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Medical director
responds to allegations

By Jeff M. Hardison © Feb. 4, 2016 @ 6:17 p.m.
The medical director for the Levy County Department of Public Safety (LCDPS) said he disagrees with what Dr. Devaiah Pagidipati said Tuesday morning (Feb. 2), when Dr. Pagidipati told the Levy County Board of County Commissioners that the LCDPS ambulances are not transporting people to Regional General Hospital in Williston when those patients request to be taken to that hospital.

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     Dr. Jason Jones is the LCDPS medical director. Dr. Jones said the LCDPS Paramedics must take patients where they want to go, as long as those individuals are awake coherent.
      However, in cases where the patient is suffering from a stroke for instance, those patients must be taken to emergency rooms at hospitals in Gainesville or Ocala that are equipped to deal patients who are critically ill.
     Dr. Jones is an assistant professor at the University of Florida in the Department of Emergency Medicine. He performed his residency training in Emergency Medicine at U.F., and additional subspecialty fellowship training in Emergency Medical Services (EMS) at U.F. under Dr. Christine Van Dillen. His medical school education was at the University of Texas and he earned a bachelor's degree in Public Policy from Duke University in Durham, N.C.
     In 2014, Dr. Jones assumed the position of LCDPS medical director from Dr. Van Dillen.
     The LCDPS Determination of Hospital Destination Protocol was in place before he became the medical director, and it has been mandatory knowledge provided in writing to every Paramedic and EMT at Levy DPS, and has been in the public domain at all times (http://levydps.com/files.html), Dr. Jones noted.
    It has not changed once during his tenure.
    It states that ambulances are to take any patient to the ER of the patient's choice, unless excluded by the following parameters:
     • No paramedic is to influence the patient's choice of hospital or assume that a given hospital cannot offer its usual range of services, thereby preferentially re-routing patients to select facilities. However, paramedics may educate patients requesting information regarding their specific type and acuteness of emergency consistent with recognized local practice.
     • If the patient expresses no choice, and if no other appropriate party is available or has reason to act on behalf of the patient, transport the patient to the closest appropriate emergency room.
     • If the patient is unable to make such a judgment (minors, etc.), transport the patient to the emergency room of choice of an appropriate party acting on behalf of the patient (parent, guardian).
     Exceptions exist for alert patients (stroke, STEMI [heart attack], etc.), such as patients meeting Florida Trauma Alert criteria. Patients with pediatric and obstetric emergencies are preferentially routed to hospitals with pediatric and obstetric certifications.
     Patients who are unconscious, critically ill, or potentially critically ill and at risk of serious harm may be transported to facilities offering advanced capabilities at their paramedic's discretion. These exceptions exist to protect patients most likely to need emergent specialized, advanced, or life-saving therapy.
     In February of 2015, Dr. Jones personally met with every Levy County EMS paramedic and reemphasized the Determination of Hospital Destination protocol and the importance of impartiality.
     He also met with Dr. Pagidipati and the staff of Regional General Hospital on multiple occasions throughout 2015, including two full walk-throughs of RGH.
     Dr. Jones has let them know at every opportunity that the entire LCDPS values RGH and its importance to the medical and financial health of Levy County.
     “And we appreciate working closely together,” Dr. Jones said. “A successful Regional General Hospital is good for everyone in Levy County. We have invited all employees of RGH to Levy DPS education and training sessions, and we send our EMS command staff to meet with their ED (emergency department) staff often.”
     Nevertheless, Dr. Pagidipati has repeatedly insisted that Levy DPS change its medical protocols to preferentially and specifically transport patients to Regional General Hospital, Dr. Jones said.
     “We can’t break the law,” Dr. Jones said.
     His reasoning is that it would help generate revenue for the hospital. Dr. Jones said that he respects Dr. Pagidipati’ opinion, “… but I have consistently explained that to do so would violate patient preference, patient safety, and the law.
     “I have implored Dr. Pagidipati and RGH for the past year to provide me any evidence that a patient has been transported away from RGH against their will and against our protocols,” Dr. Jones said on Thursday (Feb. 4). “I have not been provided a single name, case, or example.”
     Dr. Jones continued his response to Dr. Pagidipati’s assertions that seemed to indicate Dr. Jones was giving Gainesville hospitals a preference over RFH.
     “A basic tenet of EMS is that our patients aren't routine walk-ups or office visits,” Dr. Jones said. “Patients requesting 9-1-1 emergency response frequently have dangerous and life-and-limb-threatening conditions. They expect a very high level of care, and often naturally select facilities with advanced capabilities.
     “RGH is an important hospital in our community,” Jones continued, “but it lacks many of the emergency capabilities provided by neighboring hospitals. These include 24/7 physician presence in the ED, board-certified emergency doctors, in-house specialists (such as cardiologists, neurologists, pediatricians, and ophthalmologists), in-house surgeons (such as orthopedic surgeons, general surgeons, and obstetricians), operating rooms, critical care, ICUs, a cardiac cath lab, and other advanced interventions like blood transfusions. Even patients who are ultimately discharged home from these facilities often require emergent treatment by a specialist first.”
     Dr. Jones said he was unable to attend the Tuesday morning (Feb. 2) County Commission meeting because he was working with Lake County paramedics and could not be present.
     Dr. Pagidipati’s presentation was not on the agenda. He spoke during the public comment part of the meeting.

Doctor questions protocol;
of Williston may close

Dr. Devaiah Pagidipati explains that he needs to see more paying patients at RGH of Williston or the hospital may be closed. That would cause the loss of jobs to 150 people, and it would mean the county amublance service would have to take 2,700 more people to the hospitals in Gainesville each year, when looking at the past year's visits to the RGH Emergency Room as a measure.

Story and Photos
By Jeff M. Hardison © Feb. 2, 2016 @ 3:37 p.m.
“I’m on oxygen now,” Dr. Devaiah Pagidipati, the owner of Regional General Hospital (RGH) of Williston said after exiting the Levy County Courthouse on Tuesday (Feb. 2).

     He was speaking metaphorically with HardisonInk.com as he expressed his feelings regarding the $3.5 million of his own money that he spent to improve and keep RGH functioning in Williston since he bought it in 2014.
     Dr. Pagidipati had just left the regular bi-monthly County Commission meeting, where he told the Levy County Board of County Commissioners that he perceives a problem with protocol being practiced by the Levy County Department of Public Safety (LCDPS).
     The failure of ambulances to take patients to RGH is among the reasons for less revenue coming in than might have been anticipated.

Levy County Commissioner Rock Meeks listens to the presentation on Tuesday morning.

     If there is nothing wrong with the protocols, Dr. Pagidipati asked rhetorically as he spoke in front of the courthouse, then why are 70 to 80 percent of the people who are being taken to hospitals in Gainesville having to be picked up and taken home by cars the same day?
     Those patients could have been treated and released from the RGH ER, he said.
     He had just asked the County Commission that same question that he posed on the courthouse steps. Essentially, the doctor was saying there are people being taken to high-end hospital emergency rooms when the rural ER at RGH is more than adequate to completely meet their medical needs.
     He shared a story to show this problem more vividly. A pharmacist at RGH, who is very aware of medical care, was involved in a vehicular accident, Dr. Pagidipati said. She was picked up by an LCDPS ambulance.
     She told the LCDPS staff members that she wanted to be taken to the ER at RGH. They refused to take her, Dr. Pagidipati said. So she had to have a deputy with the Levy County Sheriff’s Office transport her from the accident scene.
     Dr. Pagidipati told the County Commission on Tuesday that Williston Fire Chief Lamar Stegall can confirm this type of action has happened before.

Levy County Commissioner Danny Stevens listens to the doctor speak about the hospital.

     On Wednesday morning (Feb. 3), Chief Stegall, who spoke with HardisonInk.com even though the chief was on a hunting trip in Alabama, confirmed in no uncertain terms that he has witnessed LCDPS staff refusing to take a patient to RGH. The chief noted that he was not aware of the particulars of the patient’s medical complaint, but he confirmed that he has seen this happen before.
     The regular County Commission meeting on Tuesday included two positive testimonials by county commissioners Lilly Rooks and Mike Joyner – both saying they received excellent care as patients at RGH.
     Dr. Pagidipati’s message opened with him telling the County Commission that indigent care at RGH was draining him. He told the commissioners that there was a time when he had plans to build a 100,000 square-foot one-stop urgent care facility in Levy County -- like the one he opened in Ocala in August of 2015.
     That facility in Ocala is a brand new multi-specialty facility.
     The $2.25 million the doctor spent in 2015 for indigent care in Williston, Pagidipati said, however had used up those funds that had been earmarked for that project.
      Pagidipati said that while any other business owner can refuse to serve an indigent who cannot pay for services, a hospital does not enjoy that ability. He must provide care, because that is the law of the land.
     The time has come when he must decide what to do with RGH, he said.
     LCDPS ambulances make 6,000 trips a year to Shands and North Florida Regional Medical Center in Gainesville, he said.
     “We get about 20 a month,” he said. (240 a year)
     Bringing patients to the hospital is the lifeline that is needed, he said.
     “If you don’t do that,” Dr. Pagidipati said, “we can’t survive.”
     If the current trend continues, Pagidipati said, he may close the hospital completely, or change it into a nursing home for chronic care patients.
     He mentioned that Chiefland’s dream of a $40 million hospital has never reached fruition.

LCDPS Director David Knowles announces the seventh ambulance is now active for Levy County.

     Earlier in the meeting, LCDPS Director David Knowles had said there are now seven ambulances in the county, and they are on call 24-hours-day every day.
     The RGH Emergency Room has treated 7,200 people, Dr. Pagidipati said.
     Of those 7,200 people, he said, only 100 to 150 needed to go to another hospital afterwards.
     If Regional General Hospital of Williston closes, Dr. Pagidipati said, then that is 7,200 ER trips that LCDPS will need to add on its run list to Gainesville hospitals. That means the county will need to double its ambulance fleet, Dr. Pagidipati said, because the RGH option will no longer exist.
     Beyond that, if RGH closes, there will be 150 people who will become unemployed.
     Pagidipati said the County Commission chose to hire medical directors who are employees of Shands and North Florida Regional Medical Center. The medical transportation protocols that were created, Pagidipati said, dictate that patients are taken to Shands and NFRMC.
     Pagidipati said it is his opinion that medical directors who work for specific out-of-county hospitals is a conflict of interest.
     The doctor said he needs help from the County Commission, and from the people in Levy County.
     “I hate to do this (close the hospital),” Dr. Pagidipati said. “I don’t have too much time. I have sent $3.5 million since I came here.”
     Joseph Lander, who is connected with RGH, said the LCDPS has refused to take a patient to RGH.
     One difficulty RGH faces is when a person requests to go the RGH, they are told “That’s not an appropriate facility. That perpetuates the negative stereotype in the community,” Lander said.
     Anthony Spadavecchia said that when he was with LCDPS, he had to call for medical direction regarding a cardiac arrest. He was told to take the patient to the closest appropriate facility.
     “Well the closest facility was Regional General,” he said. “And that was to get the highest level of care.”
     He said a physician was at the ER at the time. Spadavecchia was told not to take that patient to Regional General, he said.
     “If that was my mother, my father, one of you all,” he continued, “I would want that to go to the highest level of care, which would have been Regional General.”
     He said it does not make sense to him to add another 40 miles of transportation to another hospital, when the staff in the back of the ambulance is having “to do compressions on the chest of somebody’s chest, somebody’s loved one.”
     Dr. Pagidipati said there are between 70 to 80 percent of the patients who are taken to Gainesville hospitals, when they could be treated and released from the RGH Emergency Room in Williston.

Levy County Commissioner Lilly Rooks speaks about how she saw immediate medical assistance and is extremely pleased with RGH.

     Commissioner Rooks shared her experience with RGH.
     She had gone to hospital during an open house tour of the facility.
     “I ended up in the emergency room,” Rooks said. “And I had all kinds of tests run – CT, everything. Within 30 minutes I had the results.”
     Rooks said the hospital had a cardiologist there, and he checked her out.
     “Everything happened so fast,” Rooks said. “And I got excellent treatment there.”

Levy County Commissioner Mike Joyner gives a testimonial about how well he sees patients, including himself, treated for medical problems at RGH.

     Commissioner Joyner joined with the testimonials. He said in his job, the men “get banged up quite a bit.”
     “I have dropped several of my men there,” Joyner said. “They get excellent care. I had to go there a few weeks ago – and by the way you’ve got a pretty good bone doctor there too. He can fix your broke bones.”
     Joyner said he could not have asked for better care, and he plans to go to this hospital in the future.
     Joyner said the hospital obtained “a bad reputation” from previous owners. The great hospital now and the wonderful people there now, Joyner said, cannot be promoted by anyone other than the hospital itself.

Commission Chairman John Meeks said he has yet to see proof of people being taken to a hospital other than the one they requested.

     Commission Chairman John Meeks said he has heard the serious allegations that LCDPS is transporting people to hospitals other than RGH when patients want to go to RGH, or that LCDPS staff are telling patients that RGH is not adequate for their medical needs.
     Meeks said he wants to see proof to support these allegations.
     Chairman Meeks said he heard allegations like this a year ago, but has yet to see the proof he sought then of this being true.
     Commissioner Danny Stevens said he also has sought the names and dates of these alleged events. Stevens then added to that statement.
     Dr. Donald McCoy Jr., M.D., was the medical director before the doctors from Shands and NFRMC, Stevens said. From what Dr. McCoy told Stevens all through the years, and according to the medical director the county has now, Stevens said, the hospital must meet certain criteria before a patient can be taken there.
     Stevens went on to say that a patient taken to RGH may need a doctor who is not there at the time, and then they would have to be taken to some other hospital. That one transport turns into two, he said.
      Dr. Pagidipati repeated for Stevens that out of the 7,200 ER visits in 2015, there were fewer than 200 who needed to then go to another hospital for that higher level of service.
     The overwhelming majority of patients, Dr. Pagidipati said, do not need to be transported all the way to Gainesville rather than to Williston.
      Chairman Meeks said everyone wants to see RGH succeed. There is a protocol that is in place. He intends to continue to work with Dr. Pagidipati to “strengthen our relationship with the hospital and our emergency medical service.”
     “Whatever we can do to work with you, we intend to do,” Chairman Meeks said. “But we cannot conscientiously endanger lives. I’m not saying everybody we take to Gainesville has to go to Gainesville. So those people could come to you, and probably should come to you.
     “But if it is the patient’s choice to go somewhere else (rather than RGH),” Meeks said, “and to this day, I have yet to be shown any proof of where a patient has been coerced to go to a different hospital” then they will be going to the Gainesville hospitals.
     Jim Jones, the vice president of the union that represents the LCDPS paramedics and EMTs, said all of the staff follow the rules, laws and protocols that are put in place.
     “I don’t want it to sound like anybody that I represent is doing this maliciously,” Jones said. “It’s not like that. We are good people. We provide good medical care. We just do what someone else tells us to do. So, don’t hold any hard feelings toward the people who transport you to the hospital.”
      Regional General Hospital (RGH) of Williston continues on the path promised for residents and visitors of the North Central Florida area.
     The hospital now has a gamma camera added to its inventory of tools for doctors to use as they diagnose and treat patients. RGH recently partnered with Cardiovascular Institute (CVI) of Ocala to help people with heart issues.
     Dr. Paul Urban of CVI said this business has 11 doctors and seven nurse practitioners. said that institute will be providing a cardiovascular professional at RGH. That cardiovascular staff is anticipated to be at RGH seven-days-a-week, Dr. Pagidipati said.
     The hospital now has nuclear imaging available too. It has an ob/gyn doctor. It has a dermatologist. It has an endocrinologist.
     Among the services available at RGH now are 24/7 Emergency Services; CT Scan; Electrocardiogram; General Medical Services; Pulmonary Rehabilitation; Pain Control Center; Radiology; the Rural Health Clinic; Ultrasound; and Laboratory services.

Fanning Springs leaders
enter plea-negotiated agreement

Adjudication of guilt withheld
fines and costs are $350 for each defendant

By Jeff M. Hardison © Feb. 2, 2016 @ 5:27 p.m.
* Updated Feb. 3, 2016 @ 10:07 a.m.
     BRONSON --
Three Fanning Springs City Council members entered plea-negotiated agreements Tuesday (Feb. 2) to charges that they violated the Florida Statute 286.011, the Sunshine Law, in relation to open meetings, according to reliable sources, including one of the defendants.

     Eighth Judicial Circuit State Attorney William P. "Bill" Cervone on Jan. 26 had filed information with the office of Levy County Clerk Danny Shipp charging the three Fanning Springs City Council members with a second degree misdemeanor, according to records.
     Councilman Ronald Queen, 79, Councilwoman Barbara Locke, 78, and Councilwoman Jane Nogaki, 72, were the accused. Councilwoman Locke is not the Barbara Locke who is the administrator for the Levy County Health Department.
     According to the charging document, the three members of the Fanning Springs City Council knowingly attended a private meeting with each other, and this meeting was not in accordance with the requirements of the law where the meeting was open to the public.
     This allegedly private meeting happened on or about Sept. 21, 2015. One piece of evidence of this meeting is a tape recording of the conversation, where they spoke about public business, but not so the public could hear the conversation.
     The tape was made by City Clerk Sheila Watson who had turned on the machine for taping the regular City Council meeting, before the meeting started.
     The three City Council members were sitting at the large desk in the City Council Meeting Room of Fanning Springs City Hall at the time.
     Although they had been scheduled for first arraignment on Feb. 16, they made the plea deal with the state. Levy County Court Judge James T. "Tim" Browning accepted the plea of "no contest" and he withheld an adjudication of guilt.
     A plea of "no contest" is not saying the defendant is agreeing with the state that they are guilty, however they do concede that the state has enough evidence to move forward with the charge and it could go to trial.
     With fines and court costs, each defendant is paying $350. They are all able to say they were not adjudicated guilty of this crime.
     In a telephone interview with HardisonInk.com on Tuesday evening, Councilwoman Nokgaki said the defendants through their various attorneys let the judge know there was no intention by any of them to keep the process of their making a decision for a vote on budget matters out of the view of the public. They were just conducting business in a due-diligence manner as they thought was proper, Nogaki said.
     The three Fanning Springs City Council members now have a better understanding of the Sunshine Law, Nogaki said.
     Since these three individuals were charged with a second degree misdemeanor, if they had been convicted, then the maximum penalty that could be imposed by a judge is a fine not to exceed $500 or by imprisonment in the county jail for a period not to exceed 60 days.
     Florida’s Government-In-The-Sunshine Law provides the public with a right of access to governmental proceedings. In this instance, the three people are elected officials who decide matters for the city of Fanning Springs. The public has a right to hear all of the conversations between them leading up to them making decisions as members of the City Council.
* Updated
     Councilwoman Locke said she wanted to make a statement about this matter.
     "Please know," Locke said, "it is, and will remain, our intention to serve our constituents in Fanning Springs to the best of our abilities.

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Sixty-Seventh Jingle Singer

The newest singer to perform the HardisonInk.com jingle is Haven Hospice Care Center Administrator Anita Howard. She sang on Friday afternoon (Jan. 22) just outisde the Community Building, which is on the same campus with the Care Center in Chiefland. If you see Jeff Hardison and you want to sing the jingle, just let him know or send an email to hardisonink@gmail.com. He asks people to sing it, too, and some of them agree to sing it. (Thanks people!)
Published Jan. 22, 2016 @ 4:o7 p.m.

-- Video by Jeff M. Hardison

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