05-002179 Pinellas County Emergency Medical Services, Office Of The Medical Director vs. Mike Jones Status: Closed Recommended Order on Monday, March 13, 2006.

Summary: Repondent`s refusal to respond to a 911 call for emergency medical services merited the revocation of his county paramedic certificate.

STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

PINELLAS COUNTY EMERGENCY )

MEDICAL SERVICES, OFFICE OF THE )

MEDICAL DIRECTOR , )

)

Petitioner, ) Case No. 0 5 - 2 179

)

vs. )

)

MIKE JONES , )

)

Respondent. )

)

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

1 01 East Kennedy Boulevard, Suite 900

Tampa, Florida 336 02

For Respondent: Mike Jones, pro se

2118 Carmen Street

Tampa, Florida 3360 6

STATEMENT OF THE ISSUES

The issues in this case ar e whether Respondent c ommitted

the alleged violation and, if so, should h is Pinellas County

Paramedic Certificate be revoked.

PRELIMINARY STATEMENT

By copy of a letter dated Ma y 10, 2005 , and addressed to

Jamie Geer, chief of the City of Clearwater Fire D epartment, the

Pinellas County medical director advised Respondent that h is

Pinellas County Paramedic Certificate was revoked.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 assist ance, in

violation of Pinellas County Emergency Medical Services ("EMS")

rules, regulations , and protocols. Petitioner is charged with

violating Medical Operations Manual Protocols 3.1 h and 3.1 k ,

as well as Pinellas County EMS Rules and Regulations,

Sec tion V.M.3.k.

Respondent denied the allegations and timely requested a

f inal 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 R ecommended O rde r.

At hearing, Petitioner presented the testimony of Laurie

Romig, M.D., the m edical d irector 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; an d 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, P etitioner 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 P roposed

R ecommended O rder 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 P inellas 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 Protoc o ls ," 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 , Respon dent

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, o perated 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 s upervisor. CFRD c hief ,

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 task s of driving

and filing reports and that the positi on 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 t hat the lead medic and the

paramedic are required to follow the same Pinellas County EMS

rules and M OM protocols. Nonetheless, given the list of duties

entrusted to the lead medic, it was not unreasonable for

Respondent to view Mr. Murray as his superviso r.

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 CF RD'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 S outh Maywood

Avenue. The caller reported that a sexual assault had occurred.

T he Clearwater Police Department and the Sunstar Ambulance

Service were also dispatched to the stated address.

8 . The address, 309 S outh 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

re sidence and sexually assaulted her on many occasions. The

repor ts 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

responde r of a sexual assault.

9 . By the time R49B received the call from the dispatcher,

officers from the Clearwater Police Department w ere on the way

to the address. Mr. Murray told the dispatcher to have the

police officers call back if they arrived and disc overed 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 S outh 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 enforce ment to secure the area before emergency services

personnel enter. There was no indication that the woman at

309 S outh 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 S outh 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 c alls 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 w hen

there is evidence of maliciousness. Chief Geer noted that all

indications were that the caller at 309 S outh Maywood Avenue

believed she needed medical assistance. In such cases, the

paramedics do not have the discretion to ignore a 911 call or to

wai t for the police to let them know whether the emergency is

"real."

13 . Dr. Laurie Romig, the m edical d irector 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 c ertain 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 S outh

Maywood Avenue dispatch, the communications supervisor for the

Sunstar A mbulance S ervice notified David Hudak, the Pinellas

County m edical c ommunications o fficer, 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

q u ality a ssurance m anager, 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 bri efed 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 inform al , 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 S outh Maywood Avenue. Mr. Lock confirmed that Respondent

and Mr. Murray were properly disp atched to 309 S outh 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 Pro tocols and Pinellas County EMS r ules

regarding a paramedic's duty to act.

18. The formal investigatory hearing was held on May 3,

2005, before Dr. Romig. At the hearing, Res pondent 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 parame dics 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 :

[I]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 k now

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 m ake 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 su p eriors.

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 S outh Maywood Avenue was a nui sance

caller , if not a "problem caller" under Chief Geer's criteria .

However, Respondent's evidence falls far short of demonstrating

that he w as justified in not responding to the call from that

residence on the morning of March 26, 2005.

23. The Pinel las 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. R espondent 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

dire ctor "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 proce ed 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 m edical d irector'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 bu rden.

28 . Petitioner proved by clear and conv incing 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

Pe titioner '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 o rder

finding Respondent guilty of the violations alleged in the

Notice of Revocation dated Ma y 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

w ww.doah.state.fl.us

Filed with the Clerk of the

Division of Administrative Hearings

this 13 th day of March, 2006.

ENDNOTE S

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.