A British Columbia paramedic says she’s at risk of losing her licence after a patient’s adult child complained she didn’t take their parent to the hospital.
Amelia Bridge, who has worked as a primary care paramedic for BC Ambulance Service in several communities across the province over the last six years, maintains she made the right decision by letting the patient refuse further treatment and transportation. She says she is frustrated with how the complaint against her was handled.
Due to patient confidentiality, Bridge is not able to talk about the details of what happened. Her union, employer and the Ministry of Health told The Tyee they won’t comment on the individual case.
But Bridge, the union and the ministry all offered general comment about a patient’s right to refuse care and what happens when someone complains about a refusal they believe shouldn’t have been accepted.
The Ambulance Paramedics of British Columbia union says that, by far, most complaints about paramedics are related to patients not being taken to the hospital.
The decision on whether a paramedic takes a patient to the hospital or allows the patient to refuse medical care is complicated, said Dave Deines, provincial vice-president of the union, CUPE Local 873.
A paramedic generally becomes responsible for a patient when they arrive on scene.
Paramedics will first check if the patient’s airway is clear, if they’re breathing and if they have circulation, Bridge said. After that they move on to a secondary assessment, which focuses on why the patient called 911.
Sometimes a patient will say they don’t want a specific test done, such as a blood sugar test that pricks a finger or a blood pressure test that squeezes an arm. They may decline treatment like an IV, Bridge said.
A paramedic might talk with the patient to explain why a certain test or treatment is recommended, but generally the patient has the right to refuse any medical care they don’t want, Bridge said.
Patients have the legal right to refuse care, and when they do there are policies and clinical guidelines that all paramedics have to follow, Deines told The Tyee.
But there are also limits in the right to refuse care.
A patient has to be able to make their own medical decisions, which requires them to be medically stable, competent and able to understand what they are saying no to, Deines said.
Certain people, such as minors and incarcerated people, aren’t allowed to make their own medical decisions, and someone using substances might not be able to understand what they’re saying no to, he said.
Bridge told The Tyee that her training and understanding is that even if a patient is bleeding to death, they are allowed to refuse care and a paramedic would have to respect that.
But, she added, if a patient is unconscious, or if they lose consciousness, there’s “implied consent.” Then, paramedics can step in, provide medical care and take a patient to the hospital even if they previously declined help.
For all British Columbians covered by the Medical Services Plan, calling 911 and then refusing or not needing transport . Being transported to a hospital costs $80. Being transferred between hospitals is free.
For anyone not covered by MSP, transport to a hospital costs $848, or $4,394 per hour to be flown by helicopter.
When a patient refuses care, Deines said, a paramedic needs to make sure the patient has a clear understanding of what that refusal means.
This includes explaining their medical assessment and what the risks of refusing further treatment and transport would be, up to and including death, he said.
If a patient still refuses care and the paramedic judges them to be able to make their own medical decisions, the patient will be asked to sign an electronic release form that “clearly outlines that they are competent and refusing further treatment and transport,” Deines said.
If a patient says they don’t want care but a paramedic thinks they are high-risk, the medic can call a “specialized paramedic” and get a second opinion, he said.
Most paramedics in the field are trained as primary care paramedics. If a medic goes back to school they can train to be an advanced care paramedic, or critical care paramedic, which is the highest level of paramedic in Canada.
Most medics in the field call advanced care paramedics for a second opinion when patients refuse care. Critical care paramedics can also advise when needed, Deines said.
Paramedics can also call in police officers, who, under the Mental Health Act, can take to be assessed or examined by a doctor if the officer thinks the person could be a danger to themselves or others or will get worse if not treated.
This could include patients having a mental health crisis or experiencing cognitive impairment due to conditions such as dementia.
In B.C. refusal of care always has to come from the patient and is not allowed to come from the paramedic, Bridge said.
She said her patient didn’t want to go to the hospital in the middle of the night and made a plan with their spouse to see their family doctor first thing in the morning. The refusal of care form was signed and, until Bridge got the complaint, she thought that was the end of it.
The complaint process
Paramedics in B.C. are independently licensed and regulated by the Emergency Medical Assistants Licensing Board, which is charged with a similar duty to that of a professional college.
Anyone can file a complaint about a paramedic with their employer, BC Emergency Health Services, or with the licensing board.
The licensing board received 360 complaints in the 2024-25 fiscal year and close to 60 of them were outside of the jurisdiction of the board, the Health Ministry told The Tyee in an emailed statement. The ministry was not able to say how many of those complaints found the paramedic at fault.
Bridge said that when she got her complaint she was told she was the board’s 650th complaint of the year.
“This shows us we’ve either got thousands and thousands of incompetent medics running around or people are angry at the system in general and we need to take a closer look at those complaints,” she said.
When the board gets a complaint, it first checks if it’s legitimate and then, if needed, can refer the investigation to an unbiased third party, the ministry said.
Bridge said her case was investigated by . She said she found this frustrating because her investigator didn’t have a medical background and conducted a “police-style investigation,” where it felt as if he was “trying to get me to admit to something, or to trip up my words.”
She added that she is concerned third-party investigators will default to complainants being right.
The ministry said the board started working with third-party investigators in 2022, and investigators can speak with the board’s clinical adviser or critical care paramedics if they need clinical expertise.
Bridge said she believes no health-care experts were consulted during the investigation that resulted in a finding against her.
After an investigation is complete, the investigator presents their information to the board, which decides whether to dismiss the complaint or move forward. The board is made up of an emergency physician, a primary care paramedic and an advanced care paramedic.
Many cases use an alternate dispute resolution rather than going to a hearing.
Alternate dispute resolution can include education, clinical consultations, licence suspension for a specific period of time (usually four days) or other requests.
If a paramedic chooses not to sign the alternate dispute resolution, the ministry told The Tyee, the matter would then go to a hearing.
The Tyee contacted BC Emergency Health Services for comment, but it declined and said all questions should be directed to the ministry.
Bridge said that in an alternate dispute resolution she was asked to take an eight-day suspension, sign an admission of guilt, have five meetings with a clinical adviser from the licensing board and take four courses.
She said she is willing to meet all the requirements other than signing an admission of guilt.
“I don’t want to assassinate my character,” she told The Tyee. “I know I followed policies and procedures and did right by my patient because that’s what they wanted.”
Signing an admission of guilt would also leave her vulnerable to a civil lawsuit from the patient’s family, she said, adding that a senior nurse practitioner and a legal firm that deals in medical malpractice have warned her that complaints can be followed with lawsuits. She added she did not have liability insurance at the time of the complaint.
Deines said the union recommends all paramedics get liability insurance, which costs around $100 per year.
Bridge said she’d like to see the government introduce legislation that protects paramedics so they aren’t so vulnerable to lawsuits.
She told The Tyee she has retained a lawyer to argue her case and hopes the complaint against her will be dismissed.
