Published 12:00 am Wednesday, December 2, 2009

By Mark Wineka
Salisbury Post
A just-released report reveals that several missteps at the W.G. “Bill” Hefner VA Medical Center in Salisbury failed to detect a veteran’s advancing colon cancer in 2004.
When a private physician finally diagnosed the man’s condition, the cancer could not be treated, and the veteran died within seven weeks.
The report, compiled by the U.S. Department of Veterans Affairs’ Office of Inspector General, follows numerous revelations last year into past substandard care at the Salisbury veterans hospital.
Questions about the hospital led to a congressional hearing in 2007 and promises by the medical center to improve treatment and care.
“This is further confirmation,” U.S. Rep. Mel Watt, D-N.C., said Monday, “that we needed to improve funding for veterans health care to improve both the VA facilities and the quality of care at these facilities.
“I hope the corrective actions already announced by the director and staff will prevent future incidents of this kind reported in the Inspector General’s report and will eventually restore confidence in the quality of care at the Hefner VA Medical Center.”
Hefner VA Medical Center Director Carolyn Adams has outlined several steps her hospital has taken in response to the Inspector General’s most recent findings.
The VA Office of Inspector General conducted an investigation after someone filed a complaint that his friend, who had a history of colon polyps, had received inadequate care at the Hefner VA and its Winston-Salem-based outpatient clinic.
The person who complained did not specifically allege wrongdoing but questioned how his friend could progress from a “clean bill of health” to untreatable colon cancer in such a short amount of time.
A private physician diagnosed the 69-year-old veteran with colon cancer in January 2005. He died seven weeks later.
The government report does not reveal the patient’s name.
In its executive summary, the VA Office of Inspector General concluded that the patient’s diagnostic testing was delayed on several occasions and that the medical providers missed “multiple opportunities over a period of years” to diagnose the colon cancer.
“We believe that had providers followed up with appropriate colonoscopy surveillance testing to remove polyps,” the summary said, “it is possible that the patient’s developing colon cancer could have been detected and treated in time to prevent metastatic disease.”
The person who complained initially wrote to the Veterans Benefits Administration Regional Office in Winston-Salem April 22, 2005, outlining his concerns. No action was taken.
The complainant resubmitted his letter to the VA office of Inspector General in April 2007.
According to the report, when the veteran complained to his VA doctors of “stomach problems” in 2004, he was told to take over-the-counter laxatives, even though he had a history of colon polyps.
In March 2004, a colonoscopy was attempted but aborted because it was difficult to pass the colonoscope and painful for the patient.
He never received a follow-up colonoscopy.
The veteran had been a patient at the VA from 1995 through Jan. 3, 2005.
The VA Office of Inspector General conducted a site visit Sept. 25-26, 2007, and interviewed the complainant, the patient’s stepdaughter, the medical center’s clinical care providers, administrative personnel and others familiar with the veteran’s care.
Inspectors found the VA at fault in three broad areas, including a delay in follow-up testing after incomplete colonoscopies; the wrong kinds of follow-up testing; and a failure to prevent metastatic colon cancer.
The inspectors made two recommendations:
– That the Veterans Integrated Service Network ensure that the medical center’s director requires that patients with known risk factors for colorectal cancer receive appropriate and timely diagnostic testing and referrals in accordance with professional practice guidelines.
– That the director of the Veterans Integrated Service network make sure the medical center’s director require this case be evaluated for possible disclosure to the patient’s family.
The report says the case will be disclosed to the family in March 2008.
Adams, the Hefner VA Medical Center director, confirmed in written comments that her facility will provide “institutional disclosure” to the patient’s family, which will be offered “appropriate options and will be made aware of the tort claim process and the 1151 Disability Claim process.”
“They will be provided assistance in filling out the necessary forms,” Adams said.
Her “Director’s Comments,” contained at the back of the Inspector General’s report, also outline the steps the Hefner VA Medical Center has taken in response to the first recommendation.
The hospital established a program support position Dec. 26, 2007.
The person is setting up an electronic database to track all positive colorectal cancer screening results and abnormal colonoscopy findings.
The new position also collaborates with the chief of gastroenterology, the endoscopy nurse manager and medicine administrative officer to improve screenings, Adams said.
In addition, a registered nurse case manager has been established to track high grade dysplasia and cancer identified from endoscopies.
During fiscal year 2007, the hospital also created a Colorectal Cancer C-4 Collaborative Team.
Adams reported that gastro-intestinal service contracts for Charlotte and Winston-Salem clinics were amended three months ago to increase patient referrals from 80 per month to 110 per month
An additional gastroenterologist was hired Jan. 7. The hospital is continuing to recruit two more gastroenterologists, Adams said.
A third physician extender was appointed in December 2007, and a fourth physician’s assistant position will be filled, according to Adams.
Contact Mark Wineka at 704-797-4263 or mwineka@salisburypost.com.

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