The U.S. Department of Veterans Affairs will open an independent investigation into why a VA emergency room refused to treat a nonveteran who suffered a heart attack a short distance from its entrance.
Rep. C.W. Bill Young said VA officials told him Friday that their medical inspector will conduct an inquiry. The investigation comes after Young asked the agency to show him its written policy for treating nonveterans who fall seriously ill near VA facilities.
The Bay Pines VA Medical Center says it always directs paramedics to take critically ill nonveterans to other hospitals, even when its emergency room is the closest, unless an urgent medical need takes place on its sprawling campus.
But on June 26, Mark A. Surette, 51, a longtime VA employee, suffered a heart attack on VA property just 200 feet from Bay Pines' emergency room.
Still, the emergency room refused to treat him, directing paramedics to take Surette to a hospital 3 miles away. Surette was pronounced dead there.
Pinellas County and VA officials say it is impossible to know whether the longer trip cost Surette his life.
Young said regulations provided to him by the VA appear to clearly allow the treatment of nonveterans. He said the regulations make no distinction about where the patients fall ill, whether on VA property or off.
He acknowledged, however, the possibility of confusion.
Young said VA officials in Washington need to give their emergency rooms around the nation clear direction.
"I think it would be well for the VA to notify all its medical facilities about just what the rules and regulations are so there won't be any question in the future," Young said.
A national VA spokesman and the medical inspector's office did not return calls for comment.
The medical inspector is an independent arm of the VA that possesses wide powers to interview VA employees, review medical records and present findings to VA officials in Washington.
The Pinellas County medical director, Dr. Laurie Romig, already has launched a local investigation into the paramedic response to Surette's illness.
Surette's daughter, Erica Bailey, 23, of Minot, N.D., said she was pleased by the news of the VA inquiry.
"This should never have happened," Bailey said of the refusal to treat her father, "and they should make sure it never happens again."
Bailey has said she is frustrated by the inability of VA and Pinellas officials to agree on one version of what happened in her father's case.
The divergent VA and Pinellas accounts of Surette's collapse and what direction paramedics have been given in the past only got muddier Friday with the release of a 2-year-old agreement between the VA and Pinellas.
Bay Pines has said one reason it refused to treat Surette was that the emergency room staff thought he had collapsed off its property. VA personnel, they said, were confused because paramedics don't usually call asking for permission to bring a patient there.
But the April 2005 agreement, obtained through a public records request by the St. Petersburg Times, shows that paramedics are required to call the VA before attempting to bring a patient to the facility.
The pact says paramedics need to give Bay Pines a patient's Social Security number and name so that the VA can determine whether an individual is a veteran and eligible to be treated at the facility.
John Pickens, a regional VA spokesman, said the document probably referred only to patients being transported to the VA from outside its property.
On VA property, "They don't have to call. They don't need to seek clearance," Pickens said.
The county failed to cite that 2005 agreement when it announced that it had signed a "memorandum of understanding" on Thursday with Bay Pines that allows paramedics to bring critically ill nonveterans there if they fall ill on Bay Pines property.
The new agreement says paramedics don't have to call first. Asked why the earlier agreement hadn't been revealed to reporters, Craig Hare, division chief for Pinellas emergency management officials, said it was an oversight.
Pinellas officials had said they had entered into no previous agreement with Bay Pines.
In any case, Hare stressed that paramedics have little interaction with the hospital's emergency room, which treats up to 21,000 patients annually. In the last year, two dozen of them have been nonveterans.
"It's a very rare circumstance for a nonveteran to be taken there by ambulance," said Hare.
Neither Pinellas officials nor the VA can agree on whether they ever had a verbal understanding about when nonveterans can be brought to the Bay Pines emergency room.
Earlier in the week, the county medical director, Romig, said a verbal agreement existed that ensured Bay Pines would accept seriously ill patients if it was the closest hospital. She offered no distinction about where the patient fell ill. Romig later reversed herself.
On Friday, the VA sent Young a statement saying Bay Pines and the county had recently discussed the issue of treating nonveterans.
"They reaffirmed," the unsigned statement said, "their long-standing oral agreement that paramedics are empowered to determine where to take patients, including nonveterans, based on the urgency of their medical condition, and that Bay Pines ER will provide appropriate medical care for any patient they receive in their ER."
This statement made no distinction about a patient's location. A VA official in Washington, where the statement was released, did not return calls.
"It appears to me to be fairly clear that a nonveteran in life-threatening distress can be treated in the emergency room" even if they fall ill off VA property, Young said.
Pinellas officials say they can't recall a case in which another nonveteran fell ill on VA property but was denied treatment at Bay Pines.
"We deal with policy and protocol all the time," Romig said. "But you can't write policy and protocol to cover every single possible situation.''
William R. Levesque can be reached at email@example.com or (813) 226-3436.