STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

PINELLAS COUNTY EMERGENCY ) MEDICAL SERVICES, OFFICE OF THE ) MEDICAL DIRECTOR, )

)

Petitioner, )

)

vs. )

)

MIKE JONES, )

)

Respondent. )

Case No. 05-2179

)

RECOMMENDED ORDER

Pursuant to notice, a final hearing in this case was held on October 6, 2005, in Largo, Florida, before Lawrence P. Stevenson, a duly-designated Administrative Law Judge of the Division of Administrative Hearings.

APPEARANCES

For Petitioner: Dawn Siler-Nixon, Esquire

Ford and Harrison LLP

101 East Kennedy Boulevard, Suite 900 Tampa, Florida 33602

For Respondent: Mike Jones, pro se

2118 Carmen Street

Tampa, Florida 33606 STATEMENT OF THE ISSUES

The issues in this case are whether Respondent committed the alleged violation and, if so, should his Pinellas County Paramedic Certificate be revoked.

PRELIMINARY STATEMENT

By copy of a letter dated May 10, 2005, and addressed to Jamie Geer, chief of the City of Clearwater Fire Department, the Pinellas County medical director advised Respondent that his Pinellas County Paramedic Certificate was revoked. The medical director took this action because Respondent allegedly refused to respond to a 911 call for emergency medical assistance, in violation of Pinellas County Emergency Medical Services ("EMS") rules, regulations, and protocols. Petitioner is charged with violating Medical Operations Manual Protocols 3.1h and 3.1k,

as well as Pinellas County EMS Rules and Regulations, Section V.M.3.k.

Respondent denied the allegations and timely requested a final hearing. The matter was forwarded to the Division of Administrative Hearings for assignment of an Administrative Law Judge to conduct the hearing and prepare a Recommended Order.

At hearing, Petitioner presented the testimony of Laurie Romig, M.D., the medical director for Pinellas County EMS; David Lock, quality assurance manager of the Office of the Medical Director ("OMS"); Jamie Geer, fire chief of the City of Clearwater; and Respondent. Petitioner's Exhibits numbered 1 through 11 were admitted into evidence. Respondent testified on his own behalf and offered Respondent's Exhibits numbered 1 through 6, which were admitted into evidence.

The Transcript of the proceeding was filed on October 27, 2005. At the conclusion of the hearing, the parties agreed to file proposed recommended orders ten days after the Transcript was filed. On November 4, 2005, Petitioner filed an agreed motion for an extension of time to file proposed recommended orders, which was granted by order dated November 7, 2005. In accordance with the order, Petitioner timely filed a Proposed Recommended Order on December 2, 2005. Respondent did not file a proposed recommended order.

FINDINGS OF FACT

1. At all times relevant to this proceeding, Respondent was employed as a paramedic by the City of Clearwater Fire and Rescue Department ("CFRD"). In this capacity, Respondent worked under the auspices of the medical director for Pinellas County

   EMS.

   
   

2. The Pinellas County emergency protocols are written

   
   

   requirements that paramedics must follow when administering emergency treatment to patients. The protocols are published in a document entitled Pinellas County Medical Operations Manual, commonly called the "MOM Protocols," which are approved by the medical director and distributed to all Pinellas County EMS paramedics. Respondent received a copy of the most recent medical operations manual in January 2005.

3. At all times relevant to this proceeding, Respondent and fellow paramedic, Trevor Murray, were members of CFRD Crew "B" shift for Pinellas County, referred to colloquially as "R49B." Mr. Murray was the "lead medic" according to then- current CFRD nomenclature, meaning that he drove the team's vehicle, operated the vehicle's radio, made decisions regarding appropriate medical treatment to be rendered to a patient, and was responsible for all written reports.

4. The evidence conflicted as to whether the lead medic, Mr. Murray, functioned as Respondent's supervisor. CFRD chief, Jamie Geer, testified that the position of lead medic was merely a designation bargained for by the firefighters' union in order to obtain a pay differential for the additional tasks of driving and filing reports and that the position carried no supervisory responsibility.

5. Respondent testified that, whatever the official view espoused by Chief Geer, the common understanding in the firehouse was that the lead medic supervised the paramedic with whom he rode. Respondent conceded that the lead medic and the paramedic are required to follow the same Pinellas County EMS rules and MOM protocols. Nonetheless, given the list of duties entrusted to the lead medic, it was not unreasonable for Respondent to view Mr. Murray as his supervisor.

6. There was no dispute that the Pinellas County OMD recognizes only the designation "paramedic," meaning a paramedic certified by the State of Florida and certified by the Pinellas County OMD. The Pinellas County OMD took no official notice of the CFRD's distinction between lead and non-lead paramedics.1

7. During the early morning hours of March 26, 2005, Respondent and Mr. Murray were the crew of R49B. At approximately 5:30 a.m., R49B was dispatched in response to a 911 call for emergency medical assistance at 309 South Maywood Avenue. The caller reported that a sexual assault had occurred. The Clearwater Police Department and the Sunstar Ambulance Service were also dispatched to the stated address.

8. The address, 309 South Maywood Avenue, was immediately recognized by Mr. Murray as the residence of a 41-year-old female who had called 911 approximately 15 times over a two-year period for the same type of complaint. The various patient care reports filed by Pinellas County EMS over the course of two years indicated that the woman had an extensive psychiatric history. She claimed to be the victim of a massive government conspiracy that included the FBI, the CIA, and the DEA. She claimed that then-Attorney General John Ashcroft had entered her residence and sexually assaulted her on many occasions. The reports indicated that she was difficult and combative at times with the police and paramedics who responded to her calls. The

   record indicates that she had accused at least one emergency responder of a sexual assault.

9. By the time R49B received the call from the dispatcher, officers from the Clearwater Police Department were on the way to the address. Mr. Murray told the dispatcher to have the police officers call back if they arrived and discovered that an actual emergency existed. Mr. Murray then placed R49B back on "available" status, meaning that it was free to respond to other calls. The record indicates that R49B was not called back on the morning of March 26, 2005, concerning 309 South Maywood Avenue.

10. Respondent and Mr. Murray manned an Advanced Life Support Unit ("ALS Unit"). MOM Protocol 3.1k provides, in relevant part:

    An ALS Unit . . . must continue to the scene of every 911 request for service and determine the need for EMS first hand. Once the 911 system is activated for an EMS call, a County Certified Paramedic must investigate it. An EMS response shall not be canceled by the general public or law enforcement.

    
    

11. Chief Geer testified that the quoted protocol means that paramedics have no discretion as to whether to respond to a 911 call, unless there is a possibility of violence. MOM Protocol 6.5 may be invoked to provide for "staging" on a call involving possible violence. Staging essentially provides for

    law enforcement to secure the area before emergency services personnel enter. There was no indication that the woman at

    309 South Maywood Avenue posed a threat of violence, though she had been accusatory and otherwise verbally abusive to EMS personnel. As of March 26, 2005, there were no standing orders to stage on calls from 309 South Maywood Avenue.

12. Chief Geer further testified that 15 calls in one day or week might cause the CFRD to label someone a "problem caller" meriting special treatment, but that 15 calls over a two-year period was insufficient. Chief Geer stated that it is not uncommon for Alzheimer's patients, for example, to dial 911 several times in one day. A caller is labeled a "problem caller" and referred to the Clearwater Police Department when there is evidence of maliciousness. Chief Geer noted that all indications were that the caller at 309 South Maywood Avenue believed she needed medical assistance. In such cases, the paramedics do not have the discretion to ignore a 911 call or to wait for the police to let them know whether the emergency is "real."

13. Dr. Laurie Romig, the medical director for Pinellas County EMS, testified that it is imperative for Pinellas County EMS to have the same response for every 911 call. The fact that a certain address is known and notorious among paramedics is not germane. The caller could be another person at the same address

    or the same person with a different problem. The only way to be sure that a 911 call is a false alarm is to respond to the call.

14. At the hearing, Respondent conceded that he and Mr. Murray should have responded to the call. He made no

    attempt to minimize the dereliction of duty involved in failing to respond to a 911 call. Respondent's defense was that

    Mr. Murray, the lead medic, made the decision not to respond to the call. Respondent testified that he objected to Mr. Murray's decision, but that he considered it a direct order from a superior that he must follow. Respondent did not report the incident to superior officers at the time it occurred.

15. After hearing R49B's radio response to the 309 South Maywood Avenue dispatch, the communications supervisor for the Sunstar Ambulance Service notified David Hudak, the Pinellas County medical communications officer, about the incident.

    Mr. Hudak initiated a quality assurance review ("QAR"), a process designed to assure that Pinellas County EMS personnel have provided quality care and observed the applicable MOM Protocols. Mr. Hudak also informed the Pinellas County OMD's quality assurance manager, David Lock, of the incident and the initiation of the QAR. Mr. Lock took charge of the investigation.

16. On March 28, 2005, Mr. Lock met with Dr. Romig and Jeff Bernard, the executive director of the Pinellas County OMD,

    and briefed them on the subject of his investigation. Dr. Romig testified that "my jaw dropped" upon hearing what had occurred, because she had never encountered a situation in which paramedics had not responded to a 911 call. Dr. Romig placed Respondent and Mr. Murray on "clinical suspension," pursuant to Pinellas County EMS Rule XIII.E.1.a., pending the outcome of the QAR. A clinical suspension precludes a paramedic from participating in patient care in any capacity.

17. The QAR process consists of an informal, fact-finding process followed by a formal hearing before the medical director. Mr. Lock initiated the informal stage by reviewing the documentary record, including the written incident reports and copies of the patient care records from previous calls to

    309 South Maywood Avenue. Mr. Lock confirmed that Respondent and Mr. Murray were properly dispatched to 309 South Maywood Avenue, that neither Respondent nor Mr. Murray notified their superior officer of their failure to respond to the call, and that Respondent and Mr. Murray admitted that their conduct was in violation of MOM Protocols and Pinellas County EMS rules regarding a paramedic's duty to act.

18. The formal investigatory hearing was held on May 3, 2005, before Dr. Romig. At the hearing, Respondent again admitted to violating MOM Protocols. After the hearing,

    Dr. Romig decided to revoke Respondent's county certification.

19. Dr. Romig testified that her decision hinged on the question of trust. Dr. Romig oversees approximately

    750 paramedics and 750 emergency medical technicians, all of whom work under the authority of her medical license. See Section 401.265, Florida Statutes (2005).2 She was not aware of Respondent's existence until this situation arose. Dr Romig testified as follows:

    1. t's been said over and over again today about the basic expectation of the public being that when they call, we come. And when I provide the authority for paramedics and EMTs to work under my license, because we're such a big system, I can't get to know each and every one of them intimately in order to establish, you know, a trust level, so I have to grant them trust to begin with.

    
    

    And my problem is, if I can't trust that they follow such a basic tenet as "you call, you go," how can I trust them to make much more complex decisions such as administering medications or doing procedures that could actually harm somebody as much as help them. . . . I don't have any evidence to say that their skills aren't good, but it's their decision making that I have to call into question and whether or not I can trust them to do what I ask them to do.

    
    

20. Dr. Romig testified that in the case of an improperly administered medication, she could require training and testing to ensure that the paramedic does not repeat the error. However, Dr. Romig believed there is no way to remediate her basic trust in a paramedic's judgment once it has been broken. Therefore, she concluded that revocation was the only

    appropriate remedy. Dr. Romig's testimony is credited, and her conclusion was reasonable.

21. Respondent's claim that he was only obeying the instructions of his superior, Mr. Murray, would be more compelling had Respondent taken any subsequent action to bring Mr. Murray's breach of duty to the attention of their superiors. Respondent's silence at the time of the incident indicates acquiescence, if not approval, of the course of action taken by Mr. Murray.

22. Respondent offered evidence sufficient to establish that the resident of 309 South Maywood Avenue was a nuisance caller, if not a "problem caller" under Chief Geer's criteria. However, Respondent's evidence falls far short of demonstrating that he was justified in not responding to the call from that residence on the morning of March 26, 2005.

23. The Pinellas County OMD must ensure that EMS personnel provide quality care and are not a danger to the safety of the county's residents. As the medical director, Dr. Romig is ultimately accountable for the actions of the paramedics operating under her license. Respondent breached the most basic level of his duty as a paramedic: to respond to every 911 call for emergency medical assistance. Given all the circumstances, Dr. Romig had sufficient cause to revoke Respondent's Pinellas County Paramedic Certification.

    CONCLUSIONS OF LAW

    
    

24. The Division of Administrative Hearings has jurisdiction over the subject matter of and the parties to this action pursuant to Sections 120.569 and 120.57, Florida Statutes.

25. Pursuant to Subsection 401.265(1), the medical director "must supervise and assume direct responsibility for the emergency medical technicians and paramedics operating for that emergency medical services system." As the medical director of the Pinellas County EMS, Petitioner supervises and assumes direct responsibility for EMTs and paramedics in that system.

26. Petitioner alleges that Respondent violated Pinellas County Emergency Medical Services Protocols 3.1h, related to the duties of a first responder, and 3.1k, related to duty of an ALS unit to proceed to the scene of every 911 request and determine the need for EMS first hand, as well as Pinellas County EMS Rules and Regulations, Section V.M.3.k, providing that persons working pursuant to a medical director's certification may be disciplined for just cause, "including unbecoming behavior or unprofessional conduct reflecting a poor system image." For these alleged violations, Petitioner seeks to revoke Respondent's certification as a paramedic in Pinellas County, Florida.

27. Petitioner must prove the allegations against Respondent by clear and convincing evidence. Ferris v.

    Turlington, 510 So. 2d 292 (Fla. 1987); and Evans Packing Co. v. Department of Agriculture and Consumer Services, 550 So. 2d 112 (Fla. 1st DCA 1989). Petitioner has met its burden.

28. Petitioner proved by clear and convincing evidence, including Respondent's own admission, that Respondent improperly failed to respond to a 911 call requesting emergency medical services and that just cause exists warranting the revocation of Petitioner's Pinellas County Paramedic Certificate.

RECOMMENDATION

Based upon the foregoing Findings of Fact and Conclusions of Law, it is hereby

RECOMMENDED that the Pinellas County Emergency Medical Services, Office of the Medical Director, enter a final order finding Respondent guilty of the violations alleged in the Notice of Revocation dated May 10, 2005, and revoking Respondent's Pinellas County Paramedic Certificate.

DONE AND ENTERED this 13th day of March, 2006, in Tallahassee, Leon County, Florida.

S

LAWRENCE P. STEVENSON

Administrative Law Judge

Division of Administrative Hearings The DeSoto Building

1230 Apalachee Parkway

Tallahassee, Florida 32399-3060

(850) 488-9675 SUNCOM 278-9675

Fax Filing (850) 921-6847 www.doah.state.fl.us

Filed with the Clerk of the Division of Administrative Hearings this 13th day of March, 2006.

ENDNOTES

1/ Chief Geer testified that, pursuant to a new union contract, the CFRD no longer employs the "lead medic" designation, though he was unclear as to when this new contract took effect.

2/ All citations are to Florida Statutes (2005) unless otherwise indicated.

COPIES FURNISHED:

Mike Jones

2118 Carmen Street

Tampa, Florida 33606

Dawn Siler-Nixon, Esquire Ford and Harrison LLP

101 East Kennedy Boulevard, Suite 900 Tampa, Florida 33602

Laurie A. Romig, M.D., FACEP Office of the Medical Director

Pinellas County Emergency Medical Services 12490 Ulmerton Road

Largo, Florida 33774

Robert Swain, Esquire

Pinellas County Attorney's Office

315 Court Street, 6th Floor Clearwater, Florida 33756-5165

NOTICE OF RIGHT TO SUBMIT EXCEPTIONS

All parties have the right to submit written exceptions within

15 days from the date of this Recommended Order. Any exceptions to this Recommended Order should be filed with the agency that will issue the Final Order in this case.

Docket for Case No: 05-002179

Orders for Case No: 05-002179