The STARS mistake

‘Is there a real need for this helicopter service? Would we be better off to beef up the services of our home grown, fixed-wing transporters and tender out a contract to local suppliers, including helicopter operators, to work under the experienced guidance of our tried and true air medical transporters and EMS?’

A STARS helicopter lands at the Foothills Medical Centre in Calgary.
A STARS helicopter lands at the Foothills Medical Centre in Calgary.

Dorothy Dobbie Issues in the News
Dorothy Dobbie
Issues in the News

Occasionally people make a bad deal and live to regret it. We wince and struggle on, learning lessons from our mistakes, knowing we will have to pay. However, when government makes these kinds of mistakes, we all pay, so we all need to know just what the deal is to ensure that it never happens again.

Such is the case with the sad story of the untendered deal struck by the Manitoba government and STARS (Shock Trauma Air Rescue Society) to provide emergency helicopter transport in this province.

It appears that, as the old saying goes, Manitoba bought a pig in a poke.

Not only did the province not tender the $100 million-plus contract, it failed to do its due diligence with regard to how the program would operate in Manitoba’s unique circumstances.

There were a lot of mistakes, the first being whether such a service is even justified in this province due to the location of the helicopter base in Winnipeg, the flight range of the helicopters in question, the distribution of the population to be served, and last but not least, the capacity of the contractor to provide the services promised.

Consider that the range of the STARS helicopter is 250 km. With Winnipeg as the centre, this reaches just past Brandon on the west (not even to the oil patch where the nature of the work may mean accidents and a need for emergency services), just barely Dauphin on the north, east to the Ontario border (only 211 km away) and south to the U.S. border about 100 km away. A glance at a population density map shows that Manitoba’s population is heavily concentrated in Winnipeg and in a very small area surrounding Winnipeg. How much work is there likely to be in this truncated 250 km radius outside the Greater Winnipeg area, when Winnipeg itself accounts for 62 per cent of the entire population?

The answer is not much and “not much” is what we are seeing.

Even before STARS was grounded, its activity levels were questionable. To make itself look useful, it had been engaged in inter-facility transfers, an activity outside its original scope of work and one that is covered by the government-run Lifelight medevac air services for transports 128 km outside Winnipeg and the Emergency Medical Service ground transport within that radius.

The STARS agreement with Manitoba Health focuses heavily on its ability to train and educate personnel in rotary wing medical transfer. Medical education is one of the core competencies contained and promised in the service purchase agreement between Manitoba Health and STARS, yet we now learn from the new health minister that the training has been shifted to the Winnipeg Regional Health Authority and will be provided, she says, under the direction of Dr. Brian Postl, including “training, accreditation for personnel, quality assurance for clinical operations.”

How does this fit with the agreement that explicitly provides for these services to be provided by the contractor? Indeed in the agreement, STARS goes so far as to promise to train others! “…STARS shall organize/facilitate an ongoing critical and emergent care transport medicine education program for rotary wing air medical providers, fixed wing and ground EMS providers and any other rural and critical care providers across the province . . .”

Further in the schedules section of the agreement, it states that:

“This component of STARS operations encompasses education, training, outreach and research to build competencies with other chains of survival agencies involving STARS calls to ensure proper treatment and movement of patients.

The mobile training program will provide specialized critical care skills training to STARS crews and other emergency care providers utilizing high fidelity mannequins. The STARS Mobile Simulation Program would be available in Manitoba for the training of other air and land ambulance crew members as well.

STARS will provide a 0.5 clinical educator who will provide ongoing training and development of STARS Manitoba crews  and a 0.5 community educator who will lead outreach programs to rural hospitals and chain of survival partners (police, fire, etc) in Manitoba utilizing STARS ‘s mobile simulation motor home.”

The agreement boasts that a STARS rotary wing medical director will “provide local leadership to the Manitoba STARS crew and Manitoba medical community including education training and patient quality control” and blah, blah,blah.

The promises in the agreement and the actual services provided are so very far apart that it would be laughable if it weren’t so serious. Notable also is the fact that it was the absence of these very competencies in Manitoba that was cited as the reason for not tendering the contract, even though there is a Manitoba helicopter company that was prepared to invest in the expertise to provide the service.

Meanwhile, the office of the auditor general published a scathing report on the deal, pointing out that procurement rules were broken in handing out the untendered contract, that the costs are unsupportable, in that compared to similar services provided in Saskatchewan and Alberta, Manitoba is paying over 618 per cent more per mission. What was originally released as being a $100 million contract, is now cited as a $159 million contract over 10 years. It should be noted that there are no limitations on the cost in the agreement.

The auditor general cited other infractions as well, but perhaps the most worrisome is the damage done to the health of several of the patients. In one, a child was left with brain damage, in another STARS ran out of epinephrine to treat a severely allergic man, and of course, there is the tragic death of Kristen Joiner who died when there were problems with the oxygen tank in her transport from Steinbach to Winnipeg. In all, there were 16 patient incidents under review.

Manitoba Health engaged a third party to assess operations. Dr. Stephen Wheeler of the British Columbia air ambulance service slammed the amount of training STARS gives its people, saying 10 weeks is hardly adequate. Both B.C. and Ontario provide 12 to 24 months training. Among his 20 recommendations was one that STARS be accredited in Canada instead of by the American organization that provides its current certification.

All this is just the tip of the iceberg – the deeper one goes into the file, the more worrisome it is. The auditor general reported a long list of deficiencies in the services: the way the program is operated, the fact that STARS has failed to live up to its fundraising obligations in Manitoba and the horrifyingly high cost of those services that have been provided.

This brings us back to the question of whether this service is justified in our province. In addition to over-the-top costs, there is a report that during the suspension period, 20 out of 21 STARS-qualifying missions that were handled by ground ambulance actually transported the patients an average of 26 minutes faster than they would have been transported by STARS!

Given that inter-facility transport is not supposed to be in the scope of work for STARS, that the third party investigator specifically recommended that STARS not be used for this transport, and that much of this service is already provided by Lifeflight, is there a real need for this helicopter service? Would we be better off to beef up the services of our home grown, fixed-wing transporters and tender out a contract to local suppliers, including helicopter operators, to work under the experienced guidance of our tried and true air medical transporters and EMS?

When people make mistakes, it is simple common sense to stop doing whatever caused the mistake. Government should do no less.

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