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More quality of care issues cited at Marion VA

BY JOHN D. HOMAN, THE SOUTHERN

Friday, March 28, 2008 9:57 PM CDT

MARION - Three additional complaints filed by families of veterans concerning the quality of care at the VA Medical Center in Marion were addressed this week in a detailed report by Dr. Jerome Herbers, who is with the Office of the Inspector General in Washington, D.C.

"We appreciate the work the VA Inspector General completed on these cases referred to their office," said Washington VA spokesman Matt Smith. "Although this report revealed no new instances of improper care, the VA remains vigilant as we continue to rebuild the quality of care at Marion and restore veterans' confidence in our ability to provide them with the world-class care they have earned through their service to our country."

In the first complaint, the wife of a veteran in his 50s alleged a surgeon in February 2007 performed total knee arthroplasty on her husband - a patient with kidney cancer - and physicians disagreed about the cause of a subsequent infection he developed in his knee.

During a second hospitalization for a diagnosis of cellulitis of the right lower leg with possible infection of the right knee, the patient complained of severe abdominal pain and a CT scan identified a kidney mass. While treating physicians initially differed regarding the possibility of a knee joint infection, the final diagnosis was cellulitis of the right lower leg, and this infection was treated appropriately.

"We did not substantiate the allegation that clinicians missed a cancerous kidney mass during the patient's preoperative physical examination for a total knee arthroplasty," Herbers said. "The preoperative physical evaluation documented that there was no abdominal organ enlargement."

The second complaint concerned the management of lung cancer with a patient, a man in his 60s with a history of diabetes and a longtime history of heavy smoking.

The patient alleged that a surgeon mistakenly removed the upper lobe instead of the middle lobe of his right lung during surgery in February 2007, and therefore, his cancer was not adequately treated. The complainant reported that staff at the private hospice where the patient was being treated told him about a local newspaper article concerning the surgeon who had operated on this patient.

The patient further reported that one of his other providers at the medical center told him about concerns regarding the quality of care provided by this surgeon.

That provider allegedly told the patient that the surgeon had not properly documented details about which lymph nodes he had biopsied. The provider did not believe this affected the patient's outcome.

"We did not substantiate the allegation that the surgeon erred by removing the upper lobe instead of the middle lobe of the right lung," Herbers said. "The pre-operative CT scan showed cancer in the right main stem bronchus and the base of the right upper lobe. The surgeon was not able to remove the tumor in the hilum, because it was infiltrating the surrounding tissue."

The third complaint involved a man in his late 50s with a history of diabetes, hypertension, chronic renal insufficiency and a remote history of stroke. He had undergone amputations of both legs below the knee. In the first half of 2007, he had been seeing a private physician for headaches, for which he was taking a narcotic medication.

In mid-2007, the patient was admitted for long-term care at the VA nursing home care unit in Poplar Bluff, Mo. He said he was treated well initially but soon developed uncontrolled diabetes mellitus and was noted to have nausea, vomiting and episodes of diarrhea, according to a gastroenterologist.

A CT scan of the abdomen revealed marked thickening of the wall of the left colon. He was transferred to a medical unit and treated with antibiotics and given parenteral nutrition.

The patient's condition worsened abruptly, and he was transferred to the Marion hospital for urgent surgical evaluation. A surgeon performed colon decompression. After five days of management in the intensive care unit, he was taken to the operating room for a sub-total colectomy. During surgery, an anastomosis was created between the ileum and the distal sigmoid colon. Eight days after surgery, the patient was transported back to Poplar Bluff, Mo., where he died of sepsis and diabetic ketoacidosis."We did not substantiate the allegation that a patient received sub-standard quality of care," Herbers said. "Based on our case review and consultation with two non-VA surgeons, we concluded that the care provided to this patient was appropriate."

Herbers said because none of the allegations could be substantiated, no recommendations were made by the Office of the Inspector General to the secretary of the Veterans Health Administration.

john.homan@thesouthern.com / 351-5805