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 broader questions from health-care leaders.
The complaints committee ruled the actions of the two health-care workers “had the potential to seriously harm the patient as well as the profession” after one drove the baby to Winnipeg instead of waiting for a ground ambulance.
But it’s a case that has two health-care unions raising concerns about patient transfers, staffing shortages and rising call volumes.
The baby arrived at the Dauphin Regional Health Centre on Oct. 5, 2024, and staff decided it needed to be taken to Winnipeg’s Children’s Hospital, according to the two recently released disciplinary decisions.
Staff contacted Manitoba’s Medical Transportation Coordination Centre, which triages and dispatches resources in rural parts of the province, to arrange transportation, the decision says. At first, they planned to use air ambulance to move the baby.
But the triage centre then decided that due to poor weather, the baby would get transported when a ground ambulance was available.
Fog and rain hit the Dauphin area that afternoon, according to Environment and Climate Change Canada. While Dauphin is located about 250 kilometres northwest of Winnipeg as the crow flies, it’s about a three-and-a-half-hour drive.
But there was “a delay in transport” and the child’s parents no longer wanted to wait, the decisions say.
At around 5 p.m., the infant’s parents expressed a desire to leave the emergency department against medical advice to take their baby to Winnipeg themselves.
The manager, who was also a registered nurse, then arranged for a handivan to transport the child and a nurse agreed to take the child, according to the decisions.
An emergency department charge nurse and doctor advised the manager that the baby was stable, but the manager’s position was that a handivan would be an acceptable method of transportation, the decision says.
A nurse was contacted at home by the child’s mother, who asked the nurse to do the transport, according to the decisions. The nurse agreed to do the transport when contacted by staff at the hospital.
But using a handivan to transport an eight-day-old infant wasn’t in line with policies at the Dauphin health centre or Prairie Mountain Health, the decisions say.
The nurse got to the hospital in Dauphin around 7:45 p.m and left about an hour later. The nurse gathered supplies and a report from the charge nurse, but she felt the child’s condition was worse than the report suggested.
The nurse did not review the infant’s health record, assess the baby or review or conduct any emergency or contingency safety planning for the trip.
The child was transported by the nurse in just under four hours, during that time the nurse checked the baby’s oxygen levels and pulse. The regulator’s investigation found the baby’s oxygen levels and heart rate dropped. No further information about the child’s condition was provided.
The nurse who was disciplined by the college has 10 years experience and the manager 20 years, working mainly as a supervisor. Neither have been previously disciplined. The nurse was fined $1,000, while the manager was ordered to pay $2,000.
Union concerned about paramedic staffing shortages
For his part, Manitoba Association of Allied Health Care Professionals executive director Jason Linklater stressed that paramedics will come when they’re called and people should wait and stay on the line with dispatchers until they get there.
But he said the union representing rural paramedics is concerned the staffing shortages in the Prairie Mountain Health region specifically are leading to longer ambulance wait times.
Linklater said staffing vacancies among paramedics working outside Winnipeg is “putting lives at risk when the resources aren’t there for patients when they need them.”
He said there are fewer ambulances on the road due to the paramedic staffing shortages.
“In that area in particular, there’s a 40 per cent 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 with transporting patients,” said Darlene Jackson, president of the Manitoba Nurses’ Union.
Jackson also said she’d like to see improvements to some ways that patient transport is handled, such as the centralized system for patient transport support and clinical guidance.
“We would love to sit down and look at some solutions on how we can make that system more effective and more efficient,” Jackson said.
Regulator must balance supporting nurses with accountability
Martin Lussier, the College of Registered Nurses of Manitoba’s manager of communications, said a formal disciplinary process like a censure means the investigation determined a need for specific deterrence.
He said the regulator has to balance supporting nurses in meeting those standards and holding them accountable even when they face difficult circumstances.
“The college does review and take into account the exacerbating and mitigating circumstances,” Lussier said.
But he said in this case, the complaints committee determined there was a significant departure from professional standards.
Lussier said making sure nurses and other front-line providers have the resources to deal with challenges while meeting or exceeding professional standards is a question for the wider health system.
The college’s complaints committee ruled the manager instead should’ve communicated with the family and “advocated on their behalf and offered support to them to ensure the safe transfer of the infant patient.”
The decision also states the manager could’ve contacted the transportation triage centre to intervene or advocate for the patient.
“In this position, a registered nurse would be expected to follow well-established guidelines and contact [the Medical Transportation Coordination Centre] to communicate [Dauphin health centre’s] concerns with the delay in transport and determine what options were available in the situation” the decision states.
In Manitoba, MTCC triages calls and dispatches medical resources in the rural and northern parts of the province.
Shared Health and Prairie Mountain Health declined to comment.
Health Minister Uzoma Asagwara said in a portion of a prepared statement that they agree more rural paramedics are needed and that this incident highlights the pressures rural health-care workers face when arranging transfers.
“Stories like this naturally cause concern, and Manitobans deserve to know their loved ones will always be cared for safely,” Asagwara said. “Situations like this are the exception, not the norm.”
Asagwara said it’s also important the public knows established protocols and the regulatory system work to keep patients safe.
On Friday the minister said 401 net new allied health professionals have been hired since the NDP formed government two years ago.
Two registered nurses in Dauphin, Man. have been disciplined by their regulator after transferring a newborn using a handivan in October 2024. Their case is raising questions about the challenges of transferring patients in rural areas, where paramedic vacancies can lead to ambulance delays.
