Birgilio Marin-Fuentes couldn't stop coughing, couldn't sleep and decided to seek care at the closest hospital.

His wife, Claudia Luis Garcia, offered to accompany him, but the 61-year-old didn't see a need.

Marin-Fuentes left his Southeast Portland home sometime between midnight and 12:30 a.m. Thursday and drove in his black Kia 1.4 miles to Portland Adventist Medical Center.

Suffering a heart attack, he crashed into a steel pillar and wall inside the first level of the hospital's parking garage, below a sign that read "Emergency parking only" about 125 feet from the emergency room entrance.

No one noticed him for about 20 minutes, hospital officials said. But once a bystander did, the person flagged down Portland Officer Angela Luty, who was leaving the hospital's emergency room on an unrelated traffic case.

At 12:47 a.m., Luty radioed to dispatch that a car had plowed into a pillar in the garage. Thirteen seconds later, dispatch called out fire and an ambulance to respond.

Two minutes later, Luty and a second officer, Robert Quick, found Marin-Fuentes unresponsive and unconscious in his car in the parking garage, and began cardiopulmonary resuscitation.

"Hospital said they won't come out," Officer Andrew Hearst radioed to dispatch. "We need to contact AMR first."

The officers were stunned.

"It's certainly very frustrating for the officers who are not medical professionals in a hospital parking lot, to be told they have to call for an ambulance to help this man. The officers didn't stand there and argue, they continued CPR," Simpson said. "But they were in disbelief."

At 12:48 a.m.,

.

Meanwhile, Luty, who joined the bureau a year ago and is assigned to the traffic division, continued chest compressions, while Officer Robert Quick, a 9-year–veteran, gave breaths while they waited for an ambulance.

The ambulance pulled up at 12:53 a.m., six minutes after police were flagged down. Marin-Fuentes was wheeled on a gurney into the ER between 12:56 and 12:58. Marin-Fuentes was pronounced dead at 1:22 a.m.

"They just felt really helpless," said Sgt. Debbie Steigleder, the officers' supervisor who arrived at the scene later. "To know that literally 150 feet or so away there are doctors and nurses there...It's just extremely frustrating."

More

Portland Adventist Hospital officials say they followed protocol by calling 9-1-1 to the crash scene, and sent out the charge nurse, nursing supervisor and two security officials who have a mobile defibrillator to the parking garage. They also sent an ambulance paramedic who was at the hospital. ( See hospital statement at end of post.)

"We do call 9-1-1 to make sure trained responders can safely transport a patient to the emergency department," said Dr. Kelli Westcott, Portland Adventist's vice chair of emergency services. "We activate the EMS system so the trained responders can safely transport you to the emergency department because we want to give everybody the timely care that they deserve."

Westcott said a nursing supervisor assisted the officers in the resuscitation efforts, yet the hospital's official statement released late Thursday afternoon said the nursing supervisor arrived to find the ambulance already there and preparing the patient for transport to the ER.

"If a nursing supervisor came out there, that person never made themselves known," Simpson said.

The hospital said the first notification they got was that it was a car crash.

"Calling 911 is protocol because an ambulance is equipped with life-saving devices to remove someone from an automobile," said Judy Leach, director of the hospital's public affairs.

She stressed that the hospital usually calls 911 and sends their own staff into such situations, whether its someone suffering a gunshot wound, heart attack or other medical emergency on their campus.

"Unfortunately, someone tried to transfer themselves to the emergency department. That's the saddest part of what happened today," Westcott said. She urged the public to call 9-1-1 for any medical emergency.

Oregon Congressman Earl Blumenauer Monday called for a federal investigation into whether Portland Adventist Medical Center violated any laws. He asked the Center For Medicare and Medicaid Services to conduct an independent review, and said he's sending the federal law to Oregon hospitals. (See statement at end of post.)

"It is not just heartbreaking, but incomprehensible that a hospital fully capable of treating this medical emergency left police officers with no medical equipment to tend to a patient," Blumenauer said. "If the police statements are correct, this incident defies common sense and it may well defy federal law."

He cited the Emergency Medical Treatment and Active Labor Act, passed in 1986, that requires all Medicare participating hospitals with emergency departments to treat any critically ill patients on their premises, including parking lots. Marin-Fuentes died of natural causes due to heart disease, according to the state medical examiner's office.

His wife and brother-in-law had gone to the hospital later Thursday morning to try to take photos of any damage from the crash, and contact a lawyer. They said they were still seeking information, but felt a mix of guilt, anger and sorrow.

"If I would have went with him, he would've been alive," his wife, Luis-Garcia said through tears, her 12-year-old daughter acting as interpreter this afternoon. "They left him to die."

Claudia's brother, Faustino Luis, said he can't understand why his brother-in-law couldn't get help immediately from the hospital.

"If he had the accident there, why didn't the hospital help him?" he asked, speaking from his sister's home. "Why didn't they try to help him?"

Marin-Fuentes came to the United States from Cuba. Here, he worked for a carwash in Southeast Portland, where he lived with his wife and daughter.

The officers who tried desperately to revive Marin-Fuentes are disturbed, their sergeant said.

"It's very upsetting for both of the officers. Officer Luty is a brand-new officer. She did a phenomenal job. It's hard for us to do something like that, to have such personal contact with somebody and they die. It's hard for us to be put in that position where you feel helpless."



Steigleder said it was obvious that Marin-Fuentes tried to get emergency help.



"He made it to the hospital. He just didn't make it out of the car unfortunately."



She talked about the incident at roll call Thursday night, and what to do in the future should something like this occur. As a sergeant, she said she might have rushed into the ER and grabbed a gurney herself to wheel out to the car.



"Maybe pick them up and carry them into the hospital so they could get the advanced life support they need," she said. "I don't know what else we could do."



Maxine Bernstein





Statement from Adventist Medical Center

February 10, 2011





1. Our hearts and prayers go out to the family and friends who lost a loved one today.



2. We do NOT have a policy against responding to emergencies in our parking lot. In fact, we always call 911 and send our own staff into these situations whether they are gun shot wounds, heart attacks, or any other medical emergency. We have done so many times in the past year alone.



3. In this specific situation, we would like to clarify the facts: A Portland Police Officer informed us of a car accident in our garage that we believe occurred at least 20 minutes prior. We advised the officer immediately call 911 because EMS have the mobile equipment to respond to a car accident. Before the officer left our Emergency Department, our charge nurse directed a paramedic to go immediately to the scene. She also dispatched our first responders, who are trained security staff, to go outside to the scene of the accident. When the security staff arrived, the police were already doing CPR. Then the nursing supervisor ran out to the garage. She saw that the ambulance and fire department had arrived and were actively preparing the patient for transport to our emergency room.



4. We want to reassure the community that Adventist Medical Center continues to be wholly committed to serving the medical needs of all of our patients, as we have been for more than 115 years. We want to assure all patients that we will always respond immediately to their health care needs with the highest quality medical attention.



Judy Lindsay Leach

Director, Marketing

Adventist Medical Center







STATEMENT: Rep. Earl Blumenauer on Incident at Portland Adventist Hospital



Today, Congressman Earl Blumenauer issued the following statement in response to media reports about an incident at Portland Adventist Hospital:



"I am deeply disturbed by media reports that a critically ill man was denied timely care as he died of a heart attack in the Portland Adventist Hospital's parking lot. If these reports are true, it is not just heartbreaking, but incomprehensible that a hospital fully capable of treating this medical emergency left police officers with no medical equipment to tend to a patient. If the police statements are correct, this incident defies common sense and it may well defy federal law. The Emergency Medical Treatment and Active Labor Act (EMTALA), passed in 1986, requires all Medicare participating hospitals with emergency departments treat any critically ill patients on their premises, including parking lots.



I am calling for the Center for Medicare and Medicaid Services (CMS) to conduct an independent investigation of this matter to ensure that federal laws are enforced and Oregonians are protected.



In the meantime, it is important that every hospital in Oregon understand its moral and legal obligations. I will be sending information to all Oregon hospitals to ensure our health care leaders are complying with federal law and I stand ready to assist in any areas of ambiguity that might require further clarification."





On background:

The Emergency Medical Treatment and Active Labor Act (EMTALA) is the 1986 law that ensures universal access to emergency medical care at all Medicare participating hospitals with emergency departments. Under EMTALA, any person who seeks emergency medical care at a covered facility is guaranteed an appropriate screening exam and stabilization treatment before transfer or discharge. Failure to abide by these requirements can subject hospitals or physicians to civil monetary sanctions or exclusion from Medicare.



The Center for Medicare and Medicaid Services publishes a State Operations Manual , outlining the responsibilities of Medicare participating hospitals in meeting the requirements of the Emergency Medical Treatment and Active Labor Act (EMTALA). Page 34 of their manual clearly states:



If an individual who is not a hospital patient comes elsewhere on hospital property (that is, the individual comes to the hospital but not to the dedicated emergency department), an EMTALA obligation on the part of the hospital may be triggered if either the individual requests examination or treatment for an emergency medical condition or if a prudent layperson observer would believe that the individual is suffering from an emergency medical condition. The term "hospital property" means the entire main hospital campus as defined in §413.65(a), including the parking lot, sidewalk and driveway or hospital departments, including any building owned by the hospital that are within 250 yards of the hospital).



Timeline from Portland's Bureau of Emergency Communications:

12:47:03: Officer advises dispatcher of car accident in Portland Adventist Medical Center lot.

12:47:43: Disptacher creates medical/fire response call.

12:47:56: Fire/EMS dispatcher sends for code 3 ambulance and fire engine.

12:48:16: Ambulances announces its on its way.

12:49:23: Officers on scene say patient is unresponsive/not breathing.

12:49:27: Fire engine announces its on its way.

12:51:34: Officers have begun CPR.

12:53:02: Ambulance arrives.

12:54:17: Fire truck arrives.

12:54:19: AMR supervisor arrives

12:56 to 12:58: Ambulance paramedics transport Marin-Fuentes into hospital via gurney.