VA will treat civilians in pinch

"If that's the closest hospital and it's a life-and-death event," the VA secretary says.

By WILLIAM R. LEVESQUE, Times Staff Writer
Published August 7, 2007

TAMPA - Critically ill nonveterans can be taken to any Department of Veterans Affairs emergency room in the nation if it's the closest medical facility, VA Secretary Jim Nicholson said Monday.

"If that's the closest hospital and it's a life-and-death event, they should be brought immediately to the VA's emergency facility," Nicholson told the St. Petersburg Times. "As long as it's a life-threatening emergency. Absolutely. If there's confusion about that, I'm going to clarify that myself."

Nicholson's comments may alleviate uncertainty that surfaced after the Bay Pines VA Medical Center in St. Petersburg refused to treat a nonveteran who suffered a heart attack June 26 about 200 feet from its emergency room. Mark A. Surette, 51, later was pronounced dead at a hospital 10 minutes away.

Bay Pines officials said that Surette's case was an "aberration" and that a doctor thought he fell ill while off VA property.

Both the VA and Pinellas officials had said Bay Pines does not accept nonveterans who fall ill off VA property.

But during a 10-minute interview, Nicholson offered no room for ambiguity: VA doctors will treat severely ill nonveterans, even if they fall ill off department property.

"That's a responsibility we have to any citizen, and it's consistent with the Hippocratic Oath," Nicholson said. "I'm checking that out to make sure it is VA policy, and if it isn't, it darn sure will be."

Nicholson said he thought that was already VA policy, though he acknowledged being uncertain.

Surette's daughter, Erica Bailey, 23, of Minot, N.D., who has been angry at the VA's response to her father's case, expressed gratitude at Nicholson's comments.

"It's great," Bailey said. "I'm just glad something good can come out of all of this."

Nicholson visited the James A. Haley VA Medical Center in Tampa on Monday for a ribbon-cutting at the Fisher House, a facility where families of wounded veterans can stay cost-free while loved ones receive treatment.

Over the last two weeks, national VA spokespersons have not returned repeated calls for comment on the VA policy for treatment of nonveterans.

But Nicholson, who is expected to step down from his post by Oct. 1, agreed to a brief interview after the Fisher House festivities.

Nicholson said he had read news reports of Surette's case and was saddened.

"My first reaction was one of sorrow for the loss of this valued VA employee and the loss to his family and to the VA community who knew this man and valued him as an employee and a friend," Nicholson said. "It's a tragic loss."

But with the VA's medical inspector now investigating the incident, Nicholson said he would "reserve judgment" on the facts of the case until reading the inspector's report.

Nicholson said the medical inspector, an independent investigative arm within the VA, had already begun working on the case.

The Pinellas medical director, Dr. Laurie Romig, also is investigating the paramedic response to Surette's heart attack. She said Nicholson's stance is a departure for the VA.

"But I'd say it's a welcome one," Romig said. "More resources (for county paramedics) are usually better."

Chuck Kearns, Pinellas' Emergency Medical Services director, said he did not know if Nicholson's comments would lead county paramedics to start routinely bringing nonveterans to Bay Pines.

"It very well may," Kearns said.

But he noted that he doesn't know what the VA's emergency capabilities are. For example, Kearns said, a burn patient might be taken to Tampa General Hospital because it has the area's best burn unit, even if it's not the closest hospital.

County paramedics, he said, don't always take a patient to the closest emergency room. It depends on the type of injury and which hospital is best set up to treat it.

"We have to see what their clinical capabilities are," Kearns said.

The VA has said it is impossible to know if the delay in getting Surette to an emergency room cost him his life. One county EMS official said a week ago that a doctor could have done little more for Surette than paramedics on the scene.

In the days after news of the case broke, the county signed an agreement with Bay Pines saying paramedics could bring a severely ill nonveteran to its emergency room without calling first - if the patient fell ill on Bay Pines sprawling campus.

Both Pinellas and VA representatives said it has never been Bay Pines policy to accept critically ill nonveterans who fall ill elsewhere, even if Bay Pines is the closest emergency room.

"Our normal protocol is, if the patient is across the street (from Bay Pines), then we take them to St. Pete General" Hospital, Craig Hare, Pinellas' current EMS division chief, said a week ago.

Bay Pines has treated two dozen nonveterans in the last year, John Pickens, a VA regional spokesman, has said. But all those, he said, had fallen ill on the facility's 338-acre campus.

Amid the recent confusion, Rep. C.W. Bill Young asked the VA to produce its nonveteran policy. What Young received showed the agency had no prohibition against treating critical nonveterans once they were at a VA emergency room.

But the written policy he received did not appear to address the question of what the VA should do when paramedics called seeking permission to admit a patient, as happened with Surette.

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

[Last modified August 7, 2007, 00:30:19]