Family Law Blog

Can Paramedics Find Out About Patient Outcomes?

paramedics and children



The relationship paramedics have with patients usually lasts hours, or even minutes. As a paramedic’s relationship with patients ends as soon as the patient leaves their care, the paramedics often never know what how things worked out for their patients or even the patient’s final diagnosis.  If paramedics are supposed to benefit from repeat exposure to different problems so they can learn from the experience, there is a huge deficiency if paramedics are often left in the dark as to what the patient were actually experiencing.

Many good paramedics go back and ask hospital staff about the diagnosis and treatment of the patients they brought in.  This helps them understand various medical conditions, what they look like and how they are best treated.  That, in turn, allows the paramedic to better diagnose those problems in the future.  But are paramedics even allowed to get this information about their former patients?

Medical records are an intensely private, and personal set of documents. Medical professionals are only capable of sharing personal health details under a very limited set of circumstances, or with those the patient consents to sharing the information with. The limits on who and when medical professionals can disclose patient’s health concerns with is set out in the Personal Health Information Protection Act.

Section 37(1) of the PHIPA says that a health information custodians may disclose personal health information about patients for the purpose of education.

The College of Nurses of Ontario issues a Practice Standard called the Confidentially and Privacy – Personal Health Information which addresses these concerns.  In it, it says of the PHIPA:

“PHIPA permits the sharing of personal health information among health care team members to facilitate efficient and effective care. The health care team includes all those providing care to the client, regardless of whether they are employed by the same organization.”

Despite this, paramedics are still not able to access medical records for educational purposes.

In Bluewater Health v. Ontario Nurses’ Assn, the arbitrator ruled that just because a health care worker was previously involved in a file and her hospital was still dealing with the patient, she lost the right and ability to learn about the patient’s health care records as soon as she stopped working with the patient, even if it was educational to her.

In the same case, the arbitrator ruled that individuals can only access personal health information for the purpose of education if the hospital gives them explicit permission to do so.

Arbitration cases are not decisions by a judge in court.  They are not binding on a court.  So a judge could reach a different decision in a court case.  However, even if a decision is not binding, a judge may like the legal reasoning and use it anyway. 

In Ontario Nurses’ Association v Norfolk General Hospital, the Labour Arbitrator determined that: “the circle of care does not include: "A physician who is not part of the direct or follow-up treatment of an individual;”

In North Bay Health Centre v Ontario Nurses’ Ass’n. (McLellan Grievance), Arbtirator Abramsky stated:

“40 Further, if accepted, the Association’s argument that all “health care practitioners” are health information custodians entitled to rely on Section 37(1) would undermine the goals and purposes of the legislation. If a nurse (or any health care practitioner – and there are many health care practitioners at a hospital) is a health information custodian and may freely access patient health information for personal educational purposes, the privacy of patient health records could be significantly undermined. The Act does allow for the use of health information for “educating agents to provide health care” but it must be done by the health information custodian, not by an agent for his or her own purposes.”

PHIPA states in regards to agents in section 37(2) agents can only access health care information for educational purposes if its on behalf of the heath care custodian. This would indicate that paramedics are not able to learn about health care records for educational purposes, as they are not being educated for the goal of implementing the custodians service. As paramedics do not work for hospitals, they cannot be seen as their agents.

Under the provisions of the PHIPA paramedics are only able to learn about their patient’s diagnoses if they receive consent from their patients to do so. Section 18 of the Act provides the following requirements for consent:

 Elements of consent

18. (1) If this Act or any other Act requires the consent of an individual for the collection, use or disclosure of personal health information by a health information custodian, the consent,

(a) must be a consent of the individual;

(b) must be knowledgeable;

(c) must relate to the information; and

(d) must not be obtained through deception or coercion.

The Act goes on to further state that if the disclosure is not for the specific purpose of providing another health care worker assistance in providing care, then the consent given must be explicit. Based on this, it seems clear that if paramedics want to learn about the diagnosis of their patients, they must receive express consent from their patients. The act does not make clear what classifies as express consent, but the most obvious form of consent would be the patient writing a note, providing clear evidence of their explicit consent.

This is problematic and is unlikely to assist paramedics in obtaining the knowledge they require. When a patient is with a paramedic, things are hectic and the patient often is in great distress. The last thing a patient wans to think about, if it is even possible, is to sign a form allowing their medical information to be disclosed.  

Another question is whether the state of mind that people are in wine they are in a paramedics care allows them to give “knowledgeable” consent.   Further, since most Ontario Paramedics create their patient records (called Ambulance Call Reports) electronically, on tablet computers, they have no way to collect and record their patient’s consent to release health information or to transmit that consent to the hospitals, without a change to the “charting” software that paramedics use. 

It would be very helpful for paramedics to learn about their patient’s diagnosis, but under the current framework of the PHIPA, paramedics are prohibited from learning this valuable information.

John Schuman, Ontario Paramedic and Lawyer

This blog was written by John Schuman, who is both an Ontario Lawyer and has been an active paramedic for almost 25 years. John has knows about how the law affects paramedics and other first responders.  Watch the below video on legal issues affecting first responders or listen to the Ontario Family Law Podcast on special issues in Family Law for first responders.


If you are a first responder facing legal issues, contact a lawyer who understands your situation and where you are coming from.  Get in touch with John Schuman by emailing him, calling 416-446-5080 or filling out the contact form below.  As noted in the video, in addition to our understanding of your situation, we offer substantial discounts to first responders in many areas of law.


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How Should Holidays Be Divided For the Kids After Separation?

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Holidays (be they Christmas, Chanukah  Kwanza, Eid, New Years, or any other important celebration) can be difficult for separated families.  It may be impossible for the kids to celebrate with both parents and their families  - or to have the most important times, such as Christmas Morning, with both parents. Dividing up these special times with the children can be one of the biggest challenges after separation or in divorce.


The first consideration is that these are special times for the kids too - sometimes more special for the kids than for the adults.   The kids DO NOT want these special times marked by fights between their parents - especially fights in which a child may feel compelled to take a side in favour of one loved parent against another loved parent.  That can really ruin the entire special day or the entire season for the child - completely.  Parents who love and want to protect their kids must avoid fights over the kids at these special times.  It is always more important for the kids to be happy than for a parent to be “right.” 


Of course, finding a fair plan for the kids over holidays can be hard.  There are a few general principals that parents can use to help them make their plans.    When a judge has to decide what times the kids will spend with each parent over holidays,  the main consideration is what is in the children’s best interest. What is best for the kids always trumps what is best for the parents.    What is best for the kids can vary from family to family and can really be affected by what is “usual” in the family.  However, in the absence of special circumstances, the following is what many Family Court Judges feel is fair:



  1. Kids should rotate where they wake up on Christmas Morning or the parent with whom they spend special events.   Christmas is often the most problematic, but this can apply to any holiday or special event that has a particularly special time.  Kids should get the opportunity to spend this time with each parent.  But, keep in mind that for really young kids, the fight may not be worth it.  They may not know what date it is, so it can be possible to create the special time on any day. 
  2. Where Possible, Traditions Should Continue for the Kids.  This can conflict with point 1.  But that is usually more of an opportunity to resolve conflict than to create it.   If for example, one side of the family has traditionally celebrated Christmas on Christmas Eve, and the other on Christmas Day, it can be possible for the kids to attend both families’ celebrations every year, rather than miss one.  Dinner on Christmas Day is not a prize to be won - especially if it means ruining your family’s traditional Christmas Eve celebrations.  Be sensible and practical about where the kids can maximize the celebrations.
  3. Holiday Time is usually shared equally.  As with point 1, the kids should get a good opportunity to experience the holidays with each parent another families. There are some obvious exceptions to this such as when such an arrangement is not safe for the kids, or where one parent has to work and cannot take advantage of the extra time with the children.  Again, this division has to be what is best for the children. 
  4. For Christmas, parents often share the Christmas Eve through Boxing Day period equally and then share the rest to the school break equally.  For this “special period” it really makes sense for the “special day” to be divided (as set out in point 1) and it can make no sense for one parent to get the entire week around Christmas while the other parent is shut out of Christmas entirely. 
  5. Travel with the kids is OK during the holidays as long as it does not interfere with the other parent’s holidays.  There are steps you can take if another parent refuses, without good reason, to let you travel.
  6. Trying to give better or bigger presents than the other parent teaches kids that it pays to be manipulative.  Kids will play one parent against the other for better gifts if they know that their parents will fall for it.
  7. Just because you are angry or emotional about holidays after separation, does not mean your kids feel the same way.  Although it can be hard, parents should make holidays a happy time for the children.  The separation was not the kids’ fault, so they have no reason to feel angry or guilty.
  8. Trash talking the other parent around the holiday table, or at any other time that the kids are present is never OK.  In fact,  Family Court Judges view that as bad parenting and, perhaps, even a reason to change custody or the parenting schedule.  This video explains why: 

 

Nothing ruins holidays for kids like fights between their parents.  It is one of he most psychologically harmful thing that parents can do their kids.  As unfair as the other parent may be to you over organizing the holidays, exposing your kids to conflict over, or about the holidays, is more unfair to your kids. If you cannot get matters sorted out before the holidays, in or out of Family Court, then it is much better to take the high road and save your kids from the fight, then take it to the judge (or arbitrator) to fix things next time.  The judge will appreciate that you put the kids wellbeing ahead of your own, and will be displeased with any parent who used the kids as pawns over the holidays.  That can only lead to things working out better for you, and the kids, in the long run.


Guide to the Basics of Ontario Family Law Best Seller

For more information on the law as it relates to child custody, the family court process, and the alternatives to family court, get a copy of this easy-to-understand book on Ontario Family Law. by downloading it as a $9.99 Kindle eBook, Kobo eBook, or iBook for your iPad or iPhone or ordering it from Amazon as a paperback. It also includes several tips on how to get the best possible result for you and your kids. 

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However, the best way to protect your kids, and your relationship with them, is to see a good family lawyer who has lot of experience in child custody and access cases.  Certified Specialist in Family Law, John Schuman, is known for his concern for children in separation and divorce and has won many child custody cases.  To contact John, call 416-446-5869, email him, or fill out the form below. You can use the same form to comment on this page.

  

Please share this page with those around you, by using the buttons at the bottom of the page.  It may help make sure that separated parents do the right things for their kids over the holidays.

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