a sad read on the Dallas VA part 1

[booksbenji]

VA patients paint picture of neglect

Director acknowledges problems, says Dallas hospital is improving


01:28 PM CST on Sunday, February 13, 2005


By DOUG J. SWANSON / The Dallas Morning News


John Hahn lay marooned in his bed last year at the Dallas veterans' hospital, desperately seeking a nurse. An Air Force vet whose terminal bone cancer had made him a paraplegic, Mr. Hahn required turning every two hours.

That day, March 21, he started at 5:30 a.m. pushing his call button, which rang at the nearby nurse's station. No one came. He pushed it throughout the morning and into the afternoon, and still nothing.

"Called/Requested help for the past 8 hrs," he wrote in his journal.


IRWIN THOMPSON / DMN
Carol Watson gives husband Frank some coffee. 'I would never send Frank back there. Never,' she says of the hospital.
Finally, in anger and frustration, Mr. Hahn used his bedside phone to summon the police.

An officer arrived within minutes, and nurses said they had in fact checked on Mr. Hahn several times. When the officer left, a hospital aide gave the patient the relief he sought.

"Took 5 min," Mr. Hahn, 61, wrote in his journal. "Within an 8 hr period of time they couldn't find 5 mins. to turn me."

Although his solution was unusual, Mr. Hahn's story of neglect at the Dallas Veterans Affairs Medical Center is not.

Virginia Pritchett of Mineral Wells recalled her father's stay there for hip surgery.

"I can take my animals to the veterinarian and get better treatment than my father got at the Dallas VA," she said. "They shouldn't do this to anybody, let alone someone who fights for their country."

Tammy Turner of Fort Worth also took her father to the Dallas VA. "They made it a living hell there," she said.

Stephanie Canada of Dallas remembered her husband's hospitalization last year for a stroke. "The nurses there do not care if people live or die," she said. "There was plenty of staff, but they'd rather play cards."

Officials with the U.S. Department of Veterans Affairs said they are aware of problems at the medical center, which ranked last among all veterans hospitals in its adherence to federal performance standards in 2004.

Changes are being made, said Thomas Stranova, director of the VA Heart of Texas Health Care Network, which operates hospitals and clinics from the Red River to the Rio Grande.

"It's like turning around a battleship. ... We are making visible improvements," he said, adding: "We have a good distance to go yet."

Mr. Stranova did not blame funding or staffing levels for the problems. "We need to look at how we use our resources," he said. "Do we have the right people in the right place?"


Dozens interviewed

Over the last three weeks, a reporter for The Dallas Morning News has spoken to, or exchanged e-mails with, more than 150 Dallas VA patients or their families. Some said in interviews that they fared well at the Oak Cliff hospital.

"There are so many good things to point out," said Kenneth Hackney, who supervises Disabled American Veterans volunteers at the Dallas hospital. "We have people who care about the veterans. They are concerned about veterans, and they understand veterans."

Of his stay there in 2003 for a spinal epidural procedure, Mr. Hackney said: "I think it's the best care I could receive anywhere."

Even those with major complaints about the hospital praised some individual doctors, nurses and therapists who showed extraordinary devotion to duty. Some singled out the spinal cord injury unit as particularly good.

But many of those interviewed also described deliberate mistreatment at the hands of nurses and support staff. They portrayed much of the medical center as a dirty and ill-equipped institution where patients cry out vainly for aid and others are left to die alone.

Ms. Pritchett, for example, said nurses and aides routinely ignored her bed-ridden father, an 81-year-old Marine veteran of World War II who won the Navy Cross. He wasn't alone in his suffering at the hospital's Transitional Care Unit.

"I would be walking down the hall, and patients would be calling out for me to get help, because the nurses wouldn't answer," Ms. Pritchett said. When she went to nurses to complain, she said, she found them "sitting there having lunch."

Steve Van Note, a Plano police officer, said his stepfather, an Army veteran of World War II, checked into the Dallas VA in late 2003 for treatment of breathing problems. In his bathroom "there was feces splattered on the wall," Mr. Van Note said. "In one week alone there were three or four days when they didn't feed him."

Aides told the family the patient had been set for medical tests that required them to withhold food. Actually, Mr. Van Note said, no tests had been scheduled.

At the stepfather's request, the family moved him to a private facility, Mr. Van Note said. "Even he himself said, 'I need to get out of here and get to another hospital.'"

His stepfather, John M. Patton, died in April at the age of 74.

Not only patients and families find fault. Dr. Dell Simmons, a resident physician in emergency medicine at the Dallas VA, said patients are dying needlessly.

"Lives are being lost unnecessarily due to the mismanagement of this facility," Dr. Simmons said. "We're constantly in a battle to get care accomplished. ... They have an undertrained and undermanned staff, and it's poorly deployed."

Dr. Simmons, who is in the second month of his residency, said many patients face long delays in receiving routine tests and procedures, especially on nights and weekends. "Those kinds of things can turn a problem that can be easily treated into a disaster," he said, adding that he sees little hope for improvement. "People here have really kind of given up fixing problems."


Low marks

The inspector general for the Department of Veterans Affairs, in a report completed in November 2004, gave the Dallas hospital low marks in many areas, including sanitation, management and patient safety. Hospital officials said problems cited by the inspector general were eliminated while the investigation was under way.

But Robert Faulkner of Abilene, an Air Force veteran and safety engineer, said he was admitted to the hospital in November and found his room filthy. A urine-soaked pad had been left under his bed, he said. He discovered another pad in the nightstand drawer, this one smeared with excrement.

"There was bloody gauze all over the floor," Mr. Faulkner said. "I showed it to the nurse, and she said, 'What do you expect? This is the VA.' "

Dorothy Davis of Dallas said the man for whom she is a legal caretaker, a 56-year-old Army veteran, spent time in the Dallas VA in October for a stroke that paralyzed his left side. "He received the worst care any human could have," she said.

Ms. Davis said the man, who asked that he not be identified for fear of retaliation, had a tracheotomy with a breathing tube inserted. Such tubes often need to be suctioned for the removal of mucous and saliva. Many times, she said, nurses refused to perform this procedure.

"I literally had to go in and do the suction for him," she said. "The nurses would disappear."

Last month, The News disclosed results of a federal survey of medical students at the Dallas VA. They said an incompetent and uncaring nursing staff often neglected and abused patients.

One day later, the chief of nursing services for the hospital was replaced. And the national veterans health office in Washington announced it was sending two special teams to Dallas to investigate conditions.

The Department of Veterans Affairs turned down a request by The News to interview members of the inspection teams. The department also refused requests for interviews with managers of the nursing service at the Dallas VA.

Network director Stranova said the national office sent inspection teams to Dallas in part because of publicity and in part because of need.

"I'd like to say that 85 percent of the veterans who walk through our door get excellent care," he said. "But what about the other 15?"

Some patients have no complaints. Richard Hearne, 62, of Dallas said he had colon surgery last year and was treated well. "It was great for what it is," he said. "I found the people to be delightful."

An Army veteran, Mr. Hearne said much depends on one's approach. "The people who have a good attitude have a good experience. The people who have a bad attitude have a bad experience,"

Fred Cantrell of Point, Texas, said he has enjoyed excellent care during and after five surgeries at the Dallas VA. A 69-year-old Army veteran, Mr. Cantrell said part of the problem lies with the medical students.

"These wannabe doctors, they don't have any power," he said. "They can't tell a nurse what to do, so they feel like the nurses are not doing their jobs."

Expectations of nurses may be too high, said Donna Jackson, a registered nurse who worked at the Dallas VA for more than 10 years. She left in 2001.

"People have ideas in their heads about what nurses are supposed to provide," she said. "But patients may want something that's not a priority. If you want a pain pill, that should be a priority over issues of personal care."

Mrs. Jackson, who now works at a Houston VA hospital, said she found nurses at the Dallas hospital to be dedicated and compassionate.

Some nurses and doctors at the Dallas VA pointed to difficulties with poorly performing support staff, such as aides and custodians. Incompetent workers are rarely fired, they said.

"These people are protected by the union," one nurse said, "and they move from one unit to another because nobody wants them."

[booksbenji]

:mad:

"These people are protected by the union," one nurse said, "and they move from one unit to another because nobody wants them."


Lack of cooperation

Network director Stranova said hospital management and union officials "have not worked well together." He said he hopes new leadership at the hospital will provide "an opportunity to build new bridges."

Donald Burrell, president of the American Federation of Government Employees local that represents all unionized workers at the Dallas hospital, including nurses, declined to comment.

Many patients and families said hospital management has shown little interest in reacting to problems.

Ms. Turner said she filed an estimated 10 complaints with hospital officials but never received a satisfactory response. "Nobody wants to do anything there," she said. "Ninety percent of the people, if you ask them to do anything, they act like you asked them to do a flip or something."

Her father, an ex-Marine named Ronald Short, had cancer that had spread to his spine, she said. That made sitting or standing excruciatingly painful. So when she brought him to the Dallas VA for his check-ups, Ms. Turner said, he needed to lie on a gurney.

However, she said, "they wouldn't ever have a gurney. ... They told me they didn't have enough."

Once, while waiting to see a doctor, "He said, 'I've got to lay down. I've got to lay down now,' " Ms. Turner recalled. With no bed or gurney available, "I had to take him outside on one of those steel benches in the pouring rain."

Mr. Short died last year at age 68. During one of his hospital stays, Ms. Turner said, "two of the nurses that were supposed to be helping my dad were out in the hallway cussing up a storm about what they had to do for him. My dad could hear the whole thing."

She conveyed her concerns about such treatment to hospital officials, Ms. Turner said. "They never got back with us on anything. Nothing."

Lynn Lopez, the daughter of the journal-keeping Mr. Hahn, echoed those sentiments. "We complained at least 15 or 20 times over three months," she said. "The response was kind of like a brush-off. You never saw anything different."

For example, she said that despite their complaints, the staff often failed to give Mr. Hahn all his medications. Sometimes they would find his pills dumped into his bed, Mrs. Lopez said.

"We basically turned into the policing agency," she said. "We had somebody up at that hospital 12 to 14 hours a day, seven days a week." Mr. Hahn died in June.

Frank Watson, a retired American Airlines executive and Navy veteran, came to the hospital's Transitional Care Unit in January for a two-week stay. Mr. Watson, 74, has amyotrophic lateral sclerosis, also known as Lou Gehrig's disease.

Mr. Watson, who once enjoyed playing tennis, was diagnosed with the degenerative nerve disease in 2002. It has left him with no use of his legs and only two functioning fingers. He went to the Dallas VA so his wife, Carol, could have a much-needed break from caring for him.

Mr. Watson had been a patient at the medical center about five years before, "and everything was terrific," he said. This time was different.

He got one bath in two weeks. His teeth were never brushed. An emaciated patient roamed from room to room, stealing food off other patients' trays. Nurses told Mr. Watson that the man had a tapeworm.

When he needed to urinate, Mr. Watson pressed his call button for help with the bottle. Frequently no one responded. This made little sense to Mr. Watson, who could see the nurse's station from his bed.

"I could see three or four nurses sitting over there just chatting, having a good time," he said. "Sometimes they'd let it ring for around a half-hour."

At times he was left lying in his own waste for hours, and no one would answer his call button. "One night they just turned it off for an hour or more," he said.

On another occasion he asked a nurse who was in his room to help him move his feet to ease his pain. "I said, ' Nurse, could you help me for a second?' She said no and just kept on going out the door."

After he returned home, the Watsons complained and received an apology from one of the nursing managers. "He asked that we give him another chance," Mrs. Watson said. "I would never send Frank back there. Never."

Another family – a daughter, three grandchildren and four great grandchildren – came to the Dallas VA in October to visit David Sledge, 67, an Army veteran who had been admitted two days before with symptoms of a possible stroke.


A death unnoticed

Expecting a pleasant chat, they walked into his room one night and found him in bed, wearing only a diaper, unattended and not connected to equipment that monitors heart rate and blood pressure. His call button was several feet away on a nightstand.

He had been dead so long his body was cold to the touch. "His ears were blue, and his tongue was black," said his granddaughter, Teresa Garvin of Coppell. "More than half his body was discolored."

She went to the nurse's station about 50 feet down the hall. The time was 8 p.m.

"I asked the nurse, 'When was the last time you checked on David Sledge?' " Ms. Garvin said. "She said, 'We checked on him about 6:30 [p.m.]. Why?' "

An autopsy later showed the cause of death to be cardiac arrest, Ms. Garvin said.

The family was informed that Mr. Sledge had not been connected to monitors because his condition was believed to be stable, which is in accordance with standard practice at many hospitals.

An attending physician had this explanation for Ms. Garvin of her grandfather's unattended death: "She stated to me, 'I apologize, but our nurses are overworked and underpaid, and things like this just happen.' "

Network director Stranova said he believes the Dallas VA staff is large enough and sufficiently paid to deliver services well.

Hospital management, he said, needs to pay more attention to recently incorporated performance standards. "We still have a steep curve to go up, but we're climbing the curve," he said. "We're anxious to change the culture."

With the next wave of VA patients coming from the war in Iraq, officials are bracing for new challenges and increased scrutiny.

"We're here to serve veterans. They've earned it," Mr. Stranova said. "We care about them. We see them as members of our family."


Makes 1 truly sad to see our Veteran's so shamely treated
:mad: