Paramedic Dispute May Land in Court : Oceanside Leaders Irate Over County Suspension of Firefighter From Job

City leaders Monday threatened to take county health officials to court for suspending an Oceanside paramedic who last week refused a physician’s order to transport an accident victim to a certified trauma center and took the patient to a local hospital instead.

Speaking at a morning press conference at City Hall, Mayor Larry Bagley defended the paramedic’s decision as “medically sound” and “in the best interests of the people of Oceanside” and called Friday’s suspension order “a capricious and retaliatory action.”

“Our paramedic has clearly been made a scapegoat by the county in its attempt to defend its poorly constructed trauma plan,” Bagley said. “This is the classic case of a big county government picking on the little guy.”

City Manager Suzanne Foucault, meanwhile, charged that county officials had “violated the paramedic’s civil rights” as well as standard personnel procedures by releasing confidential information about the suspension to the press and by failing to consult with the paramedic or the city before issuing the order.

The 26-year-old paramedic, David Snyder, learned of his suspension when he read about it in a newspaper over the weekend. He will remain on the city payroll but work as a firefighter pending a hearing on his appeal.

While reluctant to detail what legal action might be taken, City Atty. Charles Revlett said he is likely to recommend that the city ask for a court injunction “restraining the county from meddling with us any further until this controversy is resolved.”

Monday’s events represent the latest salvo in the escalating war between Oceanside and county officials over the year-old trauma network. Oceanside leaders, charging that the system is inadequate to serve the city of 92,000, last month instructed their paramedics not to transport critically injured patients outside of the city limits if a Life Flight helicopter is unavailable.

Council members contend that sending one of Oceanside’s two paramedic units on a 30-minute drive to Scripps Memorial Hospital in La Jolla, the nearest certified trauma center, would leave the city unprotected for too long in the event of another emergency.

Paramedics were ordered instead to transport patients to Oceanside’s Tri-City Hospital, which has failed three times to win admission to the county emergency care network and is now suing the county to obtain trauma center designation.

On Aug. 5, city orders and county trauma policy clashed. Snyder, responding to an automobile accident, was directed by a nurse at the Scripps Memorial trauma unit--which was temporarily closed for equipment repairs--to transport the patient to the trauma center at Palomar Memorial Hospital in Escondido.

Citing city policy, Snyder refused, taking the 17-year-old victim to Tri-City instead. The patient, who suffered head injuries, was released Wednesday. But county officials launched an investigation into the episode and on Friday suspended Snyder.

Irate over the suspension, Oceanside officials Monday challenged the county’s authority over city paramedics and vowed to take steps to guard against any future “interference.”

“We don’t feel the county has the right to do something that is the city’s right as the paramedic’s employer,” Mayor Bagley said.

In addition, city officials note that the only formal relationship between the two parties regarding trauma care is a 1976 contract that requires Oceanside to provide paramedic service within the city limits.

“That contract says nothing about our being responsible for transporting patients outside of Oceanside,” Fire Chief James Rankin said, “and that contract has not been changed since the trauma system started up.”

“What we are questioning,” Rankin continued, “is, ‘Does the county have the authority to tell us where to take our trauma victims?’ I don’t think so.”

Gail Cooper, the county’s chief of emergency medical services, declined to comment on specifics of the case. But Cooper did say that she believes that the 1976 agreement “does not restrict where trauma patients are or should be transported.”

Asked whether the county would decertify the next Oceanside paramedic who violates county orders and obeys his employer’s instructions not to transport patients outside the city limits, Cooper said she “wouldn’t want to speculate on what action the county would or would not take.”

City officials plan to take several steps in response to the county’s suspension of Snyder, one of Oceanside’s 22 certified paramedics, first sending a letter requesting that the suspension be lifted.

Foucault said that the proper personnel procedures were not followed by those issuing the order. In addition, she argued that the suspension was unjustified because a tape recording of the radio conservation between Snyder and the Scripps trauma staff the night of the accident showed that the physician on duty “allowed” the paramedic to transport the victim to Tri-City Hospital.

A transcript of the tape indicates that, after Snyder informed Scripps that, under city orders, he was transporting the patient to Tri-City Hospital, the trauma physician replied, “We will continue medical control while you transport to the facility of your choice.”

“We believe that the trauma center doctor was telling them it was OK to take the victim to Tri-City or to the hospital of their choice,” Foucault said.

Should county officials refuse to reverse the suspension, Foucault said, the city will represent Snyder in his appeal later this month.

City officials said they also will lobby for state legislation to clarify city-county jurisdiction over trauma care and transport.

“The state Health and Safety Code is not very specific as to the authority the EMS (the county) has versus the authority of the local jurisdiction,” Fire Chief Rankin said. “Our question is where does our authority stop and the county’s begin?”

Meanwhile, Bagley said, the city has ended negotiations with the county health services staff over a backup paramedic unit designed to increase protection for the north coastal area. The unit, proposed by the county as a solution to the dispute, would be funded by the county and would serve Oceanside, Carlsbad, Vista and the unincorporated areas.

“In light of this action, the time for talking with the (county) staff has passed and I have no intention of continuing those negotiations,” Bagley said. “Instead I am going to ask members of the Board of Supervisors to sit down with council members and work this thing out.”