mosque in Lower Hamilton.

“I conclude that these various failures by the defendants were not mere negligence, lack of thought, or simple errors of judgment, but a conscious decision to disregard their training and standards,” Ariel said.

Al-Hasnawi reads the Qur’an during a religious ceremony moments before an altercation outside the Al-Mustafa Islamic Center, and was shot dead. (Al-Mustafa Islamic Center)

Repercussions in all areas of health care

Schumann said the charge usually relates to the people responsible for the detainees, who are completely dependent on others or children. He stressed that the repercussions are not limited to the paramedics, despite them being the focus of the trial.

“Because of the way the statutory test is applied, it should apply to all health professions,” he said.

He wonders whether families will insist that health care professionals be charged if they deviate from protocols or choose a treatment that carries greater “risk” to saving someone’s life.

Dr. Najma Ahmed, an expert in trauma and intensive care, testified in the paramedics’ experience that Al-Hasnawi had about a 50 percent chance of surviving that night.

Mario Bustraro, president of OPSEU Local 256, the union representing Hamilton medics, attended the entire trial, which began in November 2020.

He said that when the charges were brought in 2018, “the paramedic profession has run cold, [and] A bit of a shock to the broader healthcare sector in terms of what the potential precedent might be.”

“I think the anxiety and the coldness that occurred when the charges were brought has now deepened, and we really don’t have all the answers,” he said.

The concern, Posteraro said, is the treatment of paramedics at the scene, transportation decisions, and the care provided will be examined through a different lens – one that puts workers “in the direct line of fire.”

John Schumann, a paramedic and attorney, says health care workers will now ask: ‘If we do anything wrong now, will we be charged? And if we have a bad day, and our judgment is over, will we be charged? ” (zoom)

A family friend says it’s a change for the better

Firas Al-Najm, a friend of the Al-Hasnawi family and a human rights activist, said Tuesday that he believes this will change the field for the better.

“Hopefully, there won’t be any cases in the future,” he said. “Paramedics will know not to deal with a patient like this.”

“When he tells you he can’t breathe, if he’s injured, just take him to the trauma center. Do your thing. You’re not there to see if he acts.”

Much of the trial focused on whether paramedics followed the protocols set forth in the Basic Life Support Patient Care Standards used by the Ontario Department of Health.

Ariel said that failure to follow protocols deprived Joseph of his only chance of survival.

The judge said the delay was unjustified

Paramedics spent 23 minutes at the scene that night. 17 of those minutes were in the back of the ambulance.

Dr. Richard Verbeek, medical director of Toronto Paramedics at Sunnybrook Pre-Hospital Medicine, has testified for several days.

He said 23 minutes would be “within what we might expect given the average conditions in the trauma scene” in North America for acute and traumatic wounds as a common category.

But Verbeek, who edited the criteria, noted that a penetrating wound qualifies Hasnawi as a “load and go” case to a major trauma hospital.

Ariel said the wait was “unjustified” and that paramedics were expected to risk al-Hasnawi’s life.

Schumann said paramedics are learning to “assume the worst.” He said the tests they run could also change the hospital’s destination, treatment regimens, and how the hospital might react to an incoming patient.

“You don’t want to rush into it. You don’t want to make people do the wrong thing because they are under pressure to act.”

For a while, he said, people might feel pressure to treat everyone, regardless of show, as “at death’s door.”

“This will consume a lot of resources.”

future of care

Posteraro also said that care is likely to be affected after the ruling.

“It could be extreme on either side of the equation. Perhaps care may be affected as a result of healthcare providers or paramedics or looking at a call or treating a patient through a different lens — looking at it more defensively versus the best of the patient.”

Schumann said the finding could raise questions for workers about staying as frontline medics or moving to a more remote role, such as supervisor.

More to track …
Bulletin Observer Health

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