Why the conviction of 2 Hamilton paramedics in the death of Yosif Al-Hasnawi could change healthcare
In a legal first in Canada, two paramedics were found guilty for their role in the death of a 19-year-old from Hamilton. Now emergency responders are wondering how this precedent could change the way they do their jobs.
An Ontario Superior Court judge on Tuesday found Steven Snively and Christopher Marchant guilty of failing to provide basic necessities to Al-Hasnawi, who was shot and later died in hospital.
John Schuman, paramedic and lawyer, says paramedics followed the trial and conviction with keen interest.
“From a paramedic’s point of view, if we make a mistake now, are we going to be charged? What if we have a bad day and our judgment is wrong, are we going to be charged? said Schuman, who specializes in family law, education law and children’s rights in Toronto.
Judge calls death “tragic case”
On December 2, 2017, Al-Hasnawi stood in front of a mosque with one of his brothers and others. The shooting happened after he intervened when he saw two people approach an older man. Dale King, who shot Al-Hasnawi, was acquitted last year of second degree murder in a ruling now under appeal.
Snively, 55, and Marchant, 32, testified at their trial that they believed the 19-year-old was shot with a BB gun. But they were wrong – it was a .22 caliber handgun, and the teenager died of internal bleeding about an hour later.
“To say this is a tragic case would be an understatement,” Justice Harrison Arrell said in rendering his ruling.
The judge ruled that there was a “marked deviation” from how a properly trained paramedic would have reacted.
Paramedics did not identify the injury as penetrating and participated in dangerous elevators to move Al-Hasnawi from the sidewalk, Arrell said.
They also delayed their departure from the stage down the street from the Lower Town Mosque in Hamilton.
“I conclude that these various failures by the defendants were not mere inadvertence, lack of thought or mere errors of judgment, but rather a conscious decision to ignore their training and standards,” said Arrell.
Ramifications in the field of health
Schuman said the accusation usually relates to those responsible for people in detention, who are completely dependent on other people or children. He stressed that the ramifications are not exclusive to paramedics, although they are the focus of the trial.
“Because of the way the legal test applies, it should apply to all health care professions,” he said.
He wonders if families will insist that medical professionals be charged if they deviate from protocols or choose more “risky” treatment to save someone’s life.
Trauma and intensive care expert Dr Najma Ahmed told the paramedics trial that Al-Hasnawi had about a 50% chance of survival that night.
Mario Posteraro, president of Local 256 of OPSEU, the union that represents Hamilton’s paramedics, attended the full trial, which began in November 2020.
He said that when charges were laid in 2018, “it made the paramedical profession shudder, [and] a shock wave to the wider healthcare sector as to what the potential precedent could be. “
“I think the worry and the cold that arose when the charges were laid has now intensified, and we don’t really have all the answers,” he said.
The concern, Posteraro said, is the treatment of paramedics at the scene, transport decisions and the care provided will be looked at from a different angle – one that puts workers “in the direct line of sight.”
A change for the better, says a family friend
Firas Al Najim, a friend of the Al-Hasnawi family and human rights activist, said on Tuesday he believed this would change the terrain for the better.
“I hope there will be no more cases in the future. The paramedics will know not to take care of a patient like this,” he said.
“When he tells you he can’t breathe, if he’s injured, just take him to the trauma center. Do your job. You’re not there to see if he acts.”
A significant portion of the trial focused on whether paramedics followed the protocols outlined in the Basic Standards of Care for Resuscitation Patients used by the Ontario Ministry of Health.
Failure to follow protocols, Arrell said, deprived Yosif of his only chance for survival.
The delay was unwarranted, the judge said
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 the Sunnybrook Center for Prehospital Medicine, testified for several days.
He said 23 minutes would be “within what we might expect given the average circumstances in a trauma scene” in North America for blunt and penetrating injuries as a combined category.
But Verbeek, who edited the standards, noted that a penetrating injury qualified Al-Hasnawi as a “load and go” situation to the main trauma hospital.
Arrell said the wait was “unwarranted” and it was foreseeable that the paramedics risked Al-Hasnawi’s life.
Schuman said paramedics have learned to “take the worst”. But the tests they perform can also change the hospital’s destination, treatment regimens and how the hospital may respond to an incoming patient, he said.
“You don’t want to rush this. You don’t want people to do the wrong thing because they’re under pressure to move.”
For a while, he said, people may feel the pressure to treat everyone, regardless of the presentation, as “on the doorstep of death.”
“It’s going to consume a lot of resources.”
The future of care
Posteraro also said it was possible for care to be affected as a result of the judgment.
“It can be an extreme on either side of the equation. Perhaps care can suffer as health care providers, paramedics, review a call or treat a patient under a different angle – looking at it more defensively than in the best case the patient’s interest, ”he said.
The result, Schuman said, could raise questions for workers about staying as a frontline paramedic or moving to a more distant role, such as a supervisor.