Rebecca Vesely is AHCJ's topic leader on health information technology and a freelance writer. She has written about health, science and medicine for AFP, the Bay Area News Group, Modern Healthcare, Wired, Scientific American online and many other news outlets.
Care delivery at the Department of Veterans Affairs, which serves 9 million veterans, will be fascinating to cover in the coming years.
President Donald J. Trump campaigned on the promise to “straighten out the whole situation for our veterans.” Specifically, to reduce wait times to access care and to deliver better and more high-tech services, including telehealth. The VA is among the few federal agencies that would see a funding bump under the president’s budget proposal, with a 6 percent increase proposed. Continue reading →
Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.
In its “FOIA Friday” feature, the Project On Government Oversight reveals a spreadsheet (XLS format) of claims against the Department of Veterans Affairs, including thousands related to medical malpractice.
The spreadsheet lists administrative claims, the first step in the VA’s process for filing claims.
The data provided has details on over 12,000 claims against the VA from 1989 to November 2008, although the data appears largely incomplete for the first several years. Not all of the claims are medical malpractice-related, but several thousand are. There are fields for the VA facility involved, the date the claim was received, the date of the last tort status (where the claim is in the administrative process), the date of that status, alleged negligence descriptions (none exist for non-medical malpractice tort cases), and amount paid out, if any. The spreadsheet is over two years old, so the latest tort status field may be out-of-date for many of these claims.
The spreadsheet includes 16 cases in which more than $1 million was paid out. The descriptions of the allegations are pretty vague but those 16 cases include:
Failure To Obtain Consent or /Lack Of Informed Consent; Improper Technique; Improper Performance; Improper Management; Delay In Diagnosis; Failure To Treat; Failure To Order Appropriate Medication; Failure To Monitor; Failure To Diagnose (i.e., Concluding That Patient Has No Disease or Condit[ion)]
Failure To Respond To Patient
Surgical or Other Foreign Body Retained
Unnecessary Procedure; Intubation Problem; Improperly Performed Test; Improper Management
It’s worth noting that another recent “FOIA Friday” also was related to health. It was a letter sent by the National Institutes of Health to Emory University “after the media exposed Dr. Zachary Stowe’s cozy financial relationship with GlaxoSmithKline (GSK) while also receiving NIH grants to study antidepressants like GSK’s Paxil in pregnant women.”
Subsequent pieces chronicle the veterans’ battle for compensation, the suspected link between the defoliant and birth defects in Vietnam and continued pollution in that country from defoliants. The last, not-yet-published piece will reveal “documents showing that decisions by the U.S. military and chemical companies that manufactured the defoliants used in Vietnam made the spraying more dangerous than it had to be.”
With assistance from the Fund for Investigative Journalism, the Tribune spent a month traveling to eight provinces throughout Vietnam, conducting nearly two dozen interviews with civilians and former soldiers who say they were exposed to the defoliants.
The newspaper used a database of every spraying mission, mapping software and a GPS device to help corroborate their stories. And in the U.S., the paper researched thousands of pages of government documents and traveled to the homes of veterans to gauge the impact and measure the cost in both dollars and human misery.
According to the reporters, 65 percent of Agent Orange and its defoliant relatives were contaminated with the super-toxin dioxin, and some even contained arsenic. The full impact of this chemical onslaught is unknown, but the Tribune reporters have tracked down a number of alarming anecdotes and numbers.
“We do not know the answer to the question: What happened to Vietnam veterans?” said Jeanne Stellman, an epidemiologist who has spent decades studying Agent Orange for the American Legion and the National Academy of Sciences. “The government doesn’t want to study this because of international liability and issues surrounding chemical warfare. And they’re going to win because they’re bigger and everybody’s getting old and there are new wars to worry about.”
ProPublica’s Sabrina Shankman reviews America’s existing “public options” for health care, finding mixed results and limited utility. In addition to Medicare and Medicaid, Shankman reviews a few less prominent institutions:
The armed forces Tricare plan: Covers all active members of the military, retirees and their families, regardless of preexisting conditions. If you stick to military treatment facilities, it’s cheap.
Veterans Health Administration: Veterans who meet its standards are guaranteed high quality care, but funding is tight at the VA right now.
Indian Health Service: Allows American Indians and Alaska Natives free access to reservation clinics… until the service’s funding runs out, as it does about halfway through each year.
Healthcare Group of Arizona: It was founded to provide afforable insurance to certain small businesses, but a lack of funds and climbing deductibles mean that many employers will be better off looking to the private market anyway.
Bogdanich reports that its doctors, primarily Dr. Gary Kao, had botched 92 of 116 cancer treatments in more than six years. The unit treated prostate cancer with radioactive implants, a process known as brachytherapy. Doctors in the unit avoided regulation in part by revising surgical plans to cover for mistakes.
The first clear signs of trouble cropped up in early 2003, the unit was suspended in 2008. Here’s a brief catalog of missed opportunities to reign in Johns Hopkins-trained Kao and associates:
The unit did not have any peer review process in place.
The V.A.’s radiation safety program didn’t intervene.
Neither did the Joint Commission, the group that accredited the hospital.
Doctors in the radiation implant program weren’t properly supervised.
Or “trained in what constitutes a substandard implant and the need to report it.”
Errors went unreported for months, or even years, while patients had no idea they were even made.
The whole house of cards only came tumbling down when a mistaken purchase of lower-radiation implants triggered an investigation of previous cases. Investigators didn’t find any lower-radiation implants, but they did find errors. Lots of them.
No patients are believed to have died from this mistake-riddled treatment; the unit was suspended in mid-2008 and similar programs (whose problems don’t seem to have been as severe) were shuttered in Jackson, Miss., and Cincinnati. Seven of the affected patients were flown to a more experienced V.A. unit for additional treatment.
In a related story, The Philadelphia Inquirer reports that the problems came to light “not because the NRC finished its inquiry” but rather when a Nuclear Regulatory Commission advisory committee asked the agency for an update because “committee members had been hearing disturbing things about the Philadelphia VA’s program.”