VA To Treat Nonvets During Emergencies

By STEPHEN THOMPSON The Tampa Tribune

Published: Jul 27, 2007

ST. PETERSBURG - After a Bay Pines VA Medical Center employee suffered a heart attack and was taken to a hospital miles away rather than the center itself, the Department of Veterans Affairs on Thursday signed an agreement to ensure such a scenario doesn't unfold again.

"We've looked at this case extensively all day," said Craig A. Hare, the EMS coordinator for Pinellas County's EMS and Fire Administration. "They will accept emergency patients on their campus."

On June 26, Mark Surette, a computer assistant at Bay Pines, collapsed in a building at the center, the victim of a heart attack. The 51-year-old was not taken to the emergency room at the center that was a couple of hundred of feet away. Instead, he was taken three miles away to St. Petersburg General Hospital, where he died.

It is unknown whether the decision cost Surette his life. Paramedics worked on him for 20 minutes before taking him to St. Petersburg General, according to a chronology of events provided Thursday by Bay Pines. When paramedics started the drive, Surette didn't have a pulse, nor was he breathing, the chronology said.

What is clear is that confusion reigned that morning.

Paramedics were under the impression Surette couldn't be taken to the emergency room at Bay Pines without permission because he wasn't a veteran.

Bay Pines representatives say their emergency room has always accepted patients regardless of veteran status, but the policy was never put in writing.

On Thursday, the Department of Veterans Affairs and Pinellas County Emergency Medical Services signed a memorandum of understanding to clarify the policy.

It allows anyone undergoing a critical or acute care emergency on the Bay Pines VA campus to be taken to the Bay Pines emergency room without prior clearance.

Surette collapsed in his office, in a building separate from the main hospital building. Several employees, including registered nurses and physicians, rushed to his aid, checked for vital signs, began CPR, and yelled for someone to call 911, according to the chronology provided by John Pickens, a regional spokesman for the Department of Veterans Affairs.

Bay Pines' emergency operator was contacted and relayed the request for an ambulance to the county's dispatch center. Meanwhile, employees continued CPR.

Surette had a feeble pulse, shallow respiration and, in less than a minute, he stopped breathing altogether, Pickens said. Employees were unable to find a pulse. Paramedics shocked Surette with a defibrillator two to three times without a response, and they couldn't find a vein to start an intravenous line, according to the chronology.

One of the paramedics asked employees if Surette was a veteran. Employees said they didn't think so because he was deaf. The paramedic said Surette would then have to be taken to a community hospital.

"Although employees told the paramedics that the facility emergency room was just a few hundred feet away, the paramedics said they would just be sent to another hospital anyway," the chronology says. "Employees tried to convince the paramedics that the facility could not refuse nonveterans in emergency situations."

Unknown to the employees, an ambulance service supervisor at the scene contacted a county dispatcher who, in turn, called Bay Pines to see if the hospital's emergency room would take Surette, according to county EMS officials and a tape recording of the communication.

The response was no.

Information was relayed by the dispatcher to Bay Pines: that the patient was in cardiac arrest, that he was a non-veteran, and that he had collapsed at the VA complex, said Hare, the EMS coordinator.

The information was relayed to a nurse at Bay Pines, Pickens said. Since the emergency room typically takes patients whether they are veterans or not, he said, the nurse was taken aback by the request for permission. In her confusion, she failed to tell the doctor who made the ultimate call that the heart-attack victim was at Bay Pines, Pickens said.

"Typically, if on site, they don't call, they just bring them in," Pickens said.

County EMS administrators said that historically, paramedics dealing with Bay Pines radio beforehand and provide the patient's condition, state whether the patient is a veteran and ask whether the center will take the patient. Typically the only patients transported there are veterans or family members of veterans.

"They don't routinely take nonveterans," said Jeff Barnard, executive director of the county EMS medical director's office.

Reporter Stephen Thompson can be reached at (727) 451-2336 or spthompson@tampatrib.com.