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Paramedics cleared in death

Pinellas medical director finds no fault in the VA heart attack case.

By WILLIAM R. LEVESQUE, Times Staff Writer
Published August 10, 2007

ADVERTISEMENT [Courtesy of Erica Bailey] Mark Surette and his granddaughter, Elora Bailey.

ST. PETERSBURG - Pinellas paramedics acted appropriately when responding to a heart attack victim that the Bay Pines VA Medical Center refused to treat at its emergency room, an investigation concluded on Thursday.

Dr. Laurie Romig, Pinellas medical director, found no fault in how county paramedics performed during a June 26 incident in which they were forced to take Mark A. Surette to a more-distant hospital.

Surette, 51, a nonveteran who fell ill on Department of Veteran Affairs property about 200 feet from the Bay Pines emergency room, later was pronounced dead at St. Petersburg General Hospital nearly 4 miles away.

"I can't tell you much other than the clinical care that was provided by paramedics was within protocol," Romig said. "They worked very, very hard" to save Surette.

It was within Romig's authority to order retraining of paramedics, or suspend or terminate them, if she found they did not follow proper procedure.

Pinellas emergency medical services director Chuck Kearns said that when uncertainty developed about where to take Surette, paramedics called a supervisor for guidance.

"They did exactly what they were supposed to do," Kearns said.

Romig declined to release a copy of any investigative materials produced by her office, saying such an EMS quality-assurance review is confidential under state law.

Romig said her investigation did not examine the role the VA played in the incident. Surette had worked at the VA for 25 years, 17 of those at Bay Pines.

"It was not an investigation of the hospital side of things at all," she said. "I don't have that authority."

The VA's medical inspector is conducting its own investigation and has been interviewing VA employees in recent weeks. VA officials have declined to comment, pending that inquiry.

Turned away by VA

Paramedics had decided among themselves to take Surette to St. Petersburg General. But since Bay Pines was so close, they decided to ask for permission to take Surette there, radio communications show.

An emergency room doctor refused to treat him. But Pinellas EMS officials said a doctor could have done little more for Surette than paramedics on the scene.

The VA says the doctor thought Surette had fallen ill off Bay Pines property. It has been both Bay Pines' and county policy to direct nonveterans to other hospitals.

But on Monday, VA Secretary Jim Nicholson said in an interview that paramedics anywhere in the nation are free to bring a severely ill nonveteran to any VA emergency room, if it's the closest available.

"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 said. "As long as it's a life-threatening emergency. Absolutely."

But Romig said that, for the time being, Pinellas paramedics would not start bringing critically ill nonveterans to Bay Pines' emergency room, even when it's the closest.

"We haven't received any communication from the VA that they're ready to implement that, if it's going to be implemented," Romig said.

The exception to the county policy might be nonveterans who actually fall ill on Bay Pines property, she said.

"I need to be able to communicate with the VA about exactly what they're going to do," Romig said.

"I'm not going to make a unilateral decision."

Discussions to come

Kearns, county EMS director, said he expects talks between Pinellas and Bay Pines to commence once the medical inspector's investigation is finished.

"I fully expect that we're going to have good discussions with them when their process is finished and make tweaks in the system that are in the best interests of the patients," Kearns said.

Even before Nicholson's comments, Romig said a Bay Pines official had spoken to her about including its emergency room in the network available to paramedics. But Romig said it was a "conceptual" discussion and nothing concrete has come of such talks.

John Pickens, a regional spokesman for the VA, has declined to comment on any possible talks pending the conclusion of the medical inspector's investigation.

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

[Last modified August 9, 2007, 23:56:16]