Auditor General Releases Report On Ambulance Services

New Brunswick’s auditor general has released a scathing report about the province’s “poorly structured” contract for ambulance services.

Auditor General Kim Adair-MacPherson highlighted several areas of concern for ambulance services in a new report released Tuesday.

The report found rural communities were put at a disadvantage through the province’s contract with Medavie Health Services New Brunswick (MHSNB).

Ambulance New Brunswick is expected to respond to 911 emergency calls within nine minutes in urban areas and 22 minutes in rural areas 90 per cent of the time.

But Adair-MacPherson and her staff found performance measures used for response times masked operational challenges, allowing Medavie to meet targets and still receive bonus payments.

“It’s kind of like the law of averages where, because you have more volume of calls going to the urban centres and they arrive on time, they outweigh the rural centres where they’re not meeting the response times,” Adair-MacPherson told reporters Tuesday.

Adair-MacPherson said 19 of 67 communities failed to meet the 90 per cent target for response times in the 2017-18 and 2018-19 fiscal years.

But Medavie received full performance-based compensation both years because its performance in urban centres offset the failures in rural areas.

“In our view, combining communities to calculate performance-based payments has introduced a bias toward achieving high performance in areas of greater population density, to the detriment of rural or remote communities where 911 calls occur less frequently,” wrote Adair-MacPherson in her report.

Response Time Exemptions

Adair-MacPherson’s report also found the contract between the province and Medavie allowed for “excessive” use of response time exemptions.

Exemptions were meant to be used in circumstances “beyond the control” of Medavie which caused the ambulance to arrive on-scene beyond the time required under the contract.

Adair-MacPherson said her audit uncovered around 5,500 exemptions were approved over a two-year period between April 2017 and March 2019.

This was significant, she said, because it improved the overall ambulance response rate from below the 90 per cent expectation to above 92 per cent.

“When that happens and all those calls get backed out of the calculation and you measure and the response times, it’s really not a true measure of what their actual response times are,” she told reporters.

Adair-MacPherson also found excessive use of “full deployment exemptions,” which are claimed when the number of ambulances in an area falls below the minimum number needed to respond to emergencies.

More than 2,000 of these exemptions were claimed in the province’s three largest cities in 2017-18 and 2018-19, with Saint John and Moncton both exceeding 30 claims per month.

Adair-MacPherson said the routine use of this exemption suggests Medavie is “failing to anticipate resource requirements” in those areas.

Paramedic Vacancies

The 78-page report by the auditor general also found the ambulance contract allowed for “questionable” payments for paramedic vacancies.

Under the contract, if Medavie Health Services achieves a surplus, it is entitled to keep 50 per cent of it.

Adair-MacPherson said Medavie received $18.4 million in surplus payments over the past 12 years, including $8.8 million because of paramedic shortages.

“We were surprised that budget surpluses retention were allowed when it impacts the quality of the service,” Adair-MacPherson told reporters.

“We expected to see parameters around the ability to keep those surpluses, but in the case of paramedic vacancies, in my view, it’s like a disincentive built into the contract that there’s a financial benefit by not addressing a serious operational issue.”

The AG’s report indicated there were 96 vacant paramedic positions throughout the province as of 2019. Adair-MacPherson said it is her understanding that Medavie has measures and efforts in place for recruitment and training.

Adair-MacPherson said the province missed a chance to address some of the issues and weaknesses when the contract was renewed for another 10 years in 2017.

The auditor general said she is hopeful the parties might revisit the contract before then, but it all depends on if the Department of Health and Medavie are willing to do so.

“That’s really not for me to say, but something that I hope will happen,” she said.

Adair-MacPherson made a total of 20 recommendations in her report, which include changes to legislation and contract provisions with Medavie.

Province Responds To Report

In a statement, Health Minister Dorothy Shephard said she views the report as a chance to improve service for all New Brunswickers.

“We will use the recommendations as a launch point to reach out to Medavie Health Services New Brunswick, the company contracted in 2017 to manage the ambulance service, to improve the services for all New Brunswickers,” said Shephard.

The Department of Health said work has been undertaken to improve governance structure and performance management.

That includes implementing a comprehensive policy framework to support the Extra-Mural/Ambulance New Brunswick board of directors.

Multiple board committees have also been created, with representation from medical and clinical representatives, to increase oversight and accountability.

The department said it also recognizes the “challenging” recruitment and retention issues in the field of paramedicine.