Jeff Davis County EMS Director contests notice of violation from Department of State Health Services

FORT DAVIS — Jeff Davis County EMS Director Peggy Fonseca received a notice of violation from the Texas Department of State Health Services (DSHS) this August for failing to follow protocol when responding to a call for a person in cardiac arrest in May. 

Fonseca met this week with a DSHS panel for an informal conference on the matter, which she requested. She will have the opportunity to present facts to the panel, and it is possible the notice of violation could be modified or even withdrawn depending on what is presented, according to a DSHS spokesperson. 

If it is not withdrawn, Fonseca can decide whether to “accept any proposed enforcement action,” likely a 90-day suspension, or proceed with a hearing before the State Office of Administrative Hearings, said DSHS. 

The notice of violation — which is addressed to Fonseca — is the result of an investigation conducted by DSHS into her EMT practice. The notice states that upon her arrival on scene to a cardiac arrest patient in May, “an assessment of the person was completed, and the person was determined to be apneic and pulseless.” However, it states, she then failed to “perform life saving interventions” on the individual as required by Jeff Davis County EMS and medical director’s protocols. 

In the notice of violation letter, DSHS suggested suspending Fonseca’s EMT-paramedic certification as well as her instructor certification for 90 days, but to date no such suspension has occurred, said County Judge Curtis Evans. The matter was discussed in executive session — where officials discuss personnel or legal matters out of the public eye — during a September Jeff Davis County Commissioners Court meeting, but no action was taken on the matter.

Judge Evans said he is waiting to see how proceedings play out before taking any action but referred to the situation as “a witch hunt” — specifically, one led by a member within his own court, County Commissioner Royce Laskoskie. 

“That man is doing nothing but trying to dig up dirt on everyone,” said Evans, who added that he has also been targeted by Laskoskie, who was repeatedly calling the Texas Association of Counties legal department to “try and find something [Evans] has done illegal” to no avail. 

Laskoskie denied the witch hunt allegation, stating that Fonseca was under investigation due to her own behavior. He said he believed the matter was not being taken seriously by the court and took issue with her receiving a raise this budget cycle. He said her leadership as head of the county’s EMS department has been “nothing short of a hostile corporate takeover.” 

“I do have very grave concerns for the safety of our community due to the nature of the investigation into Ms. Fonseca’s failure to provide life-saving interventions,” said Laskoskie. “I take this matter very seriously as the state is considering a 90-day suspension of her licensing.” 

The violation, and accompanying incendiary accusations, come at a time of heightened political tension among the county officials. Laskoskie, along with County Commissioner Roy Hurley, recently forced a lower tax rate by refraining from showing up to participate in the budget process — behavior Judge Evans said “disgusted” him. (A story on the larger budget controversy, titled “Fraught budget process, resulting in lower tax rate, deepens divisions in Jeff Davis County government,” can be found in this week’s edition of The Big Bend Sentinel).

Evans added that Fonseca, who has been in the role for a little over a year after the retirement of Vickie Fowler, has excelled at her job by successfully onboarding paid EMS staff, helping professionalize a previously volunteer-run entity — then the only remaining in the Big Bend region. 

“Our volunteers were phasing out, and we had to do something or close the doors,” said Evans. “Peggy has brought it around to where it is a viable service, and it is helping the citizens of Jeff Davis County.” 

Fonseca declined to comment for this story. 

The notice of violation comes after an initial letter, dated June 5 and addressed to Jeff Davis County Ambulance, detailed that a complaint had been filed with DSHS regarding Fonseca’s alleged “withholding [of] resuscitative measures.” 

The letter prompted the ambulance service to send documents and statements to DSHS, primarily relating to whether or not its protocol allowed for Fonseca’s supposed inaction. 

EMS departments establish their own set of strict protocols, working with a medical director, which dictate how EMTs and paramedics are supposed to proceed in various situations. Dr. Travis Cosban of Big Bend Regional Medical Center is the Jeff Davis County Ambulance’s medical director. 

A warning letter was then sent by DSHS to Jeff Davis County Ambulance, dated July 24, stating that their investigation had found that the department’s quality assurance plan was not followed during the May cardiac arrest. It recommended the service review Texas EMS laws and rules to ensure compliance was met, also stating the matter was not subject to appeal and was now closed. 

A DSHS spokesperson said that the initial complaint was filed against the ambulance service and was closed “when it was determined the investigation would focus on [Fonseca] specifically.”