Officials at Bay Pines VA Medical Center were told the condition of a critically ill cardiac patient before their emergency room refused to treat him on June 26.
But a doctor who made the decision did not realize the man, a Bay Pines employee who later died, had collapsed on the Bay Pines campus.
A hospital nurse was told in a call from a paramedic that the man, 51-year-old Mark A. Surette, had collapsed on Bay Pines property. But she was confused because paramedics usually do not ask permission to bring patients to the emergency room, the hospital said.
"The nurse misunderstood," said John Pickens, regional spokesman for the Department of Veterans Affairs.
Surette, a 25-year VA employee, collapsed of a heart attack in Building 24, perhaps 200 feet from the hospital emergency room.
Since he wasn't a veteran, confused paramedics asked Bay Pines if its emergency room would treat Surette. Paramedics were directed to take him to St. Petersburg General Hospital, three miles away.
Surette was pronounced dead at that hospital, about 41 minutes after 911 was called.
Bay Pines and county officials say they don't know if the delay cost Surette his life. But Surette's family is outraged.
"Nobody ever told us they refused to treat him," said Surette's daughter, Erica Bailey, 23, of Minot, N.D. "Then to find out they knew how sick he was and still turned him away, it just blows my mind."
Bay Pines' chief of staff, Dr. George Van Buskirk, spoke Wednesday with Pinellas County medical director Laurie Romig to formulate a plan assuring all county paramedics know seriously ill nonveterans can be taken to the facility when its emergency room is closest.
A verbal understanding had previously existed between the VA and the county, Van Buskirk said. In fact, Bay Pines has treated two dozen nonveterans at its emergency room in the last year, VA officials said.
But the VA said it will now formalize the understanding in a written agreement.
"They treat nonveterans all the time," Pickens said. "The whole problem was the fact that calls usually don't come in (requesting) permission to bring someone in. Typically, they just bring them. That's the way we always understood it to work. And that's the way it should have worked."
The VA did not identify the doctor who decided against treating Surette or the nurse who took the call from a paramedic.
Bay Pines also confirmed that at the time Surette collapsed, the building where he worked had no portable defibrillators, devices that might revive a cardiac patient. The devices are frequently found at federal facilities.
Within days of Surette's death, the VA installed defibrillators in his building. Surette's collapse, Pickens said, accelerated previous plans to put them there.
Reaction to the case reverberated in Washington, where U.S. Rep. C.W. Bill Young, R-Indian Shores, called the VA's national office seeking clarification of the agency's policy on treating nonveterans.
He said the VA assured him it would treat any seriously ill nonveteran taken to its emergency rooms. But Young said he was concerned that, so far, the VA has not produced a written policy.
"In a life-and-death situation," Young said, "it appears to me that any medical professional would be willing and able to help save a life."
Romig, the county medical director, said she has opened an investigation in the case. Romig is an employee of a private company, Emergency Medical Services Group Inc., which is hired by Pinellas to oversee paramedics.
Romig said that because of high turnover, it is difficult to inform all the county's 800 paramedics that Bay Pines will treat nonveterans.
"The only way to communicate is through continuing education,'' she said. "And that takes time."
Her investigation undoubtedly will focus on a recording of the call made by a paramedic, requesting permission to take Surette to the VA facility.
The county, responding to a public records request, provided the St. Petersburg Times a copy of the recorded call. But, without informing the newspaper, the county erased portions of the recording.
Romig and Assistant County Administrator James Dates, who has oversight of Romig's office, said they did not know why the newspaper was not told of the erasure.
Romig said parts of the conversations were deleted to protect confidential patient information.
It is a violation of law to fail to cite statutory grounds for withholding all or part of a government record.
Romig, who revealed the erasure Wednesday, refused to provide a copy of the complete recording.
Dates said his office had no plan to review Surette's case until Romig completed her inquiry. Romig previously characterized the episode as a "simple mistake."
"When it involves somebody's health, I don't think it's ever a simple mistake," Dates said. "When a hospital like Bay Pines sits in a metropolitan area, it's not unusual to expect them to provide emergency treatment."
Surette's daughter, Bailey, said she was too shocked upon news of her father's death to question why he had been taken to St. Petersburg General.
Her father, who worked as a computer assistant at the time of his death, had spent 17 years at Bay Pines. He worked eight years previously for the VA in Maryland.
"It should have occurred to me: The emergency room is right there. Why didn't they take him there?" Bailey said. "Looking back on things, I should have asked about that."
She said her father, who was deaf, was found unconscious in his chair, gasping for air.
Bailey said family members were told a nurse working in the building responded immediately. They were not told any doctor responded, as the VA contends.
Someone administered CPR, Bailey said, and her father's heart stopped by the time paramedics arrived. Efforts were made to revive Surette, both in the building and later at St. Petersburg General.
She said VA employees have been very supportive. But she's still upset.
"I want to get something done so this never happens again," Bailey said.
William R. Levesque can be reached at email@example.com or (813) 226-3436.