The Dorn Veterans Administration Medical Center mismanaged its gastroenterology program so badly that, at one point in 2011, almost 4,000 patients were waiting to be examined, according to a report released Friday by the VA’s inspector general.
Delays in diagnosis and treatment were “associated” with cancers among 52 of those patients, according to the report. At least nine patients or their families had filed lawsuits about the delays, according to the report.
The report blames poor management of Dorn’s gastroenterology consultation program, including long delays in hiring staffers, failure to use tracking systems and spending only about $200,000 of $1 million designated to help reduce the backlog in examinations.
The report says steps finally were taken to resolve the backlog in consultations late in 2012, nearly three years after the concern first surfaced, in 2009. During the backlogged period, at least 280 patients were diagnosed with malignancies, including 52 cases in which the delay in diagnosis and treatment was “associated” with the cancers, according to the report.
Gastroenterology consultations, requested when physicians notice warning signs of colorectal cancer or when men reach 50 years old, often lead to a colonoscopy. VA regulations allow 60 days for a colonoscopy to be performed after a consultation is requested.
However, during the backlog period, waits of four to five months were common. One staff member said no progress was made until a patient died after a delayed consultation. The report said nine patients or their families had filed lawsuits about the delays.
More than 20 clinical providers and administrative staff were interviewed for the report, which noted “the narrative that emerged spans many years and involves a variety of complex factors.”
Among the factors:
• Hiring/staffing issues: The gastroenterology nurse manager retired in July 2009, but her successor wasn’t hired until February 2012. Two openings for registered nurses announced in March 2011 weren’t filled until January and February 2012. Also, the number of employees in the department remained well below its authorized staffing levels – 25.7 authorized workers in 2011, when the department had 20.7 workers; 33.6 authorized workers and 22.6 employed in 2012; and 35.7 authorized workers and 28.8 employed in 2013.
Management/planning: On the hospital’s planning council, administrative personnel outnumbered clinical personnel by a four-to-one margin. In September 2012, administrative personnel decided to stage a blitz effort to reduce the backlog. They brought in physicians, nurses and technicians from other facilities without input from Dorn’s gastroenterologists and nurses. Also, there was a significant turnover in Dorn’s upper managers – five medical center directors, three associate directors and four chiefs of medicine – in recent years.
• Funding: The Southeastern region of the VA sent $1 million to Dorn in September 2011 specifically to address the backlog. The Dorn business office said it was unaware the money had been earmarked for the backlog, and nearly $800,000 was spent elsewhere. The money was to have been spent to pay non-VA physicians to examine patients. But a former Dorn chief of staff told the business office not to send any more VA gastroenterology cases to outside physicians.
• Clinical practice changes: A VA policy change in 2009 led to more physicians defaulting to colonoscopies as the primary screen methods for cancer when other methods might have been appropriate. Also, patients weren’t entered into an electronic waiting list or a consultation tracking system, both designed to smooth the flow of patients through the system.
In May, The State requested information from Dorn about “a backlog of requests for colonoscopies” and any VA investigation under Freedom of Information act. An official with the hospital responded a week later, saying only, “I will forward to the appropriate staff member.” No information ever was released to the paper.
Robert U. Hamilton, who took over as Dorn’s interim medical center director in July, didn’t return a call to his office Friday seeking comment.
The report indicated several steps have been taken to reduce problems.
Dorn’s planning council now has more clinical personnel, for example. A case management system also is tracking services that are recommended and provided. The hospital’s staff also is closer to its authorized size, though the gastroenterology section chief and nurse manager left their jobs in the past eight months.
The report recommended the VA’s Southeastern leadership “take appropriate action in relationship to facility leadership deficits contributing to the GI consult backlog.”
A closer look at the numbers
According to a Veterans Administration report, the Dorn VA center mismanaged its gastroenterology program, resulting in:
3,800 - Backlogged examinations
52 - Cancers that were “associated” with delays in diagnosis and treatment
9 - Lawsuits thus far