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VA turns away cardiac victim

The man was not a vet. Paramedics were told to take him to a more distant emergency room. He did not survive.

By WILLIAM R. LEVESQUE
Published July 25, 2007

In Building 24 at Bay Pines VA Hospital in June, Mark A. Surette collapsed and was not treated at the hospital's emergency room.
	[Scott Keeler | Times]

ADVERTISEMENT Mark A. Surette [Special to the Times] Related audio: Listen to 911 call. 200 feet vs. 3 miles [Dana Oppenheim | Times] [Dana Oppenheim | Times]

ST. PETERSBURG - The man had suffered a heart attack in a building about 200 feet from the bustling emergency room at Bay Pines VA Medical Center.

But when Bay Pines worker Mark A. Surette collapsed on June 26, Pinellas paramedics weren't sure where to take him.

Surette wasn't a veteran.

So the county asked Bay Pines if its emergency room would treat him. The response: Go to St. Petersburg General Hospital, 3 miles away. Listen to 911 call.

Surette, 51, of St. Petersburg died.

Pinellas County's medical director confirmed Tuesday that she has opened an investigation into the matter, saying Surette should have been treated at the closest hospital. But she said paramedics acted properly, characterizing the inquiry as routine.

"There's no way to know if that extra time made a difference," said Dr. Laurie Romig, the medical director who has oversight of county paramedics. "Our usual practice is to take a patient to the closest emergency room."

John Pickens, a regional spokesman for the Department of Veterans Affairs who works in the same building where Surette collapsed, said the medical center frequently treats seriously ill non-veterans and has no policy against it. He said the VA also is conducting a review of its procedures as a result of the case.

"This is more an aberration than the result of any policy issue," Pickens said.

Surette's next of kin could not be reached for comment. Surette, who worked as a computer assistant at Bay Pines for 17 years, is survived by his parents and two daughters.

The 911 call from Bay Pines was made shortly before 9 a.m. Surette collapsed in Building 24 on the large Bay Pines campus, perhaps 200 feet or less from the entrance to the VA's emergency room. In four minutes, county paramedics arrived.

Surette was in full cardiac arrest. Pickens said VA medical personnel, including a doctor, also responded and provided treatment at the scene.

Though Bay Pines' emergency room is a short walk from the building, the question of where to take Surette was unclear to paramedics.

So someone from Pinellas called Bay Pines.

"Bay Pines," an unidentified caller said, according to a recording of the call. "I got a question for you. We have a request. We have paramedics working ... a facility on your campus there. The patient is not a vet. You are the closest ER. Would you guys be willing to take that patient or do you want him to go to St. Pete General?"

The response: St. Petersburg General. It took about 10 minutes to take Surette to the hospital, county records show.

The caller did not detail Surette's critical condition, nor did the VA employee who took the call ask. Romig said it's unclear if paramedics ever told the VA how ill Surette was, though the agency had personnel at the scene.

"It's just another one of those factors that could have been part of a Murphy's Law chain of events," said Romig.

Also unclear is precisely when Surette was pronounced dead. Romig and the VA could not say, and a spokeswoman for St. Petersburg General Hospital declined to comment, citing patient confidentiality.

Romig said she doesn't know of any other instance in which Bay Pines turned away a patient at its emergency room. In fact, she said VA officials had previously assured her that they would accept any seriously ill emergency patient.

"It could be that this philosophy has not yet made it to all the staff, and it's really a simple mistake," she said.

By law, hospitals are not allowed to turn away acutely ill patients from their emergency rooms, a spokeswoman for St. Petersburg General Hospital said. But officials were not sure that applied to a VA facility.

Romig said there is sometimes a degree of confusion with paramedics about where to take a patient when they respond to federal property. The confusion centers on whether the Pinellas policy of taking a patient to the nearest hospital applies to non-veterans, if the nearest hospital is a VA facility, Romig said.

That uncertainty led the county to call Bay Pines.

"We don't usually call and ask, 'Will you accept this patient?' " Romig said. "That's a rare thing. This was one of those gray areas. ... A decision had to be made. So they thought they would do the polite thing and ask.

"I don't think we could say our folks did anything incorrect," she said.

Once told to take Surette to the more-distant hospital, Romig said, "It's not a time to argue."

Pickens, the VA spokesman, said Bay Pines officials listened to a recording of the call provided to the agency by the St. Petersburg Times.

"While VA doctors and nurses were first responders, and appropriate emergency treatment was provided at the scene, our review concluded that communications regarding care for non-veteran emergency patients can be improved," Pickens said in a statement.

Officials with Sunstar, the private company that employs the paramedics under contract for Pinellas County, declined to comment.

Times staff writer William R. Levesque can be reached at (813) 226-3436 or levesque@sptimes.com.

[Last modified July 25, 2007, 13:41:26]