According to BC ambulance Service sources, the paramedics on Saturday night did actually respond to the call. They did make contact with the patient, and the patient clearly refused any assistance from the paramedics, they said.
Eight hours later, an ambulance crew responded to a second 911 call, and found the man in his 40s, known as "Wheels" or "Francis," dead next to his wheelchair.
Officials say unless a patient is believed to be incompetent, he or she has a legal right to refuse medical help.
"We never like, as paramedics, to have anybody die. That's really what we're here for, is to help people. But on the other side, we can't force assistance on somebody who doesn't want it," they said.
The sources said paramedics have no authority to transport patients to hospital if they are unwilling to go. That requires the intervention of police, he said.
The cause of death is still under investigation. And Vancouver police are conducting their own investigation.
The man's death has also triggered a review of the conditions under which emergency shelters should be opened in Canada. Normally, the shelters only open when temperatures dip below -4 C, or when there is significant snowfall or freezing rain.
Emergency shelters were not open Saturday night, and permanent shelters on the Downtown Eastside were full.