Ontario's Health Ministry is investigating at least four deaths involving ORNGE, the province's embattled air-ambulance service.
Those four cases, with which provincial coroners have also become involved, are among a total of 13 ORNGE-related incidents being examined by the investigation wing of the ministry's Emergency Health Services Branch. Neither ministry nor ORNGE representatives would confirm if any of the other incidents also involve deaths.
It's a "higher than normal" number of investigations to be under way at once, ORNGE vice-president of operations Steve Farquhar acknowledged in an interview on Wednesday. Most of them, he said, relate to complaints about either response times or about the adequacy of ORNGE's recently purchased helicopter fleet.
Three of the investigations were requested by ORNGE itself, while the other 10 were prompted by complaints from other "stakeholders," such as land-ambulance operators.
ORNGE president and CEO Chris Mazza and the entire board of directors were recently replaced following reports of exorbitant salaries and questions about the agency's mix of public and private business, and forensic auditors from the provincial Finance Ministry are examining its books. But there have also been some reports of delays in service, which prompted the agency to engage the provincial investigators.
Health-care executives at several hospitals in Northern Ontario told The Globe and Mail they have been sounding the alarm for years about delays in transferring patients by air ambulance, as well as a shortage of critical-care paramedics.
Nursing executives at several hospitals also said it takes far too long to transfer a patient from the hospital to the ambulance, once the helicopter or airplane arrives. "We complain vehemently about that," said Debbie Larson, chief nursing officer at Red Lake Margaret Cochenour Memorial Hospital.
A spokesperson for Health Minister Deb Matthews stressed that the ministry investigates every complaint that it receives about its ambulance services. Coroners' investigations, meanwhile, are being carried out by regional offices, with no indication of a central review of ORNGE's operations. But there are other indications of concerns about the agency's services.
The Ontario Air Transport Association called on the government last May to launch a review into ORNGE. In a letter to Ms. Matthews, the association – which represents carriers that dispatch air ambulances under contract with ORNGE – alleges that patient care was being compromised because of longer waits for transport.
Mr. Farquhar says one of the matters under investigation may involve ORNGE's attempt to cut down on the number of air-ambulance calls cancelled midway through – an expensive problem previously flagged by the province's Auditor-General – by adhering to clear criteria for dispatch.
There were subsequently instances when "communication breakdowns" with the scenes of car accidents or other emergencies led to grounded helicopters waiting for the green light. As of last week, Mr. Farquhar said, a policy change has been made so that helicopters will launch immediately in the case of those communication problems, rather than waiting for further information.
Ms. Matthews declined to comment on Wednesday about the service complaints, but reiterated that she is "enormously troubled by some of the practices I've become aware of" related to ORNGE's operations.