Amid chaos, life slips away
The VA emergency room was nearby, but not forthcoming.
By WILLIAM R. LEVESQUE, Times Staff Writer
Published August 4, 2007
Family photo of Mark A. Surette, the worker at Bay Pines VA Medical Center who died of a heart attack on June 26. Bay Pines' emergency room refused to treat him, perhaps because he wasn't a veteran. The photo shows, left to right, Surette, his granddaughter, Elora Bailey, his daughter, Erica Bailey, and Surette's parents, Cal and Flo Surette. The photo was taken on June 23, three days before Surette died.
ST. PETERSBURG - It was a seemingly routine Tuesday when Mark A. Surette showed up for work at the sprawling Bay Pines VA Medical Center campus.
As he walked to his office in Building 24, Bay Pines' bustling emergency room was visible about 200 feet away.
Surette, 51, could have walked there in seconds.
But in the minutes after his arrival on June 26, the distance became an unbridgeable chasm, a bureaucratic divide as real as any physical obstacle.
Soon, Surette's heart would start to fail. He never made it across that invisible line.
- - -
Born in Boston, Surette was deaf from birth. He communicated through sign language, or by writing notes.
He was a lifelong Red Sox fan and sports fanatic. As a teenager, he had a brush with history, working as a messenger at the Watergate hotel during the time of its infamous burglary.
Separated from his wife, Mary, Surette lived in recent years with the younger of his two children, 18-year-old Heather, in a St. Petersburg rental home. An older daughter lived in North Dakota.
Surette had worked 25 years for the U.S. Department of Veterans Affairs -- 17 years at Bay Pines and eight years before that in Maryland.
As he left for work that Tuesday, it was undoubtedly a happy time for Surette. His older daughter, Erica Bailey, 23, was visiting with Surette's infant granddaughter, Elora.
Surette worked as a computer assistant at the VA campus, which treats about 1,000 veterans a day.
Amid that sea of veterans, Surette had never served a day in the military.
Is he a vet?
A little before 9 a.m., a co-worker heard an odd sound from Surette's office.
She looked inside and saw Surette slumped in his chair, his eyes rolled back in his head, gasping for air.
The woman ran to get a nurse who worked in the building. A doctor who worked close by also responded, the VA said.
They checked Surette's vital signs and started CPR. Someone yelled to call 911. At first, Surette seemed to respond. His pulse was weak, his respiration shallow.
At 8:55 a.m., paramedics got the call. They arrived in four minutes.
A crowd of 30 people had gathered. For 20 minutes, paramedics worked to revive Surette. They connected a heart monitor. They shocked him with a portable defibrillator two or three times. An IV was started.
Surette was in full cardiac arrest, the VA said. His breathing and pulse had stopped.
A paramedic asked if Surette was a veteran, the VA said. Employees didn't think so because he was deaf. A paramedic then indicated Surette could not be taken to the nearby Bay Pines emergency room, the VA said.
VA employees tried to tell paramedics the emergency room would take a nonveteran in a life-and-death situation, the VA said.
Radio communications reflected uncertainty at the scene.
One paramedic asked a supervisor if Surette could be taken to Bay Pines, since it was so close.
"Yeah, that's a good question. Stand by," replied a supervisory paramedic. "We know for sure this person is not a vet?"
"He's probably not, I'm being told," said a paramedic on scene.
"Yeah, I don't see a problem transporting him to -- what would be your next closest, St. Pete General?" the supervisor asked.
"Yeah, I don't see a problem with you transporting him there," the supervisor said.
But paramedics on scene still seemed troubled.
"We can see the ER from the parking lot where we're at," one said. "We're like one building away from the ER. But you want us to transport to St. Pete General?"
The supervisor relented.
"You can give them (Bay Pines) a call to see if they'll accept the patient, since they're right there."
The call was made. Bay Pines officials clearly were told of Surette's critical condition, the county and VA agree.
Still, a VA emergency room doctor decided Bay Pines would not treat Surette.
"That's what I thought," the supervisor said.
It took 10 minutes for paramedics to drive exactly 3.8 miles to St. Petersburg General Hospital, where doctors tried to restart Surette's heart. At 9:36 a.m., four minutes after he arrived, doctors pronounced Surette dead.
An inquiry begins
Surette's death was noted in a brief obituary. That might have been the extent of publicity, except for an anonymous letter sent to the St. Petersburg Times.
The letter complained that unless employees work in the main Bay Pines hospital building, they must call 911 for help and are not allowed to summon doctors from the nearby hospital.
"Mark lay on the floor of Building 24, only a short distance from the emergency room and help that may have saved his life, but because of rules and regulations we had to call 911," the letter said.
The letter did not say the emergency room refused to treat Surette.
A VA spokesman, when first asked about Surette, said it made more sense for paramedics to respond to many calls at Bay Pines because the 338-acre campus is so big. Paramedics could get to a patient more quickly than VA doctors.
And in any case, the VA said, a Bay Pines nurse and doctor were "first responders." They just happened to be in the building.
John Pickens, a VA spokesman, told a reporter, "One of the things the public is not aware of, often if someone falls ill, if they're not a veteran, we'll reach out and treat them."
In response to the anonymous letter, the newspaper on July 16 asked the county for all public records related to the paramedic response.
Steve Fravel, a Pinellas emergency medical services coordinator, demanded: "What's your interest in this?"
Days later, controversy took root.
A recording from the county made clear that Surette had been turned away by Bay Pines.
The county medical director, Dr. Laurie Romig, insisted the county and Bay Pines had a verbal agreement that the VA would take any nonveteran taken to its emergency room.
Again, Pickens confirmed the VA would treat any nonveteran in an emergency and called Surette's case an "aberration."
That was on July 24 and 25. By July 26, the county and VA had changed their stories.
Now, Romig said no verbal agreement existed. And both she and Pickens said Bay Pines would treat a critically ill nonveteran -- but only if that patient fell ill on VA property.
Pickens said the doctor thought Surette had fallen ill off Bay Pines' campus.
The case now was getting attention in Washington.
On July 27, the VA responded to a request from Rep. C.W. Bill Young, R-Indian Shores, for the VA policy on treating nonveterans.
The VA said its "long-standing oral agreement" with the county allowed paramedics to decide where to take any patient, including a nonveteran. Once at a VA emergency room, it said, the nonveteran would be treated.
The statement made no distinction about where a patient fell ill.
While both the county and the VA continue to investigate, both insist the policy is now clear: Any nonveterans falling ill on the Bay Pines campus can be taken to and treated at its emergency room.
Off-campus, the nonveteran would have to go to another hospital.
Bailey, Surette's daughter, is upset.
Too much confusion. Too many different stories.
Recently, her father's boss called her.
"He said how bad he felt," Bailey said. "And that nobody my father worked with knew about the whole situation with the emergency room."
The boss, she said, was sorry.
[Last modified August 4, 2007, 00:50:38]
[an error occurred while processing this directive]