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Nurse Catherine Marcoux was left in Hamilton after boarding a helicopter in Windsor. When Ornge cut back on its medical staff, it was the hospitals that were left to absorb the cost of backfilling paramedics.

Brent Foster/The Globe and Mail/Brent Foster/The Globe and Mail

Hospitals in Ontario have had to absorb the costs of providing nurses on Ornge air ambulance flights, including overtime wages for those who travel long distances from their communities.

The province's air ambulance service does not have enough paramedics to staff its helicopters and airplanes, forcing the province's cash-strapped hospitals to often provide their own medical escorts for patients. Not only are hospitals dipping into their operating budgets to pay the nurses' wages, including overtime, they also have to backfill their shifts when they are short staffed themselves.

All too frequently, nurses have been left to find their own way home. One nurse was stranded at a deserted Hamilton airport hangar in the middle of the night. Another nurse had to take a three- hour taxi ride from Winnipeg to her home in Fort Frances in northwestern Ontario.

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The problem began in 2006, when Ornge took over all aspects of the province's air ambulance service from the Ontario government. Prior to then, each air ambulance had to be staffed with two paramedics around the clock – they were fined $75 an hour for failing to comply.

Hospitals and the union representing paramedics have sounded the alarm about the chronic staffing shortage. Ornge's new leadership is attempting to address the staff shortage by, among other things, having part-time paramedics fill shifts, said Rob Smith, executive vice-president of operations.

The shortage of key front-line staff at Ornge is symptomatic of an organization that focused on trying to make money instead of ensuring that patients get to the right place at the right time, say health care executives. As a result, they say, Ornge's priorities are not always in sync with those of hospitals.

Frustration with Ornge has prompted a border hospital in Ontario to use the province's air ambulance service as a last resort, opting instead to send critically ill patients to the United States.

But hospitals in Northern Ontario have no such option. The hospital in Fort Frances has a contract with a local cab company to get nurses home – the fare from Winnipeg costs $538. Hospitals in the north often transfer patients long distances to Southern Ontario, for medical procedures not available at home.

"It's a huge issue for us," said Barb Linkewich, chief nursing officer at Sioux Lookout Meno Ya Win Health Centre. "We are not in the transportation business. We provide patient care in hospitals."

One hospital executive said nurses are typically gone 12-to-18 hours, costing $500 to $750 in wages, including time and a half. Ornge reimburses travel costs for hospitals that submit invoices, but not wages.

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Thunder Bay Regional Hospital frequently provides nursing escorts, said Rhonda Crocker-Ellacott, its executive vice-president of patient care. While this poses a huge challenge, she said, time is of the essence.

"These are critically ill patients," Ms. Crocker-Ellacott said. "We can't do anything more for that patient. It's just wasting time."

Windsor Regional Hospital gave doctors the go-ahead last month to whisk patients across the border to Detroit by land ambulance – a 15 minute trip, door to door – before medicare approves the out-of-province costs, said its chief executive officer David Musyj.

"When our ER physicians are faced with a two-hour wait, minimum, or 15 minutes, time is of the essence," Mr. Musyj said.

Of the 61 patients Windsor Regional transferred to other hospitals last year, 52 were sent to Detroit.

For border hospitals, Dr. Musyj said, geography prevails over the sanctity of medicare. The new policy follows a complaint the hospital made against Ornge over an emergency department nurse who was left at the Hamilton hangar.

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Catherine Marcoux accompanied a patient who was transferred to a Hamilton hospital by air ambulance in 2009. When the pilots dropped her off at the hangar at 1 a.m. in the morning, Ms. Marcoux said, she waited 4.5 hours for Ornge to send a car to pick her up.

But she said she would not hesitate to do it again, if it means her patient can get treatment faster.

"I would rather [a patient]get transported," Ms. Marcoux said. "So, all in all, it wasn't too bad."

The union representing paramedics complained about staff shortages in an October, 2011 letter to the Ministry of Health, saying it is concerned that Ornge was violating the ambulance act by having just one paramedic aboard some flights.

Prior to Ornge taking over the air ambulance service, Voyageur Airlines Ltd. staffed its aircraft with two paramedics.

"It should never happen that an air ambulance has to take a nurse," said Max Shapiro, chief executive officer of Voyageur. "That's the whole reason behind having dedicated air ambulances."

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