The Blanco Volunteer Ambulance Corps (BVAC), along with paramedics Mark McMain and Suzy Armstead, have recently come under investigation from the Texas Department of State Health Services (DSHS). The state agency licenses EMS personnel and takes disciplinary action while investigating possible violations of the Texas Administrative Code.

On February 6, DSHS put Mark McMain's paramedic certificate on emergency suspension while it looked into reports that he allegedly took the pain medication fentanyl from the ambulance corps a total of 237 times without authorization.

Subsequently, on February 15, the state agency sent letters to paramedic Suzy Armstead and the Blanco Volunteer Ambulance Corps as a whole. The letter to Armstead alleges that she assisted McMain in misappropriating--or failed to take precautions to prevent the misappropriation--of the fentanyl, a controlled substance.

Blanco EMS received the same allegations, along with allegations that the organization "failed to adequately monitor and/or have in place appropriate measures to safeguard its controlled substances, and/or failed [to] take appropriate action regarding the safekeeping and/or misusage of its controlled substances."

DSHS proposed to revoke the corps' license and Armstead's paramedic certificate; the department asked for the recipients to opt for a hearing to answer the allegations.

State Health Services has currently taken just one action--suspending McMain's certificate. During the suspension, McMain is restricted from taking care of patients but can still drive the ambulance, direct personnel on the scene, and instruct. A hearing date has not been set and charges have not been filed. The actions of the state agency did not remove McMain as president of the BVAC board or as director of the EMS organization.

In response to the news of the suspension and allegations, the Blanco Volunteer Ambulance Corps held a public meeting last Wednesday, February 27, in the training room at the EMS station.

As president of the corps' board, Mark McMain opened the meeting with about 50 people in attendance. As the first order of business, McMain resigned as president. The positions of director and president were combined years ago, McMain stated, as the corps didn't have enough members. Now that they do, McMain was able to resign from the position. He retains his job as director.

The organization's bylaws dictate how members of the board automatically move into new positions upon a resignation. Ruthie Weirich is now president, the first vice president is Ty Grenwelge, Suzy Armstead is treasurer, Tirza Sanchez is secretary, and the parliamentarian is now David Hotz.

As director, which is a paid position, McMain continues to take care of the ambulance units and supplies; he isn't required to attend board meetings.

McMain introduced Dr. Larry Miller, who is BVAC's medical director. When caring for patients, the people working for BVAC do so under Dr. Miller's medical license. He is the medical director of 15 EMS organizations in the area, including North Blanco County EMS.

"I've known and worked with Mark McMain for over 20 years," Dr. Miller said in an email interview this week. "I have found him to be one of the most caring and dedicated paramedics I have ever known. I would trust him with my life. He has single-handedly developed Blanco EMS into one of the most outstanding rural EMS organizations in Texas. It was therefore with great shock and sadness that I learned of his use of fentanyl to treat his wife."

Dr. Miller explained to the meeting attendees that he first got a call from the Department of State Health Services that asked him to do an audit on Blanco EMS' morphine and fentanyl. The medications serve for patient comfort, he explained. "They save [the] lives" of people in pain, such as those with burns or having heart attacks.

"While we tend to judge any misappropriation of controlled drugs as black and white," said Miller. "I believe in the case of Mark McMain there are compelling reasons to reconsider his actions and our reaction to them. I believe he acted with nothing but good intentions.

"[McMain] never stole any drugs. All drugs were accounted for and records made with witnesses to their use. You do not document drugs that you are stealing. He did not use any drugs for his own use or sell them for profit. He used them all for compassionate reasons, to treat his wife who was suffering uncontrolled pain."

Blanco EMS uses drug log forms to keep track of every milli- and microgram of drugs used. During Dr. Miller's audit, the accounting balanced for drugs ordered, used, and still in double-locked storage at the station and onboard the ambulances.

Every dose of fentanyl removed was witnessed and documented by paramedic Suzy Armstead for the purpose of administration to McMain's wife. Although Armstead had signed each drug log sheet, McMain had failed to complete a run sheet for the patient, who sometimes came to the station for treatment, and at other times was given the injection at home. The doctor reported that fentanyl comes preloaded in syringes of 100 micrograms.

As medical director, Dr. Miller conducts annual audits. Except for three episodes that were documented in 2006, Miller elaborated, all of the fentanyl uses were in 2007. The audit took place in January 2008, when Dr. Miller discovered the multiple uses for McMain's wife.

McMain "believed (incorrectly) that treating patients with severe pain was within his scope of practice," Miller continued, "and would be authorized under the operating protocols. He never harmed anyone or placed the public in jeopardy.

"Now that he understands the errors of his ways, he has taken full responsibility for his actions and sincerely regrets what these actions have cost Blanco EMS, its Medical Director, his fellow EMTs, the Board of Directors and the community."

McMain and Miller both emphasized that they were going to fight the state's allegations and not allow the Blanco Volunteer Ambulance Corps to be shut down.

"I guarantee you that people will die," Dr. Miller stated. Response times from surrounding EMS organizations would be "outlandish."

Dr. John Weaver, who attended the meeting, joined others in expressing his support for BVAC. With response times of 4 minutes or less if a patient at his clinic requires transport, Weaver said, "it means lives are saved."

In answer to questions about availability of paramedics during emergency calls, Dr. Miller stated that he has given the go-ahead for advanced basic EMTs to take over if Armstead and other paramedics aren't available.

McMain conveyed his appreciation to Dr. Miller for explaining everything. "What I was doing was wrong," he said. "I apologize to everyone here for what the organization has been through. BVAC will keep furnishing great service." McMain apologized that he can't be out in the ambulance helping people, but he can still be there on location and to help with helicopter landings.

Sherry Hawkins, Mayor Jim Rodrigue, Mayor Pro-Tem Ron Houston, Blanco Volunteer Fire Department Captain Armando Delgado, and others spoke in support of McMain. Like many in the community, they prefer Mark McMain to respond to their medical emergencies as they have come to trust him over the years he has served Blanco EMS and Blanco County.

Many asked for contact information for the Texas Department of State Health Services; the Blanco County News is providing the information to anyone who wants to show their support. Kathryn C. Perkins, Assistant Commissioner, Texas Department of State Health Services, can be reached at P.O. Box 149347, Austin, Texas 78714-9347 or 1-888-963-7111. Brett Hart, EMS Compliance Manager for Central Texas, is at the same address or 512-834-6731.