Assault of difficult patient, attempt to mislead investigation provide just cause for dismissal
An Alberta paramedic who struck a patient who spit on him and then tried to downplay the incident in the ensuing investigation has had his dismissal upheld by an arbitrator for failing to meet the high standards of trust and conduct inherent to his position.
Gerrit-Dean Pinell, 36, worked as a paramedic for Alberta Health Services (AHS) in Calgary. Hired in early 2013, he had no disciplinary record with AHS. However, he experienced a few traumatic events during his tenure with the organization. In November 2014, Pinell was part of a backup paramedic crew that responded to a call in which his brother died. About one month after that incident, he was involved in a call in which a child was murdered and began experiencing symptoms consistent with post-traumatic stress disorder (PTSD) — leading to an eventual diagnosis of the condition. He went off work for several months on workers’ compensation benefits and was able to return after treatment.
However, the symptoms returned in February 2016 after Pinell attended a scene in which several teenagers were killed in a nighttime luge run at Calgary Olympic Park. Pinell once again had to take time off work while receiving workers’ compensation benefits, but he was able to return after a shorter absence.
In the early morning hours of April 18, 2016, Pinell and his partner were dispatched to a facility for people with addictions and mental illness where they found a woman with a deep cut on her face but able to stand. They put her on a stretcher and into the ambulance, but as they treated her she became more agitated and unpredictable.
The patient started thrashing and shouting, so the two paramedics used soft cloth restraints to tie her hands and feet to the stretcher frame. After this, the patient started making noises like she was going to spit, so they tried to put on a “spit sock” — a hood that fits over the patient’s head to protect the paramedics from spitting. However, the patient violently resisted their attempts, so they opted to sedate her.
Before they could sedate the patient, she spat a mouthful of saliva and blood directly at Pinell’s head, so it struck him in the chest and face, as well as the ceiling and walls of the ambulance. Pinell’s partner saw Pinell immediately draw back his right arm a short distance and strike the patient on the left cheek with a closed fist, creating a sound consistent with a blow to the face. At the same time, the partner yelled at the patient to stop and the patient said something about Pinell hitting her. According to the partner, Pinell then said, “I can’t stand patients who spit” and left the ambulance. Two police officers entered and helped the partner restrain the patient while they put on the spit sock and administered the sedative. As they got ready to drive to the hospital, Pinell said to his partner, “I hope you have a short memory.”
After they arrived at the hospital and handed the patient off to emergency room personnel, Pinell’s partner reported the incident to the supervisor on duty and Pinell texted the supervisor saying they needed to talk. Pinell then filled out the patient care record, in which he said he pushed the patient’s face away with a closed hand and held it until the police officers came in to assists. Pinell later testified that he felt nervous about how the incident might look to management.
As he was writing the patient care record, another paramedic came by and asked how he was doing. Pinell told him a patient had spit blood in his face, he had hit the patient in response and that he believed his partner was upset about it. Pinell later testified that he said he had “impacted” the patient.
After discussing the incident with Pinell, the supervisor completed a post-incident report that stated Pinell “punched the patient in the face with a closed fist, striking the patient on the left cheek,” which Pinell’s partner witnessed. The supervisor noted Pinell “demonstrated remarkable candidness and transparency” in direct discussion during which Pinell had described his action as a short jab, though less so on the patient care report that stated he had merely pushed away the patient’s face with his hand.
AHS investigated the incident, reviewing the reports and interviewing both Pinell and his partner. It tried to interview the patient, but she was unco-operative and didn’t make a complaint. There was also no apparent injury.
Pinell first characterized the contact as pushing away the patient’s face, as he did in the patient care record. When confronted with his report to the supervisor that he struck the patient in the face, Pinell then said he had lost his balance in the ambulance and fell into the patient.
Management met with Pinell on Sept. 6 and he reaffirmed his version that he lost his balance, though he disclosed his PTSD and said it may have affected his recall. He said he was still in treatment but was fit to work, but he also became argumentative and threatened to go to the media if AHS didn’t support him.
The investigation continued and a final report was completed on Oct. 25. It considered Pinell’s relatively short service, the nature of the assault, Pinell’s initial description that tried to downplay the assault and his lack of remorse that AHS felt was an attempt to mislead the investigation. The conclusion was that Pinell had committed patient assault and should be dismissed. Since there was no medical evidence that Pinell’s PTSD was connected to the misconduct or Pinell’s memory of it, AHS terminated Pinell’s employment on Nov. 1 for intentional assault of a patient. AHS stated that its trust in his ability to safely perform his duties was destroyed, public confidence in AHS was undermined and the employment relationship was irreparably damaged.
The arbitrator noted that Pinell’s partner was consistent and unwavering in his account of the incident and he had no motivation to lie about it, while Pinell’s story changed and he had a high amount of self-interest in the outcome. In addition, Pinell’s claim that he slipped and fell didn’t make a lot of sense, as the ambulance wasn’t moving and there wasn’t anything on the floor to slip on. Also, if he had fallen, his partner would have seen or heard it happen and Pinell would have said something. Instead, Pinell made a comment that he couldn’t stand patients who spit — a comment consistent with just having hit the patient rather than following a fall and accidental contact. Bringing in that explanation late in the investigation was an attempt at self-preservation and to mislead the investigation, said the arbitrator.
The arbitrator acknowledged that there was an element of self-defence to consider as the patient provoked Pinell by spitting on his chest and face and he couldn’t have just left his partner with the patient when the latter was acting out. However, the fact that the action was a quick, jabbing blow to the face rather than a push and hold of the patient’s face away indicated the purpose was to punish the patient for spitting rather than protecting Pinell or his partner. Pinell’s comments afterwards about patients who spit and hoping his partner had a short memory also supported the idea that it was intentional, said the arbitrator.
The arbitrator considered that Pinell was put in a difficult position — “in an enclosed space, with a syringe in one hand, facing a restrained but enraged, probably intoxicated and violently unco-operative patient who has just blown a mouthful of blood and saliva at him.” However, paramedics operated in a reality where such patients are unfortunately common, and first responders have a high standard of conduct to protect patients and be truthful about their responses to provocation. Pinell failed to meet these standards, the arbitrator said.
As for Pinell’s PTSD, the arbitrator noted that Pinell didn’t claim his symptoms played a role in the incident, just that they could have affected his memory of it. There was also no medical evidence linking Pinell’s PTSD to his misconduct, so it wasn’t a mitigating factor.
The arbitrator determined that AHS had just cause to terminate Pinell’s employment.
For more information see:
• HSAA and Alberta Health Services, Re (April 12, 2019), J. Leslie Wallace - Chair (Alta. Arb.).