More than a year after the Department of Veterans Affairs took unprecedented responsibility for the deaths of eight patients at a north suburban VA hospital, an investigation of the facility`s physicians has fizzled out.
The department announced Thursday that it would provide formal
“counseling“ to eight physicians at the hospital, a mild disciplinary action. The VA also promised to pursue, if justified, serious sanctions against doctors who have since left the VA but were involved in the deaths, which sparked a congressional hearing and a memo to President Bush when they were disclosed last spring.
However, interviews with VA officials and documents obtained through the Freedom of Information Act make clear there is little chance the VA will attempt serious disciplinary moves such as reporting doctors to a state licensing board or a federal data bank of questionable physicians.
The VA also said it had permanently discontinued surgery requiring general anesthesia at the 1,004-bed VA Medical Center-North Chicago. Patients will be sent to one of three other VA hospitals in the Chicago area or the VA facility in Milwaukee.
The elimination of surgery will shift the facility`s mission from that of a traditional hospital to a center focusing more on long-term and psychiatric care, VA officials said.
The reason that disciplinary action against physicians is unlikely to match the bluster is that several internal review teams dispatched by the VA sharply disagreed with the conclusion of the department`s inspector general that the North Chicago deaths were at least partly due to poor medical care.
As a result of the “multiple, and often conflicting reviews,“ concluded a memo by Dr. John Farrar, the VA`s deputy chief medical director,
“disciplinary action could probably not be sustained (if challenged).“ As support for that belief, Farrar cited VA legal, personnel and labor-relations experts.
Although VA Secretary Edward Derwinski has said he believes North Chicago doctors made mistakes that contributed to the deaths, Farrar said that the department`s position was more a legal one of accepting blame than a medical one.
“The fact that the VA agreed to accept responsibility (for the eight deaths) didn`t mean a doctor or a nurse had necessarily messed up,“ Farrar said.
“There was a perception in many places that the care at North Chicago was somewhat marginal, and . . . Secretary Derwinski . . . opted to tilt in favor of the veteran“ by accepting VA responsibility.
In late 1990, VA Inspector General Stephen Trodden examined 43 deaths after surgery that occurred at North Chicago between June 1989 and March 1990. The VA watchdog found 15 cases of what he called clearly substandard care. In eight of those cases, the VA eventually acknowledged causing or contributing to the patient`s death.
The inspector general`s report was made public in early 1991.
However, several review teams of VA physicians from other regions of the country have disagreed with Trodden`s conclusion. Most recently, a prestigious administrative review board appointed to look at the behavior of individual physicians and recommend disciplinary action found only two cases of substandard care that may have contributed to deaths.
The most serious problems in the 15 cases involved mistakes by residents, a radiologist and anesthesiologists. No surgeons were cited.
In several other cases, the board went out of its way to praise the surgical care at North Chicago as “high quality“ and “excellent.“
In response, Trodden accused the board of overlooking testimony from doctors involved in the cases and producing a report that was “limited in scope, unpersuasive in argument, (and) faulty in procedure,“ among other flaws.
Trodden shot back that board chairman James Farsetta, head of the Brooklyn VA Medical Center, had blind spots. “While criticizing our work in many areas, (he) fails to address the many specific and well-documented errors of omission and commission made by the inspector general (office) in (its) own review“ of care at North Chicago.
Last year`s inspector general report also criticized the hospital`s relationship with the nearby Chicago Medical School. On Thursday, the VA ordered the hospital to downgrade its affiliation with the school from
“institutional“ to a program-by-program basis.
Herman Finch, chairman of the school`s board of trustees, said the VA action was “disappointing,“ but it was unclear whether the bureaucratic reclasssification will affect the number of students doing work at the hospital. At any given time, the school has four students in medical specialties, 25 in psychiatry, and two in neurology at the VA, Finch said.
Derwinski acknowledged that surgery at the North Chicago hospital probably would have been eliminated even without the widely publicized deaths because of the hospital`s low volume of procedures.
“All across our system, this is the direction we should be moving,“
Derwinski said. For instance, the VA is reviewing low levels of surgery at 33 hospitals singled out by Trodden.
Meanwhile, another group of VA reviews said the elimination of surgery could make it more difficult to recruit good doctors at North Chicago.
Farrar acknowledged there could be a problem and said the VA is working on a solution.
via Va Doctors Avoid Serious Discipline – Chicago Tribune.