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"McKinney 911," answered the voice of the female dispatcher. "What is the address of your emergency?"
A nurse mumbled that she was calling from the psychiatric unit of North Central Medical Center. "I have a code blue [cardiac arrest] in progress, and I need help immediately..."
"How old is the person?"
"I don't know," she said frankly.
"...I am sending the paramedics right now," assured the dispatcher. "Ma'am, I have some questions for you."
The nurse searched for Mike Scarcella's chart but couldn't seem to find it.
The dispatcher sounded annoyed. "Ma'am, is he having breathing difficulties?"
"He has stopped breathing, and they have started to...hold on." She paused to speak to another nurse. "Are you sure this is the right Mike?"
"...OK, is he conscious at all?"
"No, he's not conscious right now."
"And he's still not breathing?"
"They're doing CPR, and we're looking for his chart," said the nurse. "Do you have his chart over there?"
"...Is he able to talk to you at all?"
"Is he changing color at all?"
"Yes, yes," she said. "That's when we noticed he went down on the floor, and he was banging his head on the floor."
"...Does he have a history of heart problems?"
"That I don't know. Actually I don't know anything about the patient."
"Do you have an AED there?"
The nurse repeated the letters, acting as if she had no idea what they meant.
"An automatic electronic defibrillator," instructed the dispatcher.
"Oh, no. Well, they might have one on the fourth floor..."
"Do you want me to send an officer with an AED?"
"Yeah, I guess it couldn't hurt..."
Precious seconds were passing. "Do you know anything about this man?" asked the dispatcher.
A second nurse answered, ostensibly more knowledgeable than the first. "I don't know that much about the man except that he's very psychotic. And the last thing that I saw was that he threw himself down on the ground and banged his head on the ground."
"Did he choke on anything first?" the dispatcher asked.
"...He didn't appear to be choking," she said.
"Does he have a history of seizures?"
"That I don't know."
Seven minutes into the 911 call, medical personnel found his chart. "He has been having withdrawal from GHB," she informed the dispatcher. "Hallucinating and inaudible. He was apparently on a medical floor."
She was referring to the intensive care unit of Plano Presbyterian Hospital, where Scarcella had been a patient for 10 days after suffering the broken jaw. Despite his mouth being wired shut, despite his being treated for pneumonia, despite his being in the throes of psychosis induced by GHB withdrawal, the Plano hospital had him involuntarily committed to North Central Medical Center's psych unit. This was not what he and his friends had envisioned when they planned his rehab.
"My fire department is on location," said the dispatcher. "I am going to disconnect. Thank you so much."
At 10:12 p.m., less than six hours after leaving intensive care, Mike Scarcella was pronounced dead.
When Gleisner received a phone call from North Central Medical Center informing her of Scarcella's death, "the hospital said he died in transit to the emergency room," she says. But two days after he died, Gleisner's fiance, Jim Cardenas, received an anonymous phone call from a nurse at North Central Medical Center, who told him "that a grave injustice had been done." In a later call, the nurse revealed his name was Robert Meskunas and that he helped admit Scarcella to the McKinney hospital, although he was off-duty when he died. Meskunas' knowledge was secondhand, a compilation of what others had observed, but he was convinced Scarcella was too unstable to be in a psych unit. "He said they should have stepped him down from critical care to regular care for three or four days," recalls Cardenas, who took notes on the conversation. Meskunas told him there was a concerted effort on the part of North Central Medical Center officials to say that Scarcella died while paramedics were transferring him to the emergency room, but that just wasn't the case. He was dead before they arrived, and the nurses charged with his care improperly responded to the code blue. He and another nurse had filed complaints about the incident with the Texas Department of Health. Meskunas told the same story to the McKinney Courier-Gazette, as did a second nurse, who wished to remain anonymous but gave the newspaper a copy of her complaint. Meskunas was removed from the "nurses schedule" and no longer works at North Central Medical Center. Meskunas has not returned phone calls seeking comment, but the Dallas Observer has obtained the findings of those complaints, which fault North Central Medical Center for violating three federal regulations, including the "failure to supervise and regulate the nursing care [of Scarcella]." "The hospital's Cardiac Arrest/Code Blue policy was not followed," says a statement of deficiency prepared by the Department of Health and Human Resources. "No cardiac monitor was attached to determine the rhythm...no IV access was obtained, and the suction was not set up and prepared to intubate."
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