In a legal first in Canada, two paramedics were found guilty for their part in the death of a Hamilton 19-year-old. Now, emergency responders wonder how that precedent might change the way they do their jobs.
An Ontario Superior Court judge on Tuesday found Steven Snively and Christopher Marchant guilty of failing to provide the necessaries of life to Al-Hasnawi, who had been shot and later died in hospital.
John Schuman, a paramedic and lawyer, says paramedics followed the trial and conviction with intense interest.
"From the paramedics' perspective, if we make any mistake now, are we going to get charged? And if we have a bad day, and our judgment's off, are we going to get charged?" said Schuman, who specializes in family law, education law and children's rights in Toronto.
Judge calls death a 'tragic case'
On Dec. 2, 2017, Al-Hasnawi was outside a mosque with one of his brothers and others. The shooting happened after he intervened when he saw two people accost an older man. Dale King, who shot Al-Hasnawi, was acquitted last year of second-degree murder in a decision now under appeal.
Snively, 55, and Marchant, 32, testified in their trial that they believed the 19-year-old was shot with a BB gun. But they were wrong — it was a .22-calibre handgun, and the teenager died from internal bleeding about one hour later.
"To say this is a tragic case would be a gross understatement," Justice Harrison Arrell said in delivering his decision.
The judge ruled there was a "marked departure" from how a properly trained paramedic would have responded.
The paramedics didn't identify the wound was a penetrating one and participated in dangerous lifts to move Al-Hasnawi from the sidewalk, Arrell said.
They also delayed leaving the scene down the street from the mosque in Hamilton's lower city.
"I conclude these various failures by the accused were not simple inadvertence, thoughtlessness or simple errors in judgment, but instead were a conscious decision to ignore their training and standards," said Arrell.
Al-Hasnawi recites the Qur'an during a religious ceremony moments before he got into an altercation outside the Al-Mustafa Islamic Centre, and was shot and killed. (Al-Mustafa Islamic Centre)
Ramifications throughout health-care field
Schuman said the charge usually relates to people responsible for those in custody, who are entirely dependent on others or children. He stressed the ramifications aren't exclusive to paramedics, despite them being at the centre of the trial.
"Because of the way the legal test applies, it should apply to all health-care professions," he said.
He wonders if families will insist health-care professionals should be charged if they deviate from protocols or choose a treatment with more "risk" to save someone's life.
Dr. Najma Ahmed, an expert in trauma and critical care, testified at the paramedics' trial that Al-Hasnawi had about a 50 per cent chance of survival that night.
Mario Posteraro, president of OPSEU Local 256, the union that represents Hamilton paramedics, attended the entire trial, which started in November 2020.
He said that when charges were laid in 2018, "it sent both a chill through the paramedic profession, [and] a bit of a shockwave to the broader health-care sector as to what the potential precedent might be."
"I think the concern and the chill that occurred when the charges were filed have now deepened, and we don't really have all of the answers," he said.
The worry, Posteraro said, is paramedics' treatment on scene, transport decisions, and the care rendered will be scrutinized through a different lens — one that puts workers "in the direct line of fire."
John Schuman, a paramedic and lawyer, says health-care professionals will now wonder: 'If we make any mistake now, are we going to get charged? And if we have a bad day, and our judgment's off, are we going to get charged?' (Zoom)
A change for the better, family friend says
Firas Al Najim, a friend of the Al-Hasnawi family and human rights activist, said Tuesday he believes it will change the field for the better.
"Hopefully there's not going to be any case in the future. The paramedics are going to know not to deal with a patient like this," he said.
"When he's telling you he can't breathe, if he's hurt, just take him to the trauma centre. Do your job. You're not there to see if he's acting."
A substantial section of the trial focused on whether the paramedics followed protocols laid out in the Basic Life Support Patient Care Standards used by Ontario's Ministry of Health.
Failing to follow protocols, Arrell said, deprived Yosif of his only chance of survival.
2 paramedics found guilty in death of Hamilton teen Yosif Al-Hasnawi
Delay was unjustified, judge said
The paramedics spent 23 minutes on scene that night; 17 of those minutes were in the back of the ambulance.
Dr. Richard Verbeek, medical director for Toronto paramedics at the Sunnybrook Centre for Prehospital Medicine, testified for multiple days.
He said 23 minutes would be "within what we might expect given average circumstances at a trauma scene" in North America for blunt and penetrating wounds as a combined category.
But Verbeek, who edited the standards, noted that a penetrating wound qualified Al-Hasnawi as a "load-and-go" situation to the lead trauma hospital.
Arrell said the wait was "unjustified" and it was foreseeable the paramedics were risking Al-Hasnawi's life.
Schuman said paramedics are taught to "assume the worst." But the tests they perform can also change hospital destination, treatment regimens, and how the hospital may react to an incoming patient, he said.
"You don't want to rush that. You don't want to have people doing the wrong thing because they're in a pressure to get moving."
For a while, he said, people may feel pressure to treat everyone, regardless of presentation, as "being on death's door."
"That's going to consume a lot of resources."
Future of care
Posteraro also said it's a possibility that care will be impacted following the judgment.
"It may be an extreme on either side of the equation. Perhaps care may suffer as a result of health-care providers, paramedics, looking at a call or treating a patient through a different lens — looking at it more defensively versus in the best interest of the patient," he said.
The outcome, Schuman said, may raise questions for workers about remaining as a frontline paramedic or transitioning to a more distanced role, like a supervisor.
With files from Dan Taekema