More than two years after James Hearst died waiting for an ambulance during Toronto's last city-wide strike, a jury at a coroner's inquest was instructed not to speculate on whether Mr. Hearst would have lived if paramedics hadn't taken 38 minutes to reach him.
The five-person jury was told the inquest, which began Tuesday and is expected to last several weeks, should look at how to prevent further delays.
"Our purpose is to learn from what happened to Mr. Hearst," said Stefania Fericean, counsel for coroner, Bert Lauwers.
She told the inquest about Mr. Hearst, who was born in Manitoba and settled in Toronto as a teenager. He later started his own business as a transportation broker and worked from home.
Ms. Fericean gave an overview of what happened the night the 59-year-old died, just days into the 2009 city-wide strike when paramedic staffing was at 75 per cent. After Mr. Hearst collapsed in the lobby of his downtown apartment building on the night of June 25, two Good Samaritans and a security guard performed CPR, waiting for paramedics. They placed three 911 calls. Meanwhile, an ambulance was idling nearby because paramedics had concerns about their safety at the scene and were waiting for police to arrive.
Mr. Hearst died from a heart attack. He was without vital signs when the first emergency workers, firefighters, responded to him.
"One of the issues may be: Do you believe that the strike affected the delivery of emergency medical services to Mr. Hearst?" Ms. Fericean said to the jury. She said jurors could look at how the Essential Services Agreement was administered and how paramedics were scheduled during the strike.
However, a court decision last April is limiting the extent to which the strike can be addressed by the inquest, after the union representing paramedics, CUPE Local 416, argued the labour action had no connection to the events leading to Mr. Hearst's death. The court's decision limits the deputy chief coroner to covering whether the strike affected delivery of medical services to Mr. Hearst. Sweeping topics such as whether paramedics should have the right to strike are not to be addressed.
The inquest began as potential labour action looms and paramedics' ability to strike was debated by the city's executive committee. While city workers could be locked out or go on strike as early as Feb. 5., paramedics held a rally Tuesday morning demanding to be made an essential service.
The first and only witness to be called Tuesday was James Edwards, a supervising coroner who oversaw the investigation into Mr. Hearst's death. He explained that an autopsy wasn't performed because it appeared the death was from natural causes. Mr. Hearst, the coroner noted, had a heart attack in 2004 as well.
Over the next weeks the jury will hear from the call takers and paramedics involved, a firefighter on scene and those who tried to revive Mr. Hearst.
Specialists expected to speak include EMS staff, the provincial health investigator who authored a report about the incident and a doctor specialized in reviving people after heart attacks. Union representatives and the city manager will be called as witnesses.
City lawyer Robert Baldwin told reporters the city believes the "most serious factor" has already been dealt with. He said protocols around paramedics waiting for police have already been revamped.
As for the strike, he said, "I don't think the evidence is going to indicate it was a significant factor."
Outside the coroner's court, Mr. Hearst's partner of eight years pointed out that he could see 40 Alexander St., the building where Mr. Hearst died. The jury will visit that apartment lobby.
"It's quite hard to relive what happened that night," said Alejandro Martinez. "There are still many questions that I have... I know it's going to be quite painful to be told all the facts about what happened."
He said he needs to know whether the strike was a factor.
"That's a good question that this inquest will solve, whether there are going to be some drastic changes that will allow EMS, paramedics... to improve their service so this doesn't happen again."