What ails hospitals: Veterans care

Investigative Reporters and Editors, Inc. The IRE Journal, Jan/Feb 2003 by Mazzolini, Joan, Porter, Jeff

The noble workings of hospitals have been ingrained on our memories since the first television doctor donned scrubs. But sometimes reality is not as grand; no one likes to think of nurses with dirty hands, surgeons who only have profit in mind, patients shuffled through the system without proper treatment and caregivers focused only on the bottom line. And yet investigations have shown again and again that while many medical personnel and hospitals try to answer that higher calling, there are others who use such poor practices that it's enough to make anyone sick.

Records detail nation's treatment, oversight gaps

When plastic surgeons at Cleveland Veterans Affairs Medical Center found infection spreading inside the belly of an elderly vet and called for assistance, they expected the hospital's top surgeon to enter the operating room.

Instead of Dr. John Raaf, they got a resident, a doctor in training. While the chief of surgery was scheduled to be at the VA for emergencies like Halver Durbin's, he was actually on the other side of University Circle about a mile away, at University Hospitals, operating on patients from his private medical practice.

It wasn't an aberration for Raaf. In fact, he had set up a routine that on Mondays and Fridays, when he was scheduled and paid by the VA, he actually was seeing private patients at University Hospitals. It was an open secret.

And it's happening at VA hospitals across the country.

The Plain Dealer produced a five-day series to detail how well - or poorly - VA hospitals care for the men and women who risked their lives in service to their country.

But the problems investigated continue: doctors not doing their jobs; unsupervised residents rotating in and out of the VA, leaving veterans' medical care postponed again- and death rates for open-heart surgery centers that would be unacceptable at any other hospital.

The VA, with more than 170 hospitals across the country, is the largest health care system in the nation. More than $19 billion of taxpayer dollars flow through them each year. But in some ways, I feel the hospitals are often ignored until a major foul-up becomes public.

That's a shame. Because they are federal facilities, much information - data that would never be available at the public hospitals - is available through the Freedom of Information Act.

I requested from each of the VA hospitals a list of their doctors, their specialties, what departments they worked in, their salaries and whether they were full or part time. Included in that was their FTEE, or full-time equivalent status.

Because of that information, I knew, for example, that Raaf was a "seven-- eighths" employee and paid more $114,000 a year to be at the VA 35 hours a week. With some good sources, I found that he had physically been in the op,ating room just 12 times during a year.

Other doctors stood out as well, including the director of orthopedic surgery who didn't do a single surgery in a year, and was in the operating room overseeing residents just 16 times.

While my best sources were in Cleveland, investigations by the VA's Office of Inspector General showed me this was a problem across the country.

I also did FOIA requests for every settlement and judgment against each VA for medical malpractice annually for five years. It didn't give me names. but did supply me with the month the settlement (which by law can't be sealed) or the verdict was rendered. That helped nail down the time period to search at the courthouse.

The FOIA request for the numbers of bypass surgeries performed by about 40 VA hospitals, death rates and all site-visit reports, yielded a ton of terrific information. I put the numbers into an Excel spreadsheet so I could sort them in different ways, such as the highest death rate to lowest or the least surgeries to most. I also computed the difference between the actual death rates versus the risk-adjusted rates, which I got with the FOIA.

First, it became clear that most VAs had death rates significantly higher than private hospitals, even when risk-adjusted for differences in patients. More than one-third of the veterans hospitals performing heart surgery didn't do at least 150 heart surgeries annually for five years, which is required by VA policy and what experts agree is the bare minimum necessary to ensure expert care. I also found that 10 cardiac centers were being "monitored" because of high patient death rates.

Second, the hospital inspection reports showed that even when the VA thought a program was doing a poor job and too many veterans were dying, it let the program stay open because the affiliated university hospital wanted it open for training programs. The reports also detailed that the chiefs of cardiothoracic surgery at the university hospital knew the surgeons at the VA were substandard but let them operate on veterans anyway.

No one told the veterans, many of whom could have gone to private hospitals under the Medicare program.

Other findings in the series included: