Members from all three political parties in the New Brunswick Legislature were unanimous Thursday in denouncing Ambulance New Brunswick for failing to improve its response times, especially in rural areas.
A senior official from Ambulance New Brunswick, the Crown corporation overseeing the service, told the legislature's public accounts committee there's been no move to rewrite the province's ambulance contract almost two years after the auditor general suggested changes.
In 2020 then-auditor general Kim Adair-MacPherson concluded that the contract skews overall response times, with data from rural areas folded into larger regions with urban areas where the performance is better.
That, and a raft of exemptions in the contract, allows Ambulance New Brunswick to hit performance targets 90 per cent of the time — and get paid bonuses — even though the numbers are often far worse in individual rural communities.
"I just don't believe in these numbers," Miramichi Progressive Conservative MLA Michelle Conroy told the officials appearing at the public accounts committee.
She later told reporters she was disappointed nothing's been done to fix the issues the audit identified with the contract.
"I don't think anything's been done to address them," she said. "We hear from paramedics all the time who say the numbers are false. We heard from our AG that the numbers were false, and no, there's not anything done to change it."
On time defined as within 9 minutes
Ambulance New Brunswick is the provincial entity that contracts with Medavie Health Services New Brunswick Inc., a private company, for ambulance services and extramural care.
Under the contract, Medavie must be on time for ambulance calls 90 per cent of the time.
"On time" is defined in the contract as within nine minutes in urban areas and 22 minutes in rural areas.
The contract allows for exemptions in circumstances beyond Medavie's control. In those cases, late responses don't count against the targets or its payments.
But the 2020 audit said those exemptions mean there's less incentive for Ambulance New Brunswick to improve its numbers.
"[Medavie] is given the opportunity to focus resources on urban areas while having decreased performance in outlying communities and without impacting its performance-based payments," Adair-MacPherson wrote.
Chuck Chiasson, Liberal MLA for Victoria-La Vallée, said this explains why there are often no ambulances on duty in Saint-Quentin and Saint-Léonard in his riding.
"I would not give Ambulance New Brunswick a pass. I think that they're not doing the job that they're contracted to do, particularly in my area."
Memramcook-Tantramar Green MLA Megan Mitton highlighted the July 2021 on-time response rate of 9.1 per cent in Port Elgin, a village in her constituency.
The overall on-time rural response rate in the eastern zone where the village is located was 88.4 per cent that month.
Measuring response times in large regions under the contract "kind of hides what's happening at different community levels," she told the officials.
"The contract is absolutely unacceptable," she told reporters later. "It's just terrible, frankly, if it allows Medavie to rake in millions of dollars when they're not meeting their targets."
No progress since 2020 AG report
In 2020 then-health minister Dorothy Shephard said she had spoken to Medavie president Richard Losier and "talking about the contract is not something that he's not willing to do. So we'll be discussing the terms of the contract and how we can make things better."
Losier said in a statement at the time that the auditor general's report "provides another opportunity for discussion on change."
But on Thursday it became clear there's been no progress on that.
"Transparently, there has not been any opening of any renegotiating of the contract, at this point," said John Estey, vice-chair of the Ambulance New Brunswick board and the director of emergency health services at the Department of Health.
He said amending the contract was in the mandate letters the health department gave Ambulance New Brunswick in the last two years but it hasn't happened.
The Crown corporation told Medavie it wanted to reopen the contract but that was delayed because of COVID-19, he said.
Without changes, "we're looking at another five years of this terrible situation," Mitton said. The ten-year ambulance contract expires in 2027.
Conroy said she will "absolutely" push within the PC government caucus for renegotiation to get underway.
Medavie says 'valid reasons' for low response rates
Medavie vice-president Jean-Pierre Savoie told reporters the on-time response rates are low in some areas, but there are valid reasons they are exempt from the organization's performance measurements.
"Obviously, it's something we don't like to see. Our goal is obviously to have 90 per cent everywhere in the province," he said.
"But we're only part of the system. There are elements that we don't have any control over that impacts our performance."
He mentioned long offload delays at hospitals and sporadic emergency department closures that tie up ambulances for many hours.
Ambulance New Brunswick expects 30,000 hours of offload delays this year, Savoie said, and at the same time call volumes have increased 12 per cent in the last year.
"That's going to impact on our performance."
Liberal health critic Jean-Claude D'Amours said it's true that hospital issues caused by staff shortages are beyond Ambulance New Brunswick's control.
But he pointed out officials from the Health Department and the two health authorities sit on the Ambulance New Brunswick board, so the system as a whole has a lot to answer for.
"The decision of one has an impact on the others, and in the end it's the citizen who pays the price."