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Pinellas paramedics already had chosen hospital.

Pinellas officials maintain they rushed a heart attack victim to a more-distant hospital on June 26 after the Bay Pines VA Medical Center refused to treat him in its emergency room just 200 feet away.

While true, that's not the full story.

A newly released recording of emergency communications, reviewed by the St. Petersburg Times on Saturday, reveals that county paramedics had already decided among themselves to take the man, Mark A. Surette, to St. Petersburg General Hospital, 3 miles away.

Shortly after that decision, a paramedic called Bay Pines to double-check and "make sure because they could see the (Bay Pines) emergency room," said Craig Hare, division chief for Pinellas emergency medical services.

At that point, a Bay Pines physician told paramedics the emergency room wouldn't treat Surette.

The recording sheds new light on the sequence of events after Surette's collapse. And it appears to show that while Bay Pines did refuse to see Surette, paramedics also had concluded that it was best to take him elsewhere, which is something the county has not previously revealed.

Surette, 51, a 17-year Bay Pines employee, fell ill on the facility's property and was pronounced dead at St. Petersburg General. While both the county and the Department of Veterans Affairs have said it is impossible to know if the longer ambulance trip cost Surette his life, Hare said Saturday it is unlikely the extra time made any difference.

"There's very little an emergency room physician could have done differently than the paramedics on the scene," Hare said.

John Pickens, a regional VA spokesman, declined to comment because of a pending investigation of the incident by the VA's medical inspector.

The recording shows a level of uncertainty among paramedics about where to transport Surette.

What they said

At the beginning of the recording, an advance paramedic who supervises those at the scene is told Surette is on VA property but that he may not be a veteran. None of the men are identified.

"Does this patient need to go to another facility or do they go right to the ER there?" someone asked the supervisor, who is at a communications center.

"Yeah," the supervisor replied. "That's a good question. Stand by. ... We know for sure this person is not a vet?"

"He's probably not, I'm being told," a paramedic said.

The supervisor answered, "I don't see a problem transporting him to - what would be your next closest, St. Pete General?"

"That's affirmative."

"Yeah, I don't see a problem transporting him there," the supervisor said.

Someone cut in, "What was the determination?"

The supervisor repeated: "We'll go to St. Pete General."

But within seconds, a call was placed to Bay Pines emergency room by a paramedic asking if it would take Surette. It refused.

"We expected that Bay Pines would not accept the patient," Hare said, explaining the paramedic communication. "The paramedics were not confused. The paramedics aggressively treated the patient and worked diligently to save his life. It's up to Bay Pines to make a decision to accept the patient. They were fully informed and they made that decision."

Bay Pines officials have said that they would have treated Surette. But they said a VA physician thought he had fallen ill off their property. The VA says paramedics don't transport nonveterans to its emergency room when they fall ill off its property.

New pact signed

On Thursday, Bay Pines and the county signed an agreement allowing paramedics to bring critically ill nonveterans to the VA emergency room without calling first, but only when they fall ill on agency property.

If a nonveteran falls seriously ill even one foot off Bay Pines property, paramedics will take the patient to another hospital.

The county and VA's versions of Surette's collapse, and prior instructions to paramedics on when to bring patients to the facility, haven't matched in the days since news of Surette's case was first published.

On Friday, Rep. C.W. Bill Young said the VA needs to provide clear direction to its emergency rooms around the nation about when nonveterans can receive treatment. That, he said, will prevent a repeat of Surette's case.

The Pinellas medical director, Dr. Laurie Romig, is investigating the paramedic response to the incident.

"Our normal protocol is that if we're across the street (from Bay Pines), we take them to St. Pete General," said Hare. "Keep in mind, we run 150,000 calls a year and transport 117,000 patients. We deal with these situations every day. We treat and transport patients appropriately."

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