VA Optometry Care, good or bad?


The recently reported settlements of $250,000 and $400,000 for veterans allegedly harmed by inappropriate management of glaucoma, a blinding disease,  by staff optometrists at the Palo Alto Veterans Affairs Hospital raises unanswered questions. As CEO of Veterans-for-Change, an organization that strives to make advances in the treatment of and improve the rights of all veterans, I can personally attest that the path to making veterans “whole” is not always as straightforward.

Although these three settlements have been cited in the press, the initial report by the Mercury News Group in July 2009 indicated the “VA informed seven [patients, which subsequently increased to eight] that improper care [rendered by the optometry service] might have caused their blindness.”

I am hopeful the remaining veterans will also reach or have reached appropriate settlements. However, the “internal review of 381 charts identified 23 glaucoma patients experienced ‘progressive visual loss’ while receiving treatment in the hospital’s optometry department.” What of the remaining 15 patients whose “visual loss” didn’t rise to the VA’s standard for notification?  What about patients being treated at other VA’s?

The Palo Alto VA situation highlights the need for appropriate enforcement of policies designed to protect patients. To its credit, the Palo Alto facility took strong action to address the situation. The ophthalmology service – which, according to written Palo Alto VA policy existing before the chart review, was supposed to be consulted by optometry on all glaucoma patients – is now supervising the optometry service, and strict specific referral guidelines have been established for not only glaucoma, but other potentially sight-threatening symptoms and signs.

Should it be presumed that veterans elsewhere did not suffer harm where such oversight from the ophthalmology sections didn’t exist (or might not have been requested)?

The VA appears to have responded nationally by requiring each center to develop its own “referral plan” related to such potentially sight-threatening disease, which might or might not require specific oversight. Is that enough protection for veterans?  The Palo Alto VA already had such a plan but the policy wasn’t followed apparently with tragic consequences.

Put simply, there is no reason to believe a patchwork of different plans will suddenly ensure our veterans receive the best possible eye care.

Without meaningful congressional hearings and in-depth chart reviews of a sizable sample of other facilities the results of which are made available to the public there is no way to know whether this was an isolated problem or one that may be pervasive throughout California, and throughout the country.

In responding to another recent crisis at a VA facility in St. Louis where failure to sterilize dental instruments may have exposed over 1,800 veterans to infectious diseases including HIV/AIDS, Katie Roberts, a spokeswoman for the Veterans Affairs department was quoted in a New York Times article  as saying “V.A. is in the process of standardizing the standard operating procedures for the cleaning of all reusable medical equipment across the country.”

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It needs to be determined whether national standardization should extend to the new Palo Alto model for addressing potentially sight-threatening eye disease.

U.S. Representative Anna Eshoo, whose congressional district contains the Palo Alto VA and to whom other congressional representatives look to for guidance regarding activities in her district, and her colleagues in neighboring districts whose constituents are served by the Palo Alto VA – U.S. Representatives Jackie Speier and Mike Honda — should demand the holding of congressional hearings on this issue and to obtain hard facts regarding the care at a more representative sample of VA facilities.

In doing so, these elected representatives can help ensure that veterans are receiving the level of quality of eye care they deserve in return for their loyal service.

1Malcolm Gay, “Veterans at St. Louis Center Are Told of Exposure Risk,” New York Times, June 30, 2010

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