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175-2000 LTC ~oJt,~ CITY OF MIAMI BEACH dTY HALL 1700 CONVENTION CENTER DRIVE MIAMI BEACH, FLORIDA 33139 http:\\ci.mlami-beach.f1.us L.T.c'No.175-2000 LETTER TO COMMISSION \"}.. -:;~ n'\ c{'". >0 0 ...... "..-(\ . , \-0 ..:.2 ,..-.!?~ . (J' .::'" (\\0' o s:: ~ 0 ?> ($' (" September II, 2000 TO: Mayor Neisen O. Kasdin and Members of the City Commission FROM: Jorge M. Gonzalez City Manager ~ ~ SUBJECT: RESPONSE TO EMS COMPLAINT AND DETERMINATION OF FLORIDA DEPARTMENT OF HEALTH INVESTIGATION In May 2000, we sent documentation to you regarding the City of Miami Beach Fire Department's investigation of a complaint submitted by Lieutenant Rick Powell of Rogers, Arkansas Fire Department. (See attachment I). The Florida Department of Health also investigated Lieutenant Powel\' s complaint and determined after extensive examination that no probable cause existed. (See attachment 2). If you require further information, please do not hesitate to either contact me or Assistant City Manager Mayra Diaz Buttacavoli. JMG:MDB:1c~. Attachments c: Mayra Diaz Buttacavoli Floyd Jordan F:\CMGR\$ALL\L TC-OO\EMSHEAL T.COM .- MIAMI BEACH FIRE DEPARTMENT CHIEF'S OFFICE Interoffice Memorandum To: Matti H. Bower City Commissioner ~ Lawrence A. ,Lr~G-' City Manager (JtI" Subject: RESPONSE TO EMS COMPLAINT Date: May 26, 2000 From: Reference: Your Memorandum dated May 16, 2000 Attached you will find the results of the Fire Department investigation of the complaint submitted to you by Lieutenant Rick Powell of the Rogers, Arkansas Fire Department. This complaint was reviewed by the Fire Chief, the Medical Director, Rescue Division Chief, EMS Training Coordinator, a Resident Doctor at Mt. Sinai Hospital, an Assistant City Attorney and others. The conclusions are that the crew of the Miami Beach Rescue unit which responded to the incident in question, followed all required and appropriate protocols for medical treatment in an attempt to save a life. Their efforts were outstanding despite the negative result. It is the opinion of all that reviewed this case that the complaint is without merit. cc: Neisen Kasdin, Mayor Luis R. Garcia, Commissioner Jose Smith, Commissioner Simon Cmz, Commissioner David Dermer, Commissioner Nancy Liebman, Commissioner Mayra Diaz Buttacavoli, Assistant City Manager Floyd-Jordan, Fire Chief c::> c::> ~ == c -< N -. C""\ c: :s r . w ,,) ...... c:\~rda"\firchief\powell.mem ATTACHMENT 1 MIAMI BEACH FIRE DEPARTMENT FIRE ADMINISTRATION OFFICE Interoffice Memorandum ~18,,~ . O"PA~ To: Lawrence Levy City Manager Date: May 25, 2000 Via: ~<. ~~ 5.~.;lOOO , Subject: COMPLAINT As a result of the EMS complaint filed by Lieutenant Rick Powell of the Rogers, Arkansas Fire Department a thorough investigation was initiated and completed. After review of the results and my own discussions with appropriate staff regarding this complaint, I concur with the conclusions of the investigation that the complaint has no merit. All the factual evidence supports the conclusion that the members of this rescue unit assessed the patient, provided appropriate treatment, and transported to an appropriate medical facility. Despite the negative outcome, this rescue unit followed proper and appropriate protocol in an exceptional manner while attempting to save a life. If you have any questions regarding this investigation or conclusion, please advise. '=' o - ::;: --<: N en ""'" r <J1 .;;- A:\COlvlPLAIN.MEM MIAMI BEACH FIRE DEPARTMENT Rescue Division Memorandum To: Floyd Jordan Fire Chief From: Edward Del Favero S. D, Rescue Division Chief iL-.( Subject: Response to Accusations Against FF T. Pratt Date: May 23, 2000 First of all, I would like to express our sorrow that Mr. Petzing passed away despite the efforts of all involved in his resuscitation attempt. Our thoughts are with his family and mends as they grieve the loss of their loved one. Second, I would like to address the complaints and accusations made by Mr. Powell targeting for the most part Firefighter II / Paramedic Ted Pratt and to a lesser degree, his crew, Firefighter I / Paramedic Robert Bergens and Firefighter I / Paramedic Jorge Sanabria. The allegations are of such a serious nature, that a full investigation was initiated. The Rescue Incident Report was pulled and reviewed, a tape of the radio traffic associated with the call was reviewed, the crew was interviewed, a copy of the Miami Dade County Coroners Official Report was also obtained and reviewed. The following individuals also reviewed the case; Dr. Harry Heinitsh, Medical Director Miami Beach Fire Rescue, EMS Training Coordinator William Azzinaro, Mt. Sinai Medical Center ER Resident Dr. Dave Bahorquez, City Attorney Rhonda Montoya, Local 15 I 0 Union President Jack Richardson, EMS Supervisor Lt. Dave DeGrange, and the Engine crew called for additional backup. The immediate result of the investigation found that there was no exigency to remove FF II Ted Pratt or his crew from responding to Emergency Medical calls. The Rescue Incident report documented the facts of the call from receipt to completion. Treatment was consistent with Miami Beach Fire Rescue Protocol. The Coroners Report listed the place of death as Mount Sinai . Medical Center. The time of death was 0905, which is 19 minutes after Rescue 2 delivered Mr. Petzing to the Emergency Facility. The cause of death was listed as "critical coronary atherosclerosis" by the Coroner. Mr. Powell alleges that he was rebuffed in his effort to provide information to FF II Pratt as he began efforts to treat Mr. Petzing. In fact, FF II Pratt remembers a by-stander providing information on the patient as they entered, then another person offered information. The second person was asked to "please step aside" since patient information was already offered and it was obvious the patient was critical. Additional information at this point would not affect patient care. This patient needed to get to the Emergency Room. Rapid treatment and transport of Mr. Petzing was accomplished, as evidenced by the Rescue Incident Report, dispatch tapes, and the Life Pak 12 Code Summary. Patient history is listed on the Rescue Incident report, "2 aspirin given before FRU arrival and C.P. 15 minutes prior to arrival and vomiting prior to arrival". Perhaps Mr. Powell's feelings were hurt, or he was embarrassed in front of his peers when his "patient report" was not taken, which compelled him to file his complaint. In fact, Mr. Powell's constant interfering and interjections could have deterred or distracted the crew of Rescue 2 from providing focused patient care. Mr. Powell lists three main issues in his correspondence: I. Having the patient move to the cot. The cot was lowered to a position even with the patient's chair. The patient was asked, not ordered to assist in sliding over to the cot. He was not asked to get up and walk across the room. This was an assisted move from a chair to the stretcher. 2. FF II Pratt abandoning his patient to get oxygen. The oxygen unit is located at the base ofthe stretcher. There was a three-man crew surrounding the patient at all times This is not abandonment. The fact that Mr. Powell states that "T. Pratt left the patient to get oxygen" which is an ALS treatment, contradicts Powell's next allegation that no BLS or ALS was initiated. 3. The patient went unconscious, and none of the members of Miami Beach Fire Rescue initiated CPR., administered Oxygen, or ACLS, but opted to wheel the patient away. Unless you are directly involved in hands-on patient care, it would be impossible to definitively and clinically declare a person "unconscious, pulseless and not breathing" which would, require the care described above. The Rescue Incident report states, "CPR entire time patient pulseless". lVIr. Powell himself identifies FF II Pratt as placing oxygen on the patient. It is also documented in the Rescue Incident report that the patient is evaluated, transferred to the stretcher, placed on the EKG monitor, is intubated, an IV established, medications administered, he is defibrillated twice, has an external pacer placed on him and is transported to Mount Sihai Hospital ED, ALL IN TWENTY THREE MINUTES. After a review of the factual evidence of this case it is clear that the patient was accessed in a timely manner, appropriate pre-hospital emergency treatment was initiated, transport to an appropriate medical receiving facility was accomplished. Unfortunately, there was a negative' outcome. Mr. Powell's account of the actions taken by FF II Pratt and his crew are fraught with speculation and subjectivity. He can only account for a fraction of the contact time FF II Pratt and crew had with Mr. Petzing. In contrast, FF II Pratt is a 13 year veteran of the Miami Beach Fire Rescue Department. He has been a Paramedic for 10 years. He has been a Rescue Team Leader (FF II) for 21/2 years. He has run over 3000 calls in this capacity. He has run close to 10,000 calls as a Miami Beach Firefighter/Paramedic. He has had consistent very good or e.;'Ccellent employee evaluations. His employee record contains 12 commendations and zero (0) reprimands. Mr. Powell's questions and allegations could have been answered through the Fire Departments normal chain of command, which, as a 20 year veteran, he should be familiar with. Unfortunately, Mr. Powell felt that contacting the Honorable Mayor and Commission of The City of Miami Beach and the State of Florida Department of Health Complaint and Investigations Bureau was the most professional, and constructive way to address his obvious hurt feelings and misconceptions. It is the opinion of myself and all who have investigated the allegations leveled by Mr. Powell, that no wrong doing was committed by FF II Pratt and his crew. They in fact did an outstanding job trying to save the life of a man with a massive heart attack. , MIAMI-DADE COUNTY MEDICAL EXAMINER DEPARTMENT NUMseR ONe ON aoa Hope ROAD, MIAMI. FL. 33139-1130 PHONE (306) 646.2400 FAX (306) 646-2418 INVESTIGATION REPORT M.E. Case #: 00-1112 DATE: MAY/06/2000 TYPE: A PETZING, ALAN 51 YEARlS) '.V>-JITE MALE ~2~O EASTLAKE BL VO CARSel\! .:;JTY, NV 89704 PLACE OF DEATH: MOUNT SINAI MEDiCAL CENTER, E? TIME OF DEATH: OCCURRED 0905 AM ,'~.AY/06;2000 55#: 386-36-7553 D.O.B. JM J/14/1939 INVESTIGATING AGENCY: MIAMI BEACH 00-18382 OFC. J. METZG;:.R INCIDENT LOCATION: 1601 COLliNS AVE. ~/IAMi BEACH FL i~CJT ASSIGNED TERMINAL EVENT: On Saturday, j'Aay 6,2000. 8:17 ,~.M., the decedent and his 'wife \~ier-? arterc:ng a breakfast meeting at a trucking convention in Miami Beach The oecedent suddenl'{ cl!.'tched nls ci-,esl A witness celiad 911. Fire rescue responded Initiated ACLS measures, ~nd transported the decadent to Mount Sinai Medical Cemer Emergency Room where he arrived, unresr;ons!ve, Int-,bated, CPR in progress. ro vital signs. and oupiis fixed ard dilated Res1cscltation effcrts were r,ot successflj!. 'ca decedent was pronounced at 905 p... M SCE:-JE Hospital ER PAST MECICAL HISTORY: According to his wife, the decedent 'Nas never sick, had not been hospitalized, and was not taking any medications. SOCIAL HIS,O,,"o(: The decedent was married and lived wilh his Wife In Carson City. Nil He was a truck dnver, as was his wife The', were beth attending a truck driver.s convention in Miami Beach Acccraln\] to illS wife. U-,e deceoent had an occasional drirk. ?-'1d smoked ar;proxlrr:ataly one pack of cigarettes a day. I~e was not known to use r'legal drugs. MEDICATiO~JS: None receivec by the ME Department CAUSE OF DEATH: CRITIC.'~L CORONARY ATHEROSCLEROSIS MANNER: i,ATURAL AUTOPSY MAY/07/2000 DOCTOR: BELL. MiCHAEL O. Mc) MORTUARY: CREMATION S'OCIETY OF SOUTH FLORIDA INVESTIGATOR: ~IELSOi,. BRENDA TUIC: oc:onOT I\,,^V '-l"""lto.ITAI\.1 "1('"\'" \ 11:'0 U::11= '"' u.rr.,....nfloIlAT'....U.1 MIAMI BEACH FIRE DEPARTMENT Combat Division Chiefs Office Interoffice Memorandum To: Chief DelFavero August 15, 1999 From: F-2 T. Pratt, F-I R. Bergens, F-I J. Sanabria Subject: Incident #006902 Regarding the allegations that Lt, Powell of the Rodger's fire department made on May 12,2000 about incident #006902, we find that Lt. Powell's allegations have no merit. Rescue 2 followed all procotols and gave the appropriate treatments for the patient's condition and well being. Respectfully submitted, F-2 T. Pratt U~'\1' . I I~c: F -I R. Bergens W F-l~S~ MIAMI BEACH FIRE DEPARTMENT Rescue Division Memorandum To: Ed Del Favero Rescue Division Chief From: William P. Azzinaro AI.e?. 5l(~(UlJ EMS Coordinator Subject: Review Rescue Run Loews Hotel- May 6, 2000 Date: May 18, 2000 1. Total scene time was 10 minutes. 2. Pt. Primary survey performed. Pt. vomited. Pt_ transferred to stretcher with assistance. Pt. intubated. Pt. LV. established. Pt. monitored and defibrillated twice. Attempted to pace patient Pt. given epinephrine. Pt. transferred to transport unit. ALL IN 10 MINUTES 3. The Brady text referred to also says "First, complete the Primmy Survey" (p. 685 under Physical Exam in the Assessment of the Cardiac Patient), not to obtain a Medical History. 4. As this patient was never stable, History was not the immediate concern with this patient. 5. While we appreciate Lt. Powell's effort to provide a History, in this case it would not have , affected treatment, and was not the priority at this time. 6. Lt. Powell assumed that the patient was pulseless and needed CPR when leaving the room, which was not the case. The patient had a pulse and did not arrest and require CPR until after clearing the Banquet area 7. Assisted transfer ofan obese patient from his chair to an adjacent stretcher was appropriaJe. 8. "Talking" to a patient is not always to get History. More critically we address the patient to see how he responds to verbal (Mental Status), ifhe can follow command, is he alert, and how he speaks (phrases or sentences) to assess respiratory status_ 9. I understand that family and bystanders may be offended when we focus on the critical patient, and if the patient is not stable, we are sometimes abrupt with these individuals who mean well. 10. Turning from a patient (in the hands of2 paramedics) to get equipment is not abandonment. 11. I think the Paramedics acted appropriately, rapidly, and accomplished multiple critical tasks in a very short period of time. Respectfully submitted, ......;-~~~ William P. Azzinaro EMS Coordinator . . ,City Manager's Email .. Cc: Subject: Lt. Rick Powell [rcpowell@ipa.net] Friday, May 12, 2000 09:59 AM . .. . mayor@cLmiami-beach.fl.us; cmgr@ci.miami-beach.fl.us: davld(@c!.mlaml-beach.fl.us; luis@cLmiami-beach.fl.us; jose@cLmiami-beach.fl.us; nancy@cl.mlaml-beach.fl.us; simon@ci.miami-beach.fl.us; matti@cLmiami-beach.fl.us; al_herndon@doh.state.fl.us; caroljordan@doh.state.fl.us; barbara oti@doh.state.fl.us romoore@landstar.com: jcrowe@landstar.com; pmarin@landstar.com Concern of Emergency Services in Miami Beach,FL From: Sent: To: Mr. Kasdin (mayor of Miami Beach) and others concerned in this matter, Mr. Kasdin, my name is Lieutenant Rick Powell. I am with the Rogers Fire Department and Ambulance Service in Rogers, Arkansas. I have been a firefighter for 20 years, EMT for 18 years and on to Paramedic for 12 of those 18 years. I am also a state evaluator for EMT and Paramedic National Registry Tests. I also work in sales for a Landstar agent in the trucking industry as my second job. Recently on May 3,2000 to May 7, 2000, Landstar held their annual national convention in the city of Miami Beach, FL I was able to attend in my capacities with Landstar along with about 1200 others from all across this country. Our accommodations were at the Loews Hotel on. Collins St.. On the morning of May 6,2000 at approximately 08:30 one of our Landstar Business Capacity Owners had an acute onset of chest pain while we all gathered for breakfast in the Americana Ballroom in the hotel. Upon noticing the commotion across the room I went to see how I could assist and found this man having sub sternal chest pain. One of our Landstar people that is also an EMT was with the patient. Hotel staff said that they had already called 911 for EMS. Upon my patient evaluation, I found a mid 50's to 60's male sitting at the table complaining of severe sub sternal chest pain with respirations 20 and a pulse close to 100. Bystanders had already given him (1) Aspirin by mouth with no relief. This patient skin was cyanotic and gray, very diaphoretic (sweating profusely). Patient was agitated and restless along with vomiting twice. As the 3 man paramedic crew from Miami Beach Fire Department arrived, I identified myself as an off duty paramedic and was going to give him a brief report on what I found in my patient evaluation. As I was describing this patients severe condition and that he needed oxygen, I was told by T. Pratt of the Miami Beach Fire Dept. to "step out of the way". Mr. Pratt men proceeded to try and talk with this patient while he was vomiting and ask the same questions while the rest of the crew waited for Mr. Pratt to instruct them as to what to do next. I stepped aside respecting the lead paramedic, Mr. Pratt. Then one of the other paramedics of the three man crew ask the patient if he could stand and move over to the ambuiance cot, while Mr. Pratt walked over to get the oxygen. The patient moved to the cot and when the crew assisted the patient with getting his feet on the cot the patient went unconscious with agonal breathing ( non life sustaining breathing). I noticed this and informed Mr. Pratt of this since his back was turned and he had left his patients side and was not aware of the change in his patients status. Mr. Pratt then informed his crew "Lets get him out of here". They proceeded to wheel this patient out of the ballroom not providing a~ . patient care (NO, CPR, Basic Life Support, Advance Life Support)1 As a Emergency Services professional myself I know that we are measured by the care we provide to our patients. This level or measure is referred to as " Standard of Care". Standard of Care is defined by Brady in the Paramedic Emergency Care version three as "A paramedic is expected to practice the same level of care as any other competent paramedic in thecommunity who has equivalent training. As a rule you are expected to perform as any other "prudent person" would in a similar situation. Any deviation form this standard might open you up 1 , .~. . allegations of negligence. I understand Mr. Pratt disregarding my patient information I had obtained, although I am used to giving a very descriptive and brief report of patient condition and would have taken about 15 seconds and been very valuable to him. 1. The issue of having the patient use his own strength to move to the cot. this would not be a poor decision if the the patient was stable and not in distress. This patient was in severe distress, classic signs and symptoms of a heart attack or myocardio infarction which a lay person could have identified. I question their methods and standard of care as to why they are asking this critical patient with a dying heart to move under his own ;lccord verses the trained 3 man EMS crew moving him to the cot. The question on this issue is, did they perform to the "Standard of Care" for this patient. 2. The issue of T. Pratt leaving his patient to get oxygen instead of instructing one of his crew member take care of this task. Once Mr. Pratt left his patient, this falls under a legal term called "abandonmenf'. 3. Now the issue of the patient going unconscious. None of the members of Miami Beach Fire Dept. initiated Cardiopulmonary Resuscitation(look listen and feel for breathing, attempt artificial respirations, check a pulse or start chest compressions). None of the members of MBFD applied oxygen to this patient. None of the members MBFD initiated Advanced Cardiac Life Support, (endotracheal intubation, cardiac monitor and/or defibrillation, IV access of medication administration). Their choice was to wheel this patient out without providing any of the care listed above. We have a saying in our dept., that when you make mistakes of this magnitude and get called to court. It is not to determine who was right or wrong, as you see that has been determined. It will be to determine how many zeros will be behind the first figure on the check that will go to the patients family. Would Mr. T. Pratt like to tell this man's family that he provided the proper" Standard of Care" to their deceased family member. Lieutenant'Paramedic Rick Powell , 2 OFFICE OF THE CITY ATTORNEY ~~ tf~.~eaM f L o R o A MURRA Y H. DUBBIN City Attorney Telephone: T eleco py: (305) 673-7-470 (305) 673-7002 May 26, 2000 Via Facsimile Lieutenant Rick Powell Rogers Fire Department 201 N. 1st Street Rogers, AK 72756-6600 RE: Your e-mail correspondence dated May 12,2000 Rescue Call on May 3, 2000 at Loews Hotel Dear Lt. Powell: I am in receipt of the above-captioned which has been forwarded to me for response. It is troubling to see that you made the decision to contact our Mayor, City Commissioners, various individuals from the Lanstar Business industry and the Florida State Department of Health. I would assume that in the 20 years you have been employed as a fIrefIghter, you are somewhat familiar with a "chain of command." Nowhere does your correspondence indicate that you contacted our City's Fire Department, before disseminating your libelous statements to the various third parties. It \vould have been appropriate to contact FirefIghter Pratt's direct supervisor, or, the Fire Chief. Nevertheless, since your allegations were extremely serious, a full investigation was initiated by the City's Fire Chief. Many individuals reviewed the case including the Fire Rescue Chief, Medical Director and EMS Coordinator as well as the undersigned, among others. In addition, the Rescue Incident Report was pulled and reviewed as well as the tape of the radio transmissions for this particular call. After a review of the factual evidence of this case it is clear that the patient was accessed in a timely manner, appropriate pre-hospital emergency treatment was initiated and transport to an appropriate medical received facility was accomplished. It is indeed unfortunate that there was a negative outcome. The proper protocols were followed in this case in an attempt to save the life of a man who had suffered a massive heart attack. I do not believe that it is necessary to refute all of your allegations specifIcally in this 1700 Convention Center Drive - Fourth Floor - Miami Beach, Florida 33139 . correspondence. Perhaps you felt hurt, rebuffed or embarassed in front of your peers when "your patient report" was not taken, and thus you felt it necessary to file your complaint. I feel compelled to remind you of a portion of the EMT Code of Ethics which states specifically that "the EMT ...assumes the responsibility to expose incompetence or unethical conduct of others to the aporopriate authoritv in a proper and professional manner." In the future. I would suggest that you keep this tenant in mind in the future. If you have any additional questions, please feel free to ~tact me. . <JJr=/~ ~LMONTOYA Senior Assistant City Attorneyl Fire Department Legal Advisor RLM:mm c: Chief Rick Williams, Rogers Fire Department Chief Floyd Jordan, MBFD Chief Ed Delfavero, ivlBFD Lawrence A. Levy, City Manager Mayra Diaz-Buttacavoli, Assistant City Manager The Honorable Neisen Kasdin The Honorable Matti Bower, Simon Cruz, David Dermer, Luis Garcia, Jr., Nancy Liebman, Jose Smith FFII Jack Richardson, President of Local 1510, IAFF , OFFICE OF THE CITY ATTORNEY. 1700 CONVENTION CENTER DRIVE. MIAMI BEACH~ FLORIDA 33139 MIAMI BEACH FIRE DEPARTMENT Fire Chief's Office Interoffice Memorandum To: Jorge M, Gonzalez City Manager Date: September 1, 2000 Via: From. Subject: Florida Department of Health Investigation Attached is correspondence regarding the Florida Department of Health investigation of an emergency medical service complaint involving one of our emergency response units. The Florida Department of Health has concluded that no probable cause existed. Please forward this information to the Mayor and members of the City Commission. I am available to respond to any questions you may have regarding this issue. FJ/mc C:FireChieDordan\DOHPratt.CMO . C) <=> -:."') :-;-1 -'J I '-'-1 en ATTACHMENT 2 MIAMI BEACH FIRE DEPARTMENT Rescue Division Memorandum - ~ OEP.fif$? To: Floyd Jordan .// d-r: Fire Chief Pn, r,-r{ . Edward Del Favero ir 0 . Rescue Division Chief ~~ . Florida Department of Health Complaint Investigation ofFF2 Ted Pratt From: Subject: Date: September 1, 2000 The State of Florida, Department of Health panel investigating complaints leveled by Mr, Powell against FF2 Ted Pratt has reached a conclusioI1- Based on extensive investigation, there is no probable cause to continue. The case is closed and all files concerning this case will remain confidential. I am extremely pleased with the outcome of the state investigation and that FF Pratt, the Fire Department and our city have been vindicated_ Thanks to the entire management team for supporting Ted during this investigatioI1- . Jeb Bush Governor lHE~ Robert G. Brooks, M.D. Secretary BUREAU OF EMERGENCY MEDICAL SERVICES August23,2000 Certified # Z 362 115 443 Return Receipt Requested Albert T. Pratt 2300 Pinetree Drive Miami Beach, FL 33140 Dear Mr. Pratt: This is to infonn you of the outcome of the complaint against you. Based upon the infonnation provided, we initiated an inquiry of the matter. After an extensive investigation, the case was presented to the Probable Cause Determination Panel, which concluded that no probable cause existed. Your case file will be closed and remain confidential in accordance with Section 401.414(3), Florida Statutes (1997). This letter serves as the department's final action in this investigation. If you have any questions, please contact me at (850) 2454440, Extension 2753 or write to the address below. ~~ Barbara Oti Investigator . cc: Art Clawson, Division Director Bureau of Emergency Medical Services & Community Health Resources Phone(850)245~ FAX (850) 488.2512 4052 Bald Cypress Way. Bin CI8 . Tallahassee, FL 32399-1738 www.doh.stale.f1.usJemsJ