As it rebounds from problems, Dorn opens new facility for recent veterans

jholleman@thestate.comFebruary 21, 2014 

A yellow ribbon tied to a tree welcomes visitors to the new Freedom Health Center at Dorn VA Medical Center. The ribbon-cutting ceremony was held at the center Friday.

JHOLLEMAN@THESTATE.COM — Joey Holleman

— As they celebrated the opening of a new facility that will expand the capacity of the Dorn VA Medical Center on Friday, hospital leaders acknowledged past problems with staffing and procedures were regrettable.

“While we have provided the highest-quality care to thousands of veterans since 1932, like any major health care system, our history has included periods that required improvement,” said David Omura, Dorn’s acting medical center director, reading from a prepared text.

Most notably, the backlog for gastroenterology consults grew to almost 4,000 patients in 2012, resulting in delays that have been linked to at least 52 cases of cancer and six deaths. The Veteran’s Administration Office of Inspector General issued a scathing report on those backlogs last year.

“What occurred at this facility has been a devastating experience for our veterans, their families and our staff,” Omura said. “Words simply cannot express the sorrow and empathy we share with the families of the six veterans whose death may have been preventable.”

When the original report was released in September, the Dorn staff declined specific comment on the gastroenterology consult issue, but Omura did cover the topic in a letter to the editor published in The State newspaper Jan. 22. On Friday, hospital leaders went into a little more detail about changes made to remedy the problems.

Staff at the hospital and experts from outside looked at the entire consult process, said Ruth Mustard, associate director of patient care and nursing services. To improve the flow of patients, three new case managers were hired, with one tasked exclusively with tracking patients from start to finish. One more physician and several more staff members were added to perform gastroenterology exams.

Mustard characterized the backlog as “a supply and demand issue.” The extra staff, along with tweaking of the processes used to move patients along in the system, have reduced the backlog. The case managers, especially, can raise red flags when delays start to grow between the time a physician recommends a colonoscopy and a patient gets the exam.

Similar gastroenterology problems cropped up previously at the Norwood VA Medical Center in Augusta. Rebecca Wiley, who was director at Norwood before moving to the top management job at Dorn, has since retired. Dorn has gone through several interim directors since then. U.S. Rep. Joe Wilson, R-S.C., said this month that he expects a permanent director to be named soon.

On another front, Dorn officials believe they have fixed the balky air filtration system that caused their operating room to be closed for all but a few days from Oct. 18 through Wednesday. Debris from specialized HEPA filters slipped through the system into the operating room, causing infection risks. After consulting with experts in the field, Dorn has replaced all of the filters and added another line of defense should the filters fail again.

Air filtration experts told the Dorn staff they never had seen a similar failure of the filters, Omura said.

During the 3½ months the operating rooms were closed, Dorn performed 166 operations elsewhere in the facility, while 648 other surgeries were reassigned to other VA facilities or private physicians. That resulted in about 20 percent fewer surgeries than if the operating rooms had been up and running, Omura said.

The operating rooms are back on schedule to perform an average of 15 surgeries per day. To help close the backlog of surgeries, extra staff has been added to keep the operating rooms open slightly longer each day.

Despite the well-publicized problems at Dorn, patient volume has continued to rise, Mustard said. That makes the opening of the new Freedom Health Center a welcome development.

The 10,000-square foot facility was built using federal stimulus money in an area in the middle of the older Dorn buildings, replacing a flower garden and basketball court. It’s home to Team Freedom, designed to be a one-stop shop for the new wave of veterans returning from recent assignments in Afghanistan and Iraq.

Those younger veterans have different needs from veterans from earlier conflicts.

Scott Casimiro, who was injured by an improvised explosive device six years ago, was a VA patient before landing a job as a certified peer support specialist with the agency. He sees the value of a separate facility for the new veterans.

“I don’t need as much of the testing or the lab work as (the older vets),” Casimiro said. “I will one day, but not yet.”

But those younger vets do need primary medical care, mental health care, pharmacists, nutritionists and rehabilitation facilities. All of that is available in the Freedom Health Center.

Moving some of those services to the new center also reduces some of the stress at the other Dorn facilities. Some of those stresses were detailed this year in another Office of Inspector General report on problems with staffing and infection control at Dorn. Omura said Friday that eight of the 12 recommendations to fix those problems already have been met, and the other four should be met within the next month.

Veterans “can rest assured we stand ready to serve them, as they proudly served our nation,” Omura said.

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