Air Canada says crew properly followed medical emergency procedures

Shanu Pande says she had been looking forward to the trip for years — a flight that would bring her father to Canada from India after he finally obtained permanent residency status.

But the September trip took a sharp turn when Harish Pant, 83, developed severe medical symptoms: chest pain, back pain, vomiting, loss of bowel control and the inability to stand up.

“He was deteriorating in front of my eyes,” said Pande, who was accompanying her father.

Flight AC051 had left Delhi shortly after midnight local time. When Pant’s symptoms started seven hours later, it was over Europe. Pande says she pleaded with the cabin crew to divert the plane and land in order to get her father to a hospital.

Instead, the flight stayed on course for nine more hours, travelling over Ireland, across the Atlantic Ocean and Eastern Canada before touching ground in Montreal. Paramedics were waiting — but Pant died as they worked on him.

“I was very hysterical,” said Pande. “My mind was gone at this point.”

Her father was officially pronounced dead at a Montreal hospital from a “presumed infarction” — dead heart tissue.

Two months later, Pande says the piercing grief has given way to anger.

“He was at the mercy of the pilot and Air Canada people,” she told Go Public. “They were inhumane and callous.”

Air Canada declined an on-camera interview request.

In an email to Go Public, spokesperson Peter Fitzpatrick wrote that Air Canada extends its deepest sympathies to Pant’s family, but also “categorically rejects any assertions that it was responsible for the customer’s death.”

The airline’s crew “properly followed the procedures” for dealing with onboard medical emergencies, wrote Fitzpatrick. When asked, he declined to explain the procedures.

Fitzpatrick also said reports from the crew differed “in several important respects” from that of his family, regarding the timing of events and how the situation was handled.

Trying to figure out how often in-flight medical emergencies occur on Canadian flights — and what determines whether an airline will divert a plane — can be like flying through thick fog without radar.

No consensus exists among airlines regarding what defines an in-flight emergency. There is no mandatory reporting when a plane diverts for a medical emergency, nor any requirement to make public why decisions to reroute are made.

“There’s too many people keeping information close to their chests,” said Dr. Shahbaz Syed, an emergency physician at Ottawa Hospital and senior editor of a blog and podcast for the University of Ottawa’s department of emergency medicine.

“The data we have available to us is quite limited.”

Experts say in-flight medical emergencies are expected to increase as airline passenger traffic rebounds from the pandemic, long-haul flights become more common and the passenger population ages.  Airlines don’t share the cost of diverting a plane, though an article in the Canadian Medical Association Journal said the price tag could climb to almost $900,000. Today, that stat appears to be almost three decades old.

‘I’m having severe chest pain’

Pande says, as part of getting his permanent residency, her father had been deemed to be in good health just a few months earlier. He was in good spirits before he, Pande and her mother-in-law boarded the plane at Delhi’s Indira Gandhi International Airport.

Seven hours later, Pant jolted awake, says his daughter.

“He’s saying, ‘I’m having severe chest pain,'” Pande recounted, demonstrating how her father was clutching his chest over his heart.

Pande says she immediately rushed to get the attention of crew members. When they came back to his seat, Pande says Pant’s face had drooped on one side, he had lost control of his bowels and felt extremely weak.

As they took him to the washroom in a wheelchair, Pande asked the chief flight attendant to reroute the plane to a nearby city so Pant could get medical attention.

When they emerged from the washroom 40 minutes later, there was still no decision to divert.

Pant and his daughter were moved to business class so he could lay flat.

‘Not life-threatening’

Fitzpatrick says the crew made “repeated pages” for a passenger with medical training to come forward — but no one did.

Pande says a crew member only made those announcements after her mother-in-law insisted.

Meanwhile, the pilot was speaking with Phoenix-based MedAire, a third-party medical provider used by over 180 airlines, according to the company.

Fitzpatrick says MedAire lets the crew to talk with doctors familiar with the challenges of practising medicine on a plane “to evaluate the passenger and devise a care plan.”

Go Public has learned that in the case of an in-flight medical emergency on Air Canada, the chief flight attendant fills out a checklist that is given to the pilot, who then discusses the case with a MedAire physician.

The airline would not tell Go Public what the checklist said in Pant’s case. His daughter says she doesn’t remember seeing anyone fill out a form about her father.

Once the plane was over Ireland — the last possible stop before the Atlantic Ocean — Pande says she again urgently asked the crew to change course. Her father now had severe back ache and was throwing up.

She was told the plane would continue to Montreal because Pant’s condition was deemed “not life-threatening.”

“I was shocked,” said Pande. “I said, ‘Why are you not diverting the plane? Do you see his condition?'”

Pande says she became frantic. She asked to speak with the pilot herself, but was denied.

Go Public asked Air Canada how the decision to stay on course was made.

Fitzpatrick, the spokesperson, said he was unable to provide that information. He said the crew “provided continuous care,” including offering him Aspirin. But Pande says her father was allergic, so she gave him a dose of her mother-in-law’s Sorbitrate — a drug used to manage severe chest pain.

Fitzpatrick said when medical experts recommend an aircraft be diverted, Air Canada will do so “without hesitation” and that diversions happen approximately 40 times a year. This year, the airline will operate about 178,000 flights.

MedAire spokesperson Chris Potter said he couldn’t comment on the case due to client privacy reasons. In a statement to Go Public, Potter wrote that his company handles 60,000 in-flight emergencies globally each year and that of those cases, fewer than two per cent result in a diversion.

Major emergency

Go Public contacted five physicians — two family doctors, two emergency room physicians and a cardiologist.

All five said Pant’s symptoms indicated a serious cardiac event.

“This is a major medical emergency,” said Vancouver cardiologist Dr. Vicki Bernstein, who practised for 40 years before retiring two years ago. “I can’t believe that [MedAire] wouldn’t have suggested that they divert.”

The others also said they would have suggested a diversion.

“It’s very important to get them [to a hospital] as quickly as possible,” said Bernstein. “Open the chest, stop the bleeding or whatever is happening.”

Pande says she understands her father might still not have survived if he had gotten earlier medical attention on the ground, but says he was robbed of that chance.

‘I should have banged on the cockpit’

Pande says once the decision had been made that the flight would not be diverted, she was pretty much left alone to care for her dad.

Syed, a doctor who’s been pressed into service on a plane, said it’s critical to keep passengers apprised of what decisions are being made in the cockpit, and why.

“If I have a heart attack or something on a plane, I do want to know how the information is being given to the pilot,” said Syed. “You can’t really keep someone in the dark as it pertains to their own health.”

In the weeks since Pant’s death, Pande’s husband has penned emails to his MP and to Minister of Transport Pablo Rodriguez, describing what happened and calling for the resignation of several top airline employees.

Pande says she, too, wants to fight for justice — and is also fighting regret.

“I should have banged on the cockpit,” she said. “Why did he have to suffer like that?”

The family is pursuing a lawsuit against Air Canada.