The Crown suggested that one of two former Hamilton paramedics, who are both charged with failing to provide the necessaries of life to a gunshot victim in 2017, participated “in a dangerous lift.”
Counsel Scott Patterson asked the accused Christopher Marchant why he didn’t stop a Hamilton police officer from lifting Yosif Al-Hasnawi by his arms from the concrete sidewalk after he was shot over three years ago on Sanford Avenue near Main Street East.
Marchant spent a second day in a virtual courtroom on Wednesday testifying in his own defence during day 23 of his trial. Marchant and fellow paramedic Steven Snively are on trial in Superior Court for the events that transpired on Dec. 2, 2017, when Al-Hasnawi died of a gunshot wound.
Patterson made his point about the dangerous lift by displaying looping security camera footage that shows Marchant and Const. Michael Zezella making a failed attempt to lift the Al-Hasnawi following an assessment at the scene.
Before showing the footage, Patterson suggested to Marchant that it is not a good idea to try to lift a patient without first knowing what other potential injuries they could have after an initial assessment.
Referring to a passage in a copy of Ontario’s patient care standards, which suggests that a primary survey of a patient should include C-spine precautions, Patterson suggested that moving somebody with that potential may sever or damage the nerve that runs down a person’s back.
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He also said the proper way to move a patient with unknown injuries is to do a “log roll” onto a spinal board, according to the care standards.
When Marchant was asked whether he was able to do a spinal assessment on Al-Hasnawi in 2017, he told the court he couldn’t.
“He wasn’t responding to my questions, so I wouldn’t have been able to do a spinal assessment to ask him the questions of that,” Marchant told Patterson.
After showing the video to the court, Patterson asked Marchant why he didn’t try to stop Zezella from trying to lift Al-Hasnawi.
“You’re the lead medical authority in this relationship with Zezella, isn’t that right?” Patterson asked.
“That’s right,” Marchant responded.
“And you don’t stop him because you figure, damage already done, might as well proceed. Is that what you’re thinking?” Patterson suggested.
“I’m not sure at that time. I might have,” Marchant replied, “I’m not sure. He attempted to stand him up, I just assisted.”
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Patterson then advanced footage to where the lift failed and accused Marchant of dropping the patient’s hand a couple of feet to the ground.
“I see what you are doing. You’re discarding Mr. Al-Hasnawi now back to the sidewalk. Isn’t that the case?” Patterson said.
“I disagree, ” Marchant replied.
Patterson would later ask similar questions of Marchant as he displayed more footage of Al-Hasnawi’s younger brother, Mahdi, making an attempt to pick up Yosif and move him towards a stretcher.
“You didn’t shout at him, ‘Don’t pick him up,'” Patterson put to Marchant.
“He had already picked him up and put him back down. No, I didn’t,” Marchant said.
‘You’re not diagnosing your assessing’
Patterson began a line of questioning on Wednesday around the decision to transport Al-Hasnawi, who had a penetrating wound to the abdomen, to St. Joes instead of Hamilton General, which was the lead trauma hospital.
Patterson said the former paramedic used the word “diagnosis” twice during testimony for the defence on Tuesday to describe what a driver and an attendant paramedic team do at a scene. He also used it on his ambulance call report (ACR) in 2017, in which he described Al-Hasnawi as in “no apparent distress.”
Marchant agreed that “diagnosis” wasn’t the right term to use but said as paramedics, that’s usually the term used.
“I mean, we can’t diagnose things that can be done in the hospital, but we can come to certain conclusions, for example, chest pain assessments, shortness of breath assessments through history,” Marchant replied.
“But I’m just asking you that you understand you’re not diagnosing, you’re assessing,” Patterson said. “And that there’s a big difference between those things.”
The Crown would later circle back to the ACR and ask Marchant about why some actions in his report were omitted on the basis that they were considered a pertinent negative — something that is used to narrow down choices to formulate a correct diagnosis.
Marchant’s ACR and incident report from Dec. 2 didn’t record a palpation — feeling with fingers or hands during a physical examination — done on the patient’s abdomen that night.
Patterson suggested that the two palpations were the “most pertinent of the negatives” missed and were omitted not once, but twice.
Marchant replied, “Yes, it wasn’t documented.”
Marchant explained to the court Tuesday that palpation is used to elicit a pain response and any “distension” which could identify fluid in the abdomen.
Patterson suggested on Wednesday that he ruled out internal bleeding when he did palpation. Marchant said he didn’t think it’s possible to rule out internal bleeding.
“How does palpation help you rule out penetrating wound? It can rule something in, but it can’t rule it out,” Patterson said.
“No, that’s true. I was going by my penetrating trauma guidelines after assessing the wound and assessing the patient, palpating the abdomen” Marchant replied.
“I came to a determination that this wasn’t a penetrating wound. It was more behavioural psychiatric by the lack of indicators on my assessment.”
Patterson would also touch on the paramedic’s visit to St. Joe’s and news that Al-Hasnawi was dead. He asked Marchant if he understood at that point that they had made at least “one major mistake” by thinking the situation was a psychiatric case when it turned out Al-Hasnawi had been shot.
Marchant replied “We had chosen the wrong hospital destination, yes.”
The Crown then asked the accused if he was blaming himself for the mistake after the news and felt responsible.
The former paramedic said he wasn’t blaming himself, just “confused and sad” playing the events back in his head.
“What I’m asking is you feel responsible, at least in part for him dying,” Patterson asked.
“Yes,” Marchant replied.
‘I agree that it was the wrong choice of words’
Earlier in the trial, the court heard from two dispatchers at the Hamilton Central Ambulance Communications Centre who painted a picture of a “busy” and “understaffed” call centre on the night Al-Hasnawi was shot.
Despite mistakes made by a 911 communications officer in filling out a report in the dispatch priority system, which determines the incident’s severity, the call on Al-Hasnawi’s “penetrating wound” was still classified as a “code four emergency” — the highest priority call.
Dispatcher Janice Mcmeekin would later field a radio call from Marchant that night asking why it was prioritized at an emergency level if Al-Hasnawi’s injury was “superficial.” She replied that it was because it was reported as a “penetrating wound.”
She later told the court that in her 21 years of experience, “99.9 per cent” of calls involving a gun are classified as high priority.
Mcmeekin filed a complaint about the call, citing the paramedic’s “sarcastic” comments over the air.
She also called Marchant the following morning, after hearing Al-Hasnawi had died, on an administration phone at the John Street station, where all calls are recorded.
In the conversation, the paramedic said Al-Hasnawi’s vital signs were “perfect” other than “acting like a dickhead.”
During his original examination by defence counsel Jeffrey Manishen on Tuesday, Marchant had admitted that using the word “dickhead” was the “wrong choice of words.” He also said that the use of “perfect vital signs” referred to everything but the elevated heart rate, which he attributed to the “exertion” in “fighting” the paramedic’s assessment.
On Wednesday, Patterson suggested Marchant’s usage of the term “dickhead” meant “stupid, contemptible or annoying” and that’s what he thought of Al-Hasnawi the whole time he had responsibility for him on the night of the shooting.
Marchant said “no,” and that he was “venting” to a dispatcher.
“I was fatigued from the night before,” Marchant said. “I agree that it was the wrong choice of words.”
Day 24 of the judge-only trial resumes Thursday.
Justice Arrell is expected to hear more testimony from the former paramedic as Patterson continues his cross-examination.
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