Florida VA Hospital, EMS Backtrack on ER Access for Non-Vets

ST. PETERSBURG - A former Pinellas paramedic said Thursday that she and her colleagues knew better than to take nonveteran patients to the Bay Pines VA Medical Center emergency room.

"If you brought them, you got turned away," said Stacie Smith, 35, a paramedic from 1996 to 2003. "It got to the point that, if you had a non-vet, why call to ask them if you couldn't bring them there?"

Her recollection was confirmed Thursday by officials at the Department of Veterans Affairs and Pinellas County. They said the VA emergency room always directs paramedics to take critically ill nonveterans to other hospitals unless they suffer a health emergency on Bay Pines' property.

The county and the VA had previously said that they had a verbal agreement allowing paramedics to take critical nonveterans to Bay Pines, if it was the closest emergency room. In detailing that pact, they made no distinction between patients on or off VA land.

On Thursday, the Pinellas medical director, Dr. Laurie Romig, backtracked, saying no such agreement ever existed. Only "discussions" were held, she said.

Bay Pines officials blamed miscommunication for a June 26 incident in which paramedics were told by the facility to take a Bay Pines worker, Mark A. Surette, to a hospital three miles away. Surette, 51, collapsed during a heart attack on VA property, 200 feet from the Bay Pines emergency room.

Surette later died at St. Petersburg General Hospital. Officials have said it is impossible to know if the delay contributed to his death.

Romig is investigating paramedics' response.

On Thursday, the VA and Romig signed an agreement saying paramedics could take seriously ill nonveterans to the VA emergency room without seeking prior clearance - only if they fall ill on Bay Pines property.

"Typically, that's how it works, if it's not a veteran," said VA regional spokesman John Pickens.

Romig and Craig Hare, an emergency medical services division chief for Pinellas, declined to discuss whether they are satisfied with the agreement, which means a nonveteran who falls ill even a foot off VA property can't be taken to Bay Pines' emergency room.

"We're happy that when patients are in physical proximity, they accept and stabilize them," Hare said.

Smith, the former county paramedic, said she recalled one 1998 incident in which an 86-year-old woman suffered a stroke across the street from Bay Pines. Paramedics sought permission to take her to the VA emergency room and were refused, she said.

The woman later died. The VA refused to discuss her case.

Also Thursday, the county released additional audio recordings to the St. Petersburg Times of communication among paramedics who responded to Surette's heart attack. The county hadn't previously released them despite a public records request by the newspaper.

The VA said that a doctor turned away Surette because he didn't realize the man had collapsed on VA property. Hare disputed that claim.

"They were fully aware of the patient's condition, and they were fully aware that we were on their campus," Hare said.

Newly released recordings also cast doubt on the VA's assertion.

"We can see the ER," one paramedic said. "We're like one building away from the ER. But you want us to transport to St. Pete General or do you want us to transport to the ER here?"

An unidentified voice responds, "It has been confirmed he is not a vet."

U.S. Rep. C.W. Bill Young, R-Indian Shores, said he has requested that the VA provide its written policy on when it will accept seriously ill nonveterans at its emergency rooms around the nation.

So far, Young said, the VA tells him such a policy exists, but it can't provide him with a copy. A national VA spokesman could not be reached late Thursday.

"They're searching," Young said. "I suspect it doesn't exist. There should be a policy for this reason: A VA hospital should not become a general hospital. But in the case of a life-threatening situation, any medical facility, government or not, should be available to save the life of a human being."

A June 2007 Bay Pines memo detailing medical rules notes unequivocally, "Persons with emergent/urgent care needs shall be admitted without delay whether or not they are eligible for VA care."

But Pickens said that only refers to nonveteran patients who show up or are taken unannounced to the VA emergency room. The memo, he said, does not refer to paramedics calling to seek permission to take nonveterans there from off VA property.

Smith, the former Pinellas paramedic, and the county confirmed that the VA goes to lengths to determine if a patient is a veteran when paramedics call seeking permission to take someone to Bay Pines from off its property.

The VA requests the last four digits of patients' Social Security numbers and part of their name, which they can use to determine whether they are veterans.

If patients are confirmed to be veterans, paramedics are often free to transport them to Bay Pines, officials said.

If not, the patient, regardless of condition, is diverted elsewhere, she said.

"If you're not a veteran, I couldn't have taken you to the VA hospital even for a bloody nose," said Smith, a Tampa resident. "And you always had to call. It was like getting an invitation to someone's house."

The VA said earlier this week that paramedics didn't have to call to get permission to go to its emergency room. But both the county and Smith said that isn't true.

Paramedics never take a patient to any emergency room without calling the hospital, they said.

Confusion exists even among some Bay Pines employees about when they can use the VA emergency room.

Roger Curry, 60, a gardener at Bay Pines' cemetery, said workers at the cemetery aren't allowed to visit the emergency room for work-related injuries and must drive to the VA's James A. Haley Medical Center in Tampa.

Curry said workers who are also veterans sometimes visit the emergency room rather than drive to Tampa.

But they go as veterans, he said, incurring some cost. In those cases, they don't file worker's compensation claims.

Asked if he would be taken to the Bay Pines emergency room if he had a serious medical problem, Curry said, "It hasn't happened yet, and I don't know."

Pickens, the VA spokesman, said those cemetery employees would be seen by Bay Pines emergency room if they required urgent care. But he confirmed that, otherwise, they must visit Haley because their health records are kept there.

"It's a completely insane way of doing things," Curry said.

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