Wednesday, November 07, 2007

Independently-Licensed VA Health Care Providers Reviewed Re: Illinois Inquiry

This has been a simmering local story since September, now widening into a system-wide review. From the Chicago Tribune:

The Department of Veterans Affairs has limited the surgical privileges of three doctors at the troubled Marion VA Medical Center in southern Illinois, and it is reviewing the credentials of 17,000 other health-care providers for veterans across the country, VA officials told a Senate committee on Tuesday.

The department also announced it is dispatching an "assessment team" to investigate hiring, personnel and management practices at Marion. It will be the third investigation launched at the facility since August, when a computer analysis showed a spike in surgical deaths at Marion and prompted officials to suspend all inpatient surgeries there.

Testifying before the Senate Veterans Affairs Committee, VA officials called their response to the Marion deaths "swift" and their credentialing process for doctors "the envy of the health-care industry." But the top official present, Dr. Gerald Cross, also expressed "some concerns" about the agency's ability to keep tabs on doctors once they've been granted privileges to treat VA patients.

In educational interest, article(s) quoted from extensively.


Sens. Dick Durbin and Barack Obama of Illinois requested the hearing. The two Democrats have pushed the VA repeatedly for information about the Marion facility, 15 miles east of Carbondale, where nine patients died in surgery from October 2006 to March 2007. That was more than four times the expected rate. ...

Under questioning from Durbin, the officials said they also have begun to review the qualifications of all 56,000 independently licensed health-care providers in the VA system. They flagged 17,000 of those providers, or about 30 percent, for further review because of their answers to questions on credentialing forms. For example, the director of quality standards for the Veterans Health Administration, Kathryn Enchelmayer, said her name was flagged because she once voluntarily surrendered a license in a state -- a practice she suggested is common for providers licensed in multiple states.

Durbin asked if that review suggests the deaths in Marion could be a sign of systemic problems in the VA's nationwide network of health-care facilities, but Cross downplayed the suggestion. "We're cautious people," he said, and out of caution "we chose to have this broad review."

The top Republican on the committee, Sen. Richard Burr of North Carolina, said he had asked the committee chairman, Sen. Daniel Akaka (D-Hawaii), to hold off on the hearing, calling it "premature and inappropriate when there's an investigation going." Durbin doesn't sit on the committee but was given permission to ask questions during the hearing.

"The more I learn about circumstances at the Marion VA hospital, the more questions I have about how the Veterans Affairs Department manages staffing and quality control at its hospitals across the country," he said.

From The Southern:

Dr. Gerald Cross (principal deputy undersecretary for Health at the Department of Veterans Affairs) and Tammy Duckworth (director of the Illinois Department of Veterans Affairs) also addressed the committee, but it was Steven McCarty's testimony that tells the tale of a hospital trip gone bad.

Texas native McCarty, a lance corporal in the U.S. Marine Corps Reserve who had recently served in Iraq as a fuel truck driver, said he was traveling through the Midwest last June with his family when he became violently ill. McCarty's parents recommended they make a quick stop at the Marion facility to get him checked out.

"Upon arriving at the emergency room, the doctor ran various tests, which included blood work and a CAT scan," McCarty said. "The results of these tests were negative. At this time, the E.R. doctor, who was a surgeon, admitted me and diagnosed my symptoms as possibly being appendicitis. He recommended removing the appendix and doing exploratory surgery. ...

McCarty said he underwent surgery June 15. He said he was told afterward that the appendix did not look as bad as physicians had expected. Two days after the surgery, McCarty said, his condition worsened.

"However, the doctors continued to follow the timetable for recovery and release after having appendicitis. At this point, one of the nurses told my parents that she would get me out of there if I were her son. She said the doctors did not know what was wrong with me. Seeing my deterioration, my parents began asking for specialists on June 18. They were told the specialists were part of the clinic and were not available to attend to hospital patients." McCarty said his parents spoke with the patient advocate at the hospital.

"We were told there was not a gastroenterologist but an infectious disease specialist was available," he said. "Four days after my surgery, my stomach still swollen and the other symptoms still there, an infectious disease specialist finally came to see me. Within minutes, he diagnosed me with dysentery and changed my antibiotic but could not explain my swollen stomach.

"I honestly looked like I was nine months pregnant. That night, my mom asked a nurse about this and she said she had never encountered a situation like this. Another nurse told us that she would never take her family to any doctors there." McCarty said his condition stabilized enough seven days after the surgery that he could travel.

"My parents asked for assistance in getting me quickly and safely home," he said. "The only assistance given was the cost of one ticket for the shuttle that runs from Marion to the St. Louis airport. When I was discharged, I was supposed to take the new antibiotic with me but was mistakenly given the old and less effective one."

The day after returning home to Texas, McCarty made a trip to the ER at Harris Methodist H.E.B. Hospital. New tests were conducted and it was discovered McCarty had a perforated colon.

"My waste was actually pouring into my abdominal cavity," he said. "I was taken into surgery that afternoon. Two sections of my colon had to be removed. Those two sections were in the same location as two of the laparoscopic incisions. Due to the severity of the infection, the wound had to be left open. After the surgery, the doctor told my parents I was lucky to be alive. If I hadn't been in such good shape and young, I would be dead." McCarty said he spent the next three weeks in the hospital and was discharged on July 11.

"I was attached to the wound vac for six weeks and now have both a colostomy bag and ileostomy bag. The doctors at Harris Methodist H.E.B. Hospital finally diagnosed the symptoms I had been experiencing since my service in Iraq as ulcerative colitis. The part of my colon that remains is not functional at this time.

"This has affected the quality of life for me and my family. This has prevented me from drawing unemployment and working. It is also hindering my advancement in the military," McCarty said. "I have no source of income and I am told it will take one year for the VA to process my disability requests. I have also applied for incapacity pay but have not received anything to date. The actions of the VA hospital in Marion have removed this Marine and countless other veterans from the war on terror. These wounds are not a result of insurgents; they are a result of incompetence on American soil."

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