2 nurses fined for taking newborn to Handivan, questions raised on ambulance service in rural Manitoba

A nurse and manager in Dauphin, Man., have been fined by their regulator for transporting a newborn baby to Winnipeg using a Handivan, but the case is raising widespread questions among health-care leaders.

The complaints committee ruled that the actions of two health-care workers “had the potential to seriously harm the patient as well as the profession” because one of them had taken the child to Winnipeg rather than wait for a ground ambulance.

But it’s a case in which two health care unions have raised concerns about patient transfers, staff shortages and rising call volumes.

According to two recently released disciplinary decisions, the child arrived at Dauphin Regional Health Center on Oct. 5, 2024, and staff decided he needed to be transported to the Children’s Hospital of Winnipeg.

The decision says staff contacted Manitoba’s Medical Transportation Coordination Centre, which coordinates testing and distributes resources in rural parts of the province, to arrange transportation. At first, they planned to use an air ambulance to transport the child.

But then the triage center decided that due to bad weather, the child would be taken if a ground ambulance was available.

According to Environment and Climate Change Canada, fog and rain occurred in the Dauphin area that afternoon. While Dauphin is located about 250 kilometers northwest of Winnipeg, as the crow flies, it’s about a three-and-a-half hour drive.

But the decisions said there were “delays in transportation” and the child’s parents did not want to wait any longer.

At approximately 5 p.m., the infant’s parents expressed their desire to leave the emergency department against medical advice to take their child to Winnipeg.

The manager, who was also a registered nurse, arranged for a handivan to transport the child and as per the decision a nurse agreed to transport the child.

According to the decision, an emergency department charge nurse and doctor advised the manager that the child was stable, but the manager’s position was that a Handyvan would be an acceptable method of transportation.

The child’s mother contacted a nurse at home, who asked to be transported to the nurse in accordance with the decision. When contacted by hospital staff the nurse agreed to transport.

But the rulings said using the HandyVan to transport an eight-day-old infant was not consistent with the policies of Dauphin Health Center or Prairie Mountain Health.

The nurse arrived at Dauphin’s hospital around 7:45 pm and left about an hour later. The nurse collected supplies and a report from the charge nurse, but felt that the child’s condition was worse than described in the report.

The nurse did not review the infant’s health records, evaluate the child, or review or conduct any emergency or contingency safety plans for the visit.

The baby was delivered by a nurse in just under four hours, during which time the nurse checked the baby’s oxygen level and pulse. The regulator’s investigation found that the child’s oxygen level and heart rate had decreased. No further information was provided about the child’s condition.

The college-disciplined nurse has 10 years of experience and the manager has 20 years of experience, working primarily as a supervisor. No one has been disciplined before. The nurse was fined $1,000, while the manager was ordered to pay $2,000.

Union worried about shortage of paramedic staff

For his part, Jason Linklater, executive director of the Manitoba Association of Allied Health Care Professionals, stressed that paramedics will come when called and that people should wait and stay on the line with dispatchers until they get there.

But he said the union representing rural paramedics is concerned that ambulances in particular are having to wait longer due to staffing shortages in the Prairie Mountain Health region.

Linklater said staffing vacancies among paramedics working outside Winnipeg are “putting lives at risk when resources are not available to patients when they need them.”

He said there are fewer ambulances on the road due to shortage of paramedic staff.

“Especially in that area, there’s a 40 percent vacancy rate,” Linklater said.

The president of the union representing nurses is also concerned about care in rural areas.

“Beyond the perimeter (highway), we’re seeing some very, very big issues in patient transportation,” said Darlene Jackson, president of the Manitoba Nurses Union.

Jackson also said she would like to see improvements in some of the ways patient transport is handled, such as centralized systems for patient transport assistance and clinical guidance.

“We would love to sit down and look at some solutions to how we can make that system more effective and efficient,” Jackson said.

Regulator must balance supporting nurses with accountability

Martin Lussier, communications manager for the College of Registered Nurses of Manitoba, said a formal disciplinary process like a censure means the investigation has determined the need for specific redress.

She said the regulator must balance supporting nurses in meeting those standards and holding them accountable even when they face difficult circumstances.

“The college reviews and takes into account aggravating and mitigating circumstances,” Lussier said.

But he said that in this case, the complaints committee determined that there was a significant deviation from professional standards.

Lussier said ensuring that nurses and other front-line providers have the resources to deal with challenges while meeting or exceeding professional standards is a question for the broader health system.

The college’s complaints committee ruled that the manager should have communicated with the family and “should have advocated on their behalf and offered them assistance in ensuring the safe transfer of the infant patient.”

The decision also said the manager should have contacted the transport triage center to intervene or advocate for the patient.

“In this situation, a registered nurse would be expected to follow well-established guidelines and contact the (Medical Transportation Coordination Center) to communicate concerns regarding (Dauphin Health Center’s) delay in transportation and to determine what options were available in the situation,” the decision states.

in manitoba, MTCC triages calls and dispatches medical resources In rural and northern parts of the province.

Shared Health and Prairie Mountain Health declined to comment.

Health Minister Uzoma Asagwara said in part of a prepared statement that he agrees there is a need for more rural paramedics and that the incident highlights the pressure rural health care workers face when arranging transfers.

“Stories like this naturally cause concern, and Manitobans have the right to know that their loved ones will always be safely cared for,” Asagwara said. “Situations like this are the exception, not the norm.”

Asagwara said it’s also important that the public knows the protocols established and how the regulatory system works to keep patients safe.

On Friday, the minister said 401 new allied health professionals have been hired since the NDP took over the government two years ago.