The night Cornelius Strang sustained life-threatening injuries from a gunshot wound to the abdomen, he waited several hours on the gravel tarmac at the Pikangikum native reserve before he was airlifted to the nearest trauma centre.
Ontario's Ornge air-ambulance service responded to the urgent Code 4 call last Aug. 28 by dispatching a plane to the remote Ojibwa community in Northwestern Ontario. But there was a problem: The aircraft could not transport Mr. Strang because its satellite phone wasn't working, leaving paramedics unable to receive direct orders from a doctor at Ornge's communications centre in Mississauga, according to sources close to the situation.
Ornge called for a second plane just after midnight on Aug. 29. Two hours later, the sources said, the plane arrived from Thunder Bay. It took another hour to transport the patient to a hospital in Thunder Bay, 440 kilometres from Pikangikum. Mr. Strang, 37, survived the ordeal after spending nearly two months in hospital.
The incident is one of 82 investigations the Ministry of Health has launched to date this year into the standard of care provided by Ornge, said ministry spokesman David Jensen. The number of cases are just a fraction of the patients Ornge transferred, but it reveals that problems continue under its new leadership. Dr. Andrew McCallum, Ontario's former chief coroner, was appointed chief executive in January. His predecessor, Chris Mazza, created a series of for-profit ventures that are under investigation by police. Dr. Mazza is now working temporarily at a hospital in Thunder Bay.
The delay in Pikangikum raises new questions about Ornge's oversight of companies that provide air-ambulance services to it under contract. In addition to operating its own fleet of helicopters and airplanes, Ornge has contracts with five air carriers.
The carriers are required to have functioning equipment, including satellite phones, aboardthe aircraft. However, Air Bravo, which dispatched the first plane to Pikangikum, was not penalized.
Ornge spokesman James MacDonald said Bravo has "rectified" the problem.
"We can assure you Ornge took this issue seriously," Mr. MacDonald said. As a result of the incident, he said, Ornge also plans to conduct regular checks on the air carriers to ensure they are complying with the contracts.
Health Minister Deb Matthews defended Ornge, saying patient care is the No. 1 priority.
Air Bravo declined to comment. Its chief executive, Rick Horwath, told a legislative committee last September probing Ornge that the contracts call for such reviews. However, he said, "I've never really seen them come around and enforce those performance reviews."
Mr. MacDonald said Ornge reviewed the Pikangikum case internally, and also notified the provincial Ministry of Health.
The ministry's Emergency Health Services Branch launched an investigation last Sept. 26 – one day after Progressive Conservative MPP Frank Klees raised the matter during Question Period, Mr. Jensen confirmed.
"When you look at Ornge, all the problems incurred over the last number of years can be traced to the lack of oversight," Mr. Klees told The Globe.
The Pikangikum incident is just the latest controversy at Ornge. The federal government recently criticized Ornge's in-house aviation operation, saying it endangered the health and safety of its pilots by failing to educate them on the hazards of operating helicopters in remote locations.
Ornge took over all aspects of Ontario's air-ambulance service from the Health Ministry in 2006. Before then, the ministry routinely fined carriers if their equipment was out of service, said Max Shapiro, chief executive of Voyageur Airlines Ltd., which had a contract with the ministry.
"It's all about whether the aircraft can be dispatched," he said.
Up in Pikangikum, neither Paddy Peters, chief of the tight community of 2,300 residents, nor Mr. Strang has been told about the ministry's investigation. Nor were they even aware of the delay.
Mr. Strang said in a telephone interview that he does not recall much about that night last August, including how he got shot.
"I really don't remember anything," he said. "The last thing I remember was waking up in the Thunder Bay hospital."
With a report from Stephanie Chambers