Inspection finds CAT scans, MRIs delayed at VA hospital

Inspection finds CAT scans, MRIs delayed at VA hospital
By John Pacenti

Riviera Beach, Florida–A federal inspection of the Veteran Affairs Medical Center found nearly 3,000 patients were not provided CAT scans or MRIs in a timely fashion, including one veteran whose pervasive lung cancer went undiagnosed for 15 months.

The backlog was rectified soon after investigators with the Veteran Affairs Office of Inspector General looked into the backlog. But some veterans and their families say that the situation is typical of long waits they must endure for crucial appointments at the hospital in Riviera Beach.

The inspectors’ report, completed in March, was sparked by eight anonymous complaints to U.S. Rep. Alcee Hastings. The Miramar Democrat has long been critical of the Bush administration for not providing more money for VA hospitals.

Hastings held a town hall meeting last month at Palm Beach Lakes High School in West Palm Beach at which about 100 veterans voiced concerns about care and staffing at the medical center.

“I will not be satisfied until all veterans in Palm Beach County and the surrounding area get the care fitting of the service they provided to our country,” Hastings said. “I don’t think that’s happening right now.”

MRIs and CAT scans are crucial tools for diagnosing cancer and other invasive diseases and injuries. MRIs use magnetic fields to generate computer images of the body’s internal tissues and organs. A CAT scan is a specialized X-ray often used to create images of the brain and spinal structures.

The inspector general’s report said that from April 2002 to May 2004, 2,977 CAT scans and MRIs at the VA hospital were not scheduled within the required 30 days. Medical center radiologists also did not interpret or verify a significant number of radiographic images within five days of exam completion, investigators found.

Lack of follow-up criticized

Investigators examined 62 primary lung cancer cases diagnosed in 2003 to determine whether delays adversely affected diagnoses or treatment. Though it was hard to tell in most cases, the inspection report cited one case in which a doctor ordered an MRI for a veteran with lung lesions on June 11, 2003. The exam was completed two weeks later, but the results were not interpreted until Sept. 26.

The results weren’t verified until Oct. 1 three months after a pulmonologist ordered the MRI. Doctors had found an abnormality, but by that time, the patient had moved out of state.

Federal investigators said that if the MRI had been interpreted immediately, as required, the patient’s follow-up care could have been better coordinated. Investigators tracked down the patient in June 2004. In September, doctors removed part of his lung and were able to make a full diagnosis. A pathologist reported “invasive squamous cell carcinoma that had moved on beyond the veteran’s lymph nodes.”

Investigators castigated the VA hospital for failing to aggressively follow up on the patient’s test results.

“Regardless of whether the lesion was cancerous and metastatic (as with this patient), or benign, to delay definitive diagnosis for 15 months in a patient with a lung lesion does not meet the standard of care,” the federal report stated.

VA hospital Director Edward Seiler defended his facility in a Nov. 15 memo to federal inspectors. Their findings affirmed the hospital “delivers excellent care to our nation’s heroes,” he wrote.

A spokesman for the medical center said the hospital started to rectify the backlog of MRIs and CAT scans in March 2004, before the federal investigation started. The hospital added two machines, at a cost of $1 million each, hired more staff in the radiology department and outsourced some appointments.

The hospital couldn’t provide the exact number of new hires in the radiology department, but staffing at the hospital overall has increased from 1,434 in 2000 to 1,740 in 2004.

The number of patients treated, though, has gone up as well. Inpatients rose from 3,676 in 2000 to nearly 6,000 last year. The VA hospital treated 527,404 outpatients in 2004, up by nearly 200,000 patients in four years.

‘We are meeting obligation’

VA hospitals are the largest health provider in the country. And with Iraq veterans returning from war, demand at veterans hospitals is on the rise. Congress last month released $1.5 billion to cover a deficit in the VA budget.

“We do the best we can with what we have,” said Phil Kaplan, spokesman for the medical center. “If a veteran walks through the door of the medical center, he will see no change in the quality health care of the medical center regardless of the budget.”

Kaplan called the federal report “history, not news.” He said complaints voiced by veterans at Hastings’ town hall meeting on Aug. 15 were from “an individual standpoint” and could be solved through the hospital’s patient advocates.

“I think at this point we are meeting our obligation to our veterans,” Kaplan said.

Even with the MRI backlog fixed, some doctors, veterans and their families say inadequate staffing can be found in other areas at the VA hospital.

Paula Lang, a clinical psychologist at the VA hospital and president of the local chapter of the American Federation of Government Employees, said veterans are falling through cracks as physicians are asked “to do more with less.”

John “Jack” Ott, a chapter service officer for the Military Order of the Purple Heart, said that during his rounds this summer, he came across a quadriplegic decorated World War II veteran Arnold Snyder staring aimlessly at a food tray. The nurse had not been in to feed him.

“When I got there at lunch time, he hadn’t eaten his breakfast,” Ott said. “They didn’t have enough people to hand-feed patients. This has been happening repeatedly.”

Snyder, who received two Purple Hearts and three Silver Stars as a U.S. Army infantry commander at Normandy and the Battle of the Bulge, said he was in the hospital for a broken leg. Paralyzed from polio in all but one arm, he said all he could do was stare at the plate of food in front of him.

“They are so understaffed, the veterans are not getting the proper care,” Snyder said.

Dulce Maria Welch said her 92-year-old husband, Harry, often would go unattended by nurses in his last days. Harry Welch was a decorated veteran who had received the Purple Heart for injuries received at Iwo Jima. One night his wife said she couldn’t even find a nurse to change his diaper.

“He was soaking wet. I didn’t want him wet all night. So I changed him myself,” she said. He died July 30 and he will be interred at Arlington Cemetery on Tuesday.

Welch said the VA almost turned her husband away at the emergency room. The doctor, she said, insisted that Harry Welch was supposed to be under hospice care even though he had a card giving him walk-in status at any VA hospital.

“I felt so bad for Harry. He didn’t deserve this kind of treatment in his last days,” she said. “He had so much faith in the VA. He didn’t know that they would discard a veteran like an old pair of shoes.”