TIMELINE OF EVENTS IN PAUL ANDERSON CASE
Sunday Oct. 2
8 a.m. Friend takes Paul Anderson, 80, to Marco Urgent Care Center.
8:30 a.m. Approximate time Anderson arrives at urgent care center.
8:45 a.m. Friend walks into nearby Marco fire station for help at urgent care center.
8:48 a.m. Collier County Medic Rescue 50 ambulance dispatched to urgent care center.
8:54 a.m. Battalion Chief advises to hold call. Medic Rescue 50 placed on standby in station.
9:02 a.m. Medic Rescue 50 canceled.
9:03 a.m. Battalion Chief says NCH ambulance will transport Anderson.
9:18 a.m. Second 911 call comes in of an 80-year-old male having difficulty breathing, high blood pressure at Marco Urgent Care Center. Collier County Medic Rescue 90 ambulance dispatched.
9:19 a.m. Collier County Tower 50 firefighter/paramedic unit dispatched to Marco Urgent Care Center.
9:21 a.m. Medic Rescue 90 arrives, placed on standby.
9:22 a.m. Anderson’s friend says NCH ambulance driver arrives for 9 a.m. shift.
9:26 a.m. Confusion about a second patient
9:32 a.m. Medflight is requested.
9:36 a.m. Medflight is put on standby. Tower 50 assists with loading Anderson in NCH transport ambulance. Paramedic rides with NCH unit.
9:40 a.m. Medic Rescue 90 advises that there was only one patient and he was transported to NCH.
Monday, Oct. 3
Paul Anderson dies.
COLLIER COUNTY — Collier County paramedics will be dispatched to the Marco Island Urgent Care Center when possible to evaluate patients for emergencies to safeguard against delays that may have lead to a man's death earlier this month.
"Essentially, the Marco ambulance, if it is available, will go to the Marco health center to triage patients (when an emergency call comes in)," county spokesman John Torre said.
The ambulance team, in concert with the physician at the center, will determine if the patient needs immediate transport to a hospital. EMS would handle it in those cases, Torre said. The protocol before was for the EMS chief to first talk with NCH before sending the ambulance out, Torre said
In other instances, EMS's Operations Chief Walter Kopka will consult with NCH's transport director to determine if the hospital system's internal ambulance can be used.
The revision to the county's protocol is until a more permanent solution can be found and was requested by the Marco city manager's office, he said.
The change was prompted after the death earlier this month of Paul Anderson, 80, who waited about 40 minutes in medical distress at the urgent care center to be taken to NCH Downtown Naples Hospital on Sunday, Oct. 2,
The NCH Healthcare System, which operates the Marco urgent care center, also is looking into what happened on its end, said Dr. Allen Weiss, president and chief executive officer of the hospital system.
"We're still investigating," Weiss said, adding that he is not familiar with the details of Anderson's transport.
A friend of Anderson's took him to the urgent-care center around 8:30 a.m. that Sunday morning when he complained of dizziness. He later died at the hospital as a result of a stroke he had suffered that morning in his home.
Since 2004, NCH has operated its own limited ambulance to transport patients from one NCH facility to another, usually between Downtown Naples Hospital and North Naples Hospital, although the Marco center is included.
Not all services are available at both hospitals, such as open-heart surgery and obstetrics, and some patients are transferred to one or the other hospital because of a surgeon's preference, Weiss said.
After Anderson arrived at the urgent care center, staff called 911 at 8:48 a.m. for an EMS ambulance but it was called off after Kopka spoke to NCH's transport director. He was told the hospital was handling the transport.
The urgent-care staff called 911 again at 9:17 a.m. and an ambulance from Isle of Capris arrived on the scene when Anderson was being loaded into NCH's ambulance. Bob Rowe, Anderson's friend who took him to the urgent-care center, told authorities that NCH's ambulance driver didn't show up until 9:22 a.m. even though the center opened at 9 a.m.
One of Marco's firefighter/paramedics rode in NCH's ambulance to assist with Anderson, according to reports.
NCH uses off-duty paramedics from the county for its "intra-facility" transports; Weiss said he did not have the details why a firefighter/paramedic from the county went along that morning.
The delays in Anderson's transport to the hospital coincided with a decision by the county to stop providing backup ambulance support to NCH for hospital-to-hospital transports because of nonpayment of past bills for the service. The new policy went into effect Oct. 1.
NCH owes the county $178,742. Physicians Regional Healthcare System owes the county $431,853 for ambulance transports between its hospitals at Pine Ridge Road and Collier Boulevard. Physicians Regional does not have its own internal ambulance.
Both hospital systems stopped paying the county for the ambulance calls last summer, although Physicians Regional did make two payments of $12,500 in August, 2011.
"We believe (for) patient transports for emergencies from one hospital to another, that the county should be billing the patient," Weiss said.
A Miami attorney, Joanne Erde, sent County Attorney Jeff Klatzkow a letter in June that says a 2008 ordinance that the hospitals must pay the bills violates federal law regulating Medicare.
Weiss said when NCH moves a patient between its hospitals for the convenience of a surgeon, nobody is billed.
"If the county does the transport, Medicaid, Medicare or the patient's insurance should be billed. The law is clear," he said, adding that the matter with the county will be resolved shortly.
"I think we are working through that now," he said.