BY ANA ACLE

 For nine days, six Cubans who were squeezed together on a small raft limped
 toward South Florida with just two oars. When the Coast Guard found them 11
 miles from Miami on Feb. 25, two men had died, and the surviving four men told a
 desperate tale.

 They had been drinking sea water and urine, and were very sick. But they had
 promised each other that if any more died, the survivors would keep their bodies
 aboard. ``We all make it or we all die,'' they had pledged.

 But their ordeal did not end with their rescue by the 110-foot cutter Matagorda.
 When Ernesto Molina Ramos, 29, became critically ill, he had to wait four hours
 before getting hospital care. He died five days later from a heart attack caused by
 kidney failure. The other three were kept aboard for 14 hours before being
 hospitalized.

 Ship-to-shore Coast Guard communications obtained by The Herald show a
 system seemingly incapable of responding urgently to serious health crises on
 the high seas. Yet officials found no rules violations and are not investigating
 Molina's death. They did, however, acknowledge these circumstances:

 The Matagorda, whose 16-member crew is commanded by Lt. Scott Sharp,
 initially radioed that the rafters were ``in poor shape.'' But the ship had no sick
 bay for them. The rafters were wrapped in blankets to avoid further sun exposure
 and hypothermia, but had to lie on an open deck. The cutter had two emergency
 medical technicians aboard but they could not administer IV tubes, and were
 equipped with small black bags containing only the most basic supplies --
 stethoscopes, gauze and airway kits.

 Rather than bring the rafters ashore, the Matagorda's crew spent an hour
 completing medical evaluations, then radioed a land-based flight surgeon that
 Molina was in ``pretty bad shape'' and needed a corpsman. A corpsman is not a
 doctor, but has more training than an EMT. He cannot order an airlift or
 evacuation, but tells the flight surgeon about the patient's condition, and the flight
 surgeon makes a recommendation to the chief of operations. The operations chief
 then decides whether to bring the patient in.

 It took another hour for the corpsman to arrive by boat. Reports show Molina
 weighed 110 pounds, had a rapid and shallow pulse, was conscious but couldn't
 walk and was in pain from being dehydrated.

 The corpsman brought only one IV, not four. A second corpsman with three more
 IVs didn't arrive for another nine hours and 32 minutes. In the meantime, the three
 rafters drank water to rehydrate.

 The Coast Guard dispatched a helicopter to the scene, but not to transport the
 rafters. Its mission was to ward off news helicopters hovering over the raft.

 Adding to the situation's urgency: Moderate seas turned rougher. Meanwhile,
 questions about what to do with the rafters were relayed up and down the Coast
 Guard's chain of command. A Coast Guard report dated 5:01 a.m., Feb. 26,
 specified the White House Situation Room as one of 32 government offices being
 briefed. By then, Molina had been transported to the hospital, but the other three
 were still aboard the Matagorda.

 `WET FOOT, DRY FOOT'

 Petty Officer Scott Carr, a Coast Guard spokesman, said, ``When we come
 across migrants who are in some sort of medical need, we try to treat them on
 the boat.'' In this case, ``they felt they could handle it on the ship.''

 That prompted this protest from Cheryl Little, executive director of the Florida
 Immigrant Advocacy Center: ``Our Washington policies are driving the Coast
 Guard to do the wrong thing and to back-burner the rescue part of the mission in
 order to forcibly repatriate those fleeing their countries.''

 Five years ago, this would not have been an issue. Prior to a ``wet foot, dry foot
 policy,'' a 1995 agreement reached between the Clinton administration and the
 Cuban government, the U.S. Coast Guard brought Cuban rafters to shore
 immediately -- healthy or sick -- and turned them over to immigration officials for
 processing, Carr said. Now, refugees intercepted at sea are repatriated; only
 refugees who reach land get to stay.

 STABILIZE, HOSPITALIZE

 Critics argue that the policy has caused an increase in the number of fast-boat
 smugglers, who sneak through the Coast Guard's patrol line to deliver refugees to
 shore. But advocates of the policy say the influx of refugees has decreased
 overall.

 ``The big difference,'' Carr said about the policy change, ``is that people went from
 wanting to come aboard to having to be coerced.''

 Carr said Matagorda's crew did their best by wrapping the four rafters in blankets,
 and giving Molina oxygen and the others food and water.

 But medical doctors say the objective of any emergency rescue should be to
 stabilize and then hospitalize the patients as quickly as possible.

 The corpsman who arrived on the Matagorda to help the EMTs could not start an
 IV on Molina because his veins had collapsed, a classic symptom of severe
 dehydration. That forced the Coast Guard to bring him to shore.

 `WORST NIGHTMARE'

 Dr. Manuel Dominguez, who treated Molina at South Shore Hospital in Miami
 Beach, said he catheterized Molina immediately and tested his urine. Those tests
 determined that Molina's urine was not fresh, that his kidneys had failed.

 Not being able to start an IV is ``a rescuer's worst nightmare,'' said Dr. G. Patricia
 Cantwell, director of the pediatric intensive care unit at the University of
 Miami/Jackson Children's Hospital and medical manager of the South Florida
 Urban Search and Rescue Task Force II.

 IVs are often necessary but extremely difficult to provide for a severely dehydrated
 patient, Cantwell says. Therefore, ``you must transport as quickly as possible to
 allow higher levels of expertise to try other types of intravascular access.''

 Once the refugees were turned over to the hospital and immigration officials
 onshore, the Coast Guard's role ended in the case. The military branch says it is
 not reviewing its actions.

                     Copyright 2000 Miami Herald