VA cover up of deaths at Phoenix VA hospital

Watch today’s hearing of the House Committee on Veterans’ Affairs about whether the VA’s Inspector General (IG) was trying to cover up the VA’s responsibility for the many deaths it evaluated and reported on in its August 26, 2014 report.

http://www.va.gov/oig/pubs/VAOIG-14-02603-267.pdf

I totally agree with VA whistleblower, Dr. Sam Foote, who is testifying today that the report was a cover up.

Even a casual reading of that report raises considerable suspicions. There is negligence galore, but being lawyerly, the IG stopped short of finding causation.

Here’s the sentence on page ii of the report that all the national media reported:

“While the case reviews in this report document poor quality of care, we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans.”  (my emphasis added)

Don’t believe that.

Go to page 17 and look at Case 30. First there is new pain diagnosed and treated over the phone. We aren’t told which pain medication was dispensed. Was it a narcotic painkiller?  For sure that was below the standard of care.

Then there is a two day delay before the patient goes to the Emergency Department complaining of 10/10 severe abdominal pain. This is spite of the new painkiller. The patient was hypothermic and had a fast pulse rate of 111 beats per minute. First diagnosis is sepsis and maybe septic shock. We aren’t told a blood pressure. Then there was a 2 hour delay getting a CT scan of the abdomen which showed a perforated bowel. Then a 4 hour delay getting a surgical consult. Then the patient was seen by a resident (doctor in training) not a senior staff physician. Then another 2 hour delay before being taken to surgery. Then we are told that the patient had to be maintained on blood pressure support and a ventilator until he died 2 days later.

And the VA’s IG wants us to believe that none of the poor quality care documented in this case report was a causal factor in this veteran’s death?

They sold it to the national media on August 26, 2014. The AP, NPR, the TV networks. All took the bait.

Where was ABC-TV’s Dr. Richard Besser – he of CDC and unfair hair fame? Did he bother to read the report? Did he get to Case 30?

I hope the doctor-Congresspersons on the House Committee grill the VA IG today about all the cases, but specifically about case 30.

Someone needs to ask the IG when the patient in Case 30 got antibiotics. For every hour of delay in getting antibiotics in a patient with sepsis there is a significant increase in the death rate.  Someone needs to ask the IG is sepsis was diagnosed prior to surgery.

And someone needs to demand that the VA release details of all the case reviews to the families. The report says the VA is thinking about doing this.

I am sure that their lawyers have determined what they think are applicable statutes of limitation and repose for all the cases and don’t want to give any family any details of negligence until a time when they think they are safe from a lawsuit.

Watch today’s hearing to see if the VA gets away with its cover up.

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