A paramedic dies while waiting for an ambulance. History cannot be invented. At 24, Hugo St-Onge fell victim to a system that never knew how to put the patient at the center of its concerns. His death, like that of many others, could have been avoided. But what’s wrong with the world of medical transport in Quebec?
On December 27, 2017, around half past midnight, Emmanuelle Auger had just been in bed with her lover when she noticed that he was not feeling well. She quickly called for help.
The investigation has obtained the recording of this 16-minute call, in which we helplessly witness the conversation between Emmanuelle and the dispatcher before help arrives.
Even in fast motion, the scene is heartbreaking. This is the story of a living death. We hear it like a film whose sad ending we know, but which we watch again in the hope that it ends well.
It was 12:31 a.m. when Emmanuelle dialed 911.
EMMANUELLE – I had just gone to bed with my boyfriend, we were talking and at some point he just started making a strange noise.
DISPATCHER – Is he conscious?
EMMANUELLE – NO. Well, his eyes are open.
DISPATCHER – OK, I’ll send the medics to help you now.
EMMANUELLE – He’s really having trouble breathing. Worse, it’s not the right color either.
0 H 35. Four minutes have just passed. Emmanuelle carries out the 911 instructions with poise.
DISPATCHER – OK, here I’ll tell you how to do a heart massage. Can you lay him flat on his back, on the floor?
EMMANUELLE – No, it’s too heavy, I can’t move it.
DISPATCHER – OK, if you’re not up to it, we’ll do it like this in bed. We start now: 1, 2, 3, 4… 1, 2, 3, 4… 1, 2, 3, 4…
0 H 38. Emmanuelle still seems to have the situation under control and continues the maneuvers, encouraged by the dispatcher.
DISPATCHER – We carry on, lady, help is coming.
0 H 43. Twelve minutes have passed; Emmanuelle is worried. We feel more fragile than when we started the call.
EMMANUELLE – Will they be long?
DISPATCHER – No, they are very close.
EMMANUELLE – I don’t want him to leave me.
It wasn’t until 12:48 a.m. that help finally arrived, the firefighters from the Breakeyville sector in Lévis. They act as first responders.
Seventeen minutes have passed.
Paramedics arrived at 12:52 a.m., 21 minutes after the initial call to 911. They returned to the hospital with Hugo and continued maneuvers.
Losing your superhero
Emmanuelle, who was 21 at the time, still remembers as if it were yesterday the feeling when one of the paramedics asked her if she wanted to join them.
There was no question: I went where Hugo went. I wanted to be there when he woke up, when he woke up, not if!
But Hugo never came to his senses again. For Emmanuelle, it is impossible to forget that moment when the doctor told her that he was canceling the maneuvers.
“Honestly, you want to die. You don’t want to believe it’s happening […] I also thought I was having a heart attack. »
— A quote from Emmanuelle Auger
Almost six years later, she is still full of incomprehension, sadness and anger. Sometimes I wonder if it really happened.
Hugo St-Onge and his lover Emmanuelle AugerPhoto: Emmanuelle Auger
Two months before the events, she had photographed Hugo for a school project. I was at photography school at the time. […] Then I had to do a project on an extraordinary person, she recalls.
The purpose of the photo is to send a message.
“ [À Lévis], two ambulances at night for 160,000 residents. »
– A quote from “Message” written by Hugo in black marker on his ambulance
Two months before his death, Hugo St-Onge was photographed in front of his ambulance to denounce the lack of ambulances in Lévis. Photo: A photo offered by the family of Hugo St-Onge.
Lévis is located across the St. Lawrence River from Quebec. A growing urban sector surrounded by rural areas where there are sometimes fewer emergency services.
Hugo St-Onge, himself an ambulance driver for Dessercom in Lévis, complained about the lack of services in the area. It made him very angry. He wasn’t an angry person at all, but this really got to him and triggered a lot of emotions.
Emmanuelle was far from believing that her lover would die from what he denounced two months after this photo session. Almost six years later, she still hasn’t recovered.
Emmanuelle took a series of photos of Hugo for her school project, including this one. Photo: Emmanuelle Auger
I am unable to attend school full time. […] I was diagnosed with post-traumatic stress disorder. […] I have to take the medication every day, morning and evening, to deal with everything related to the anxiety it has left behind.
If she agrees to speak publicly today, it is because she regrets that nothing has really changed since Hugo’s death in 2017.
“It will definitely happen again. I wouldn’t wish it on anyone, not even my worst enemy. [Mais] I want that to change! It certainly won’t bring him back, but it would give me peace of mind to know that no one else will experience something like this. »
— A quote from Emmanuelle Auger
She feels like she has lost the one who completed her perfectly. I don’t know if I will find something like that in my life and I hope that everyone finds their piece of the puzzle, but above all that they don’t lose it the way I lost it. Because these are things that can be changed.
Emmanuelle and Hugo during one of their escapadesPhoto: Offered by the family
A potentially preventable death
In July 2020, two and a half years after Hugo’s death, coroner Julie Langlois presented her report.
“I dare say it is a cascade of failed meetings,” she said at a news conference. Coroner Langlois concludes that Hugo St-Onge died of a mild heart problem, which was already known but may have been preventable.
In her report, she emphasizes that the call center dispatcher’s instructions for cardiac massage on the mattress were not sufficient.
Most importantly, we learn that three ambulances were on duty in Lévis when Hugo suffered a cardiac arrest on December 27, 2017, but none were available.
It is a vehicle from a neighboring area, Saint-Charles-de-Bellechasse, which is finally used for its transport nine minutes after the emergency call at 00:40. However, Saint-Charles-de-Bellechasse is located approximately twenty kilometers from Lévis.
It also took five minutes for first responders, firefighters from the Breakeyville Sector, to be called to respond.
In Lévis, firefighters act as first responders for more urgent operations. They are equipped with a defibrillator and can provide first aid while waiting for paramedics to arrive, but cannot transport patients.
The coroner also notes that the emergency services company responsible for the area, Dessercom, was the only one not connected to the computerized dispatch system (RAO) of the CAUCA call center. This could also lead to delays in response.
This report was a cold shower for Hugo St-Onge’s parents. His father, Bruno St-Onge, was convinced there was a good reason for the response times. I couldn’t even imagine it was that bad.
Although they have been separated for several years, Hugo’s parents, Johanne Lapointe and Bruno St-Onge, are united in their fight to improve emergency services in Lévis. Photo: Radio-Canada / Denis Roberge
Coroner Julie Langlois makes a number of recommendations, including a review of ambulance services in Lévis.
Almost six years have passed since the death of Hugo St-Onge and three years since the court report was filed. Little has changed in Lévis since then.
The paramedics we accompanied for a night last May regret this.
There are literally dying people waiting for the ambulance! […] We see it all the time and it’s never anyone’s fault. “You know, there is no one to blame,” says paramedic Josée Thériault indignantly as we drive to an emergency call.
The paramedics Josée Thériault and Pier-Luc Croteau have been working together in Lévis for several years. Photo: Radio-Canada
A ten-hour shift, six missions and four transports. Twice that night we arrived at the scene of the accident and, without seeing the patients, immediately went to the emergency centers that the center considered more urgent. These two patients had to wait until another ambulance was available.
You have seen the turnover, there is always something, Josée points out to us.
“That means we walk all over the city like today,” adds Pier-Luc. One day the government will have to accept that an ambulance has the right to do nothing. […] It must be parked at a service point to cover an area at any time.
But what does it take? How many lives must be lost to consider it time to deploy an ambulance? asks Hugo’s mother.
Especially since, according to coroner Julie Langlois, we are only seeing the tip of the iceberg.
Three years after her report, Julie Langlois agreed to meet with us, even though she is no longer a coroner.
We have two cases, but we know very well that there are more. Julie Langlois alludes to another death that occurred in Lévis and was not recorded by the coroner before Radio-Canada announced the circumstances.
Attorney Julie Langlois was a part-time coroner from 2017 to 2021. Photo: Radio-Canada
Monique Labrecque, 72, died on May 24, 2020 at her home in Lévis while waiting for an ambulance. The coroner who examined his case found that since the death of Hugo St-Onge, health authorities have still not implemented the necessary corrective measures to improve ambulance care in Lévis, recommended by his colleague.
The recommendation was addressed to the Ministry of Health and Social Services (MSSS) and the CISSS de Chaudière-Appalaches.
It is necessary that it moves. There was my report, there is his, and we are still about the same! laments Julie Langlois […] We must prevent related deaths. […] We must absolutely prevent something like this from happening again. And we can’t wait until there are one, two, three, four, five deaths.
The ambulance union, their employer, Dessercom, the mayor, the CISSS de Chaudière-Appalaches: In Lévis, they have been calling for additional ambulances in unison for years. Even the Chamber of Commerce is trying to mobilize the population with a petition.
Why is the Ministry of Health and Human Services still not approving additional services in Lévis?
Zones and permits, like taxis
Quebec is divided into 178 rescue zones. Montreal and Laval are the only two where the service is offered by a public organization, Urgences-santé.
Everywhere else, companies negotiate their contracts with the government every three years. Private companies, non-profit organizations and ambulance cooperatives.
In Quebec there are around fifty companies that have permits for specific zones in which they have a monopoly. They are not subject to any accreditation process. It is a system similar to that of taxi permits.
The company responsible for the Lévis region is Dessercom, a non-profit organization (NPO) with more than 1,000 employees that provides ambulance services and medical transport throughout Quebec.
The NPO is almost entirely funded by the government and generates significant surpluses each year, largely thanks to its medical transport contracts.
With sales of more than 100 million dollars, Dessercom generates a surplus of around 10 million dollars every year. Is there no scope for action here to improve emergency services?
Former Health Minister Gaétan Barrette claims that Dessercom was consulted on the issue under his rule.
We’ve already told you: From the outside, you’re obviously more than profitable. So you have room for maneuver […] Why don’t you pay for the additional vehicle?
Gaétan Barrette was Minister of Health and Social Services from 2014 to 2018. Photo: Radio-Canada / Denis Roberge
However, the Dessercom boss claims that he has never heard of it. Maxime Laviolette reiterates that the law on prehospital emergency services and the service contract with the Ministry of Health also prevent him from adding services without authorization.
But he admits he never asked the Ministry of Health. He justifies himself: If I say to myself: Well, then I add it because we have needs in Lévis […] I’m adding Granby, Saint-Hyacinthe and Drummondville because there is a need. […] We would no longer have any room to maneuver to operate.
However, during our exchange, Maxime Laviolette wanted to reassure people. The population of Lévis continues to be well cared for. People who need an ambulance will get an ambulance. […] So I don’t want to scare the population.
Maxime Laviolette has been at the helm of Dessercom since 2008. Photo: Radio-Canada
But according to former Minister Barrette, there are many things that can be done […] when there is transparency […] And it happens. I did it in other areas when I was a minister.
My perspective was infinitely simple: Open your books. […] But do you think I had access to a lot of numbers? I can tell you that at Dessertercom, no. We were never able to penetrate the company’s accounts.
Maxime Laviolette counters that Dessercom’s financial reports have always been public and available on the Internet due to its status as a non-profit organization. And he recognizes that even if it’s not everything, there is a lot of information: the amount of donations we make, the surpluses we make, sales.
Dessercom, a unique model
Thanks to its non-profit status, Dessercom does not pay taxes or municipal taxes in the cities where it is based. This allows him to generate more surpluses.
According to Dessercom, a third of its surplus is passed on to donations. The rest is mainly used to invest in businesses, purchase new ambulance licenses and maintain barracks and vehicles.
For Gaétan Barrette, Dessercom is one of the most expansive companies in the industry.
You see them expanding into other regions. […] You see directors participating in foundations. They produce software, they produce this, that. Let’s say they are slowly but surely getting closer to the Empire. It’s amazing when you look at it.
He specifies that even if there is nothing illegal, we are faced with a dynamic of financial gain that, although less great than in trade, is still real.
For his part, Maxime Laviolette sees no problem. I say that as long as our mission is to improve care, and as long as our surplus is used to improve care, I don’t see a problem.
We presented the Dessercom model to Associate Professor at the National School of Public Administration (ÉNAP) Rémy Trudel.
“This is public money and public money must be used for the purposes for which I made it available. »
— A quote from Rémy Trudel
Rémy Trudel, Associate Professor at the National School of Public Administration (ÉNAP) Photo: Radio-Canada
According to Rémy Trudel, the Dessercom model raises many questions.
Dessercom is essentially a company that has a public contract with the Quebec government […] Providing emergency pre-hospital services. Point. It is not their responsibility to fund other services.
Lack of transparency and verification
The Quebec auditor denounced the opacity of all ambulance companies in his 2020-2021 report. Guylaine Leclerc tried in vain to obtain information from three companies without disclosing which one they were.
Their justification is that the amounts they received from the government were not subsidies, but rather the purchase of services, complained Guylaine Leclerc. Note that almost all of these three ambulance companies’ revenue came from the government.
The Auditor General of Quebec, Guylaine LeclercPhoto: Radio-Canada / Sylvain Roy Roussel
The Health Ministry promises its new contracts with ambulance companies will force them to be more transparent.
There is still a need to carry out regular monitoring and impose penalties, which the ministry has not done, despite verification mechanisms already in place in previous contracts.
In addition, the Prehospital Emergency Services Act was passed in 2002 and has not been revised since. It is outdated and promotes confusion about the roles and responsibilities of the various actors who constantly pass the buck.
Lack of performance indicators, poor deployment of ambulances, incompatible distribution systems, unhealthy power dynamics between business and government.
The same problems have been known and documented for over 30 years.
It hurts the clinician’s nerves in me to say: There are lives we could save and we didn’t. […] There are still some preventable deaths, tells us Michel C. Doré, who led the work of the recent committee that looked at the ambulance system.
Our goal is to minimize these preventable deaths everywhere in Quebec. However, it is difficult to know the exact portrait.
Authorities often describe stories like Hugo St-Onge’s as typical cases, but the truth is that we do not know the extent of the problem.
When Michel C. Doré and his committee wanted to know how many urgent calls were not answered due to a lack of available ambulances, the Ministry of Health replied that it did not have this data. Some call centers had no data and others refused to provide it.
Michel C. Doré served as Chair of the National Committee for the Transformation of the Emergency Prehospital System (CNTSPU) from 2019 to 2021. Photo: Radio-Canada
As a trained paramedic and nurse as well as a renowned civil servant, he has dedicated himself to emergency care and disaster management for almost 40 years. And in 2019, the CAQ commissioned him to plan the redesign of the prehospital emergency system.
After a year and a half of work, 3,000 hours of consultation and around a hundred meetings, in 2021 the National Committee for the Transformation of the Prehospital Emergency System (CNTSPU) submitted its findings and recommendations to the government for action with a two-year timetable.
The committee’s conclusion was clear: it was impossible to improve the system without fundamentally reforming it.
We have implemented all of the individual improvements that we have been able to make to the system in recent years. According to the committee, we have exploited to the limit all the advantages that could arise from improvements to the piece, explains Michel C. Doré.
We now need to focus on more fundamental elements such as financing, information and governance.
However, the investigation found that the Department of Health shelved the action plan and initiated further consultations to develop a new plan.
The government hired Paul Levesque, a former ambulance company manager, to lead the project. Enquête obtained a letter that he had sent to the Ministry of Health a few months before his appointment, in which he criticized the work of Michel C. Doré’s panel.
Paul Levesque, director of the Federation of Paramedic Cooperatives of Quebec Photo: Radio-Canada
According to former Health Minister Gaétan Barrette, the government lacks courage.
If it is complex, it is because we choose for it to be complex. And when I say “chooses,” it’s because we accept that we don’t have complete control. And that requires a certain amount of courage. But courage doesn’t pay off in politics.
In the world of ambulance there are many players, all representing very different interests, often to the detriment of patients.
Faced with the slowness of the system, in 2021, those close to Hugo St-Onge filed a lawsuit for more than half a million dollars against the Minister of Health, the Chaudière-Appalaches Emergency Center (CAUCA) and the CISSS Chaudière- Appalachia.
All three parties are denying the lawsuit while the trial is ongoing.
If the coroner’s recommendations had been followed, would the relatives have initiated such proceedings?
NO! Hugo’s mother, Johanne Lapointe, reacts immediately.
It’s clear, right? adds Bruno St-Onge.
.