VA announces review of thousands of health care providers

November 5, 2007

By Jim Tankersley

Nov. 6, 2007 (McClatchy-Tribune News Service delivered by Newstex) -- WASHINGTON -- The Veterans Affairs Department has limited the surgical privileges of three doctors at the troubled Marion VA Medical Center in southern Illinois, and it is reviewing the credentials of 17,000 other health care providers for veterans across the country, VA officials told a Senate committee on Tuesday.

The department also announced it is dispatching an "assessment team" to investigate hiring, personnel and management practices at Marion. It will be the third investigation launched at the facility since August, when a computer analysis showed a spike in surgical deaths at Marion and prompted officials to suspend all inpatient surgeries there.

Testifying before the Senate Veterans Affairs Committee, VA officials called their response to the Marion deaths "swift" and their credentialing process for doctors "the envy of the health care industry." But the top official present, Dr. Gerald Cross, also expressed "some concerns" about the agency's ability to keep tabs on doctors once they've been granted privileges to treat VA patients.

"We're taking the broadest possible look (at credentialing processes) to make sure that our patients can be reassured," said Cross, the principal deputy undersecretary for the VA's health department.

Sens. Dick Durbin and Barack Obama of Illinois requested the hearing. The two Democrats have pushed the VA repeatedly for information about the Marion facility, 15 miles east of Carbondale, where nine patients died in surgery from October 2006 to March 2007. That was more than four times the expected rate.

The hearings followed questions about the VA's physician credentialing procedures first raised in a Chicago Tribune story in September about deaths at the Marion VA hospital. The story revealed for the first time that Dr. Jose Veizaga-Mendez, a surgeon with a troubling professional history, was operating on veterans at the hospital for more than a year after he surrendered his license in Massachusetts during a disciplinary proceeding.

Officials linked some of those nine surgery deaths to Veizaga-Mendez, whose medical license was suspended indefinitely last month by the State of Illinois. Veizaga-Mendez agreed to stop practicing medicine in Massachusetts last year, after a state licensing board there accused him of providing "grossly substandard care" leading to serious complications and deaths. The surrender was dubbed "voluntary" and "non-disciplinary;" but Veizaga-Mendez remained licensed in Illinois and continued to work at the Marion VA facility until resigning in August.

The ongoing VA investigations at Marion have now resulted in five hospital staff members being reassigned or placed on administrative leave, officials said Tuesday, along with the three surgeons whose privileges have been limited.

Under questioning from Durbin, the officials said they have also begun to review the qualifications of all 56,000 independently licensed health care providers in the VA system. They flagged 17,000 of those providers, or about 30 percent, for further review because of their answers to questions on credentialing forms. For example, the director of quality standards for the Veterans Health Administration, Kathryn Enchelmayer, said her name was flagged because she once voluntarily surrendered a license in a state -- a practice she suggested is common for providers licensed in multiple states.

Durbin asked if that review suggested that the deaths in Marion could be a sign of systemic problems in the VA's nationwide network of health care facilities, but Cross downplayed the suggestion. "We're cautious people," he said, and out of caution "we chose to have this broad review."

Cross and Enchelmayer repeatedly cautioned lawmakers not to draw conclusions until the investigations at Marion are complete. The top Republican on the committee, Sen. Richard Burr of North Carolina, said he had asked committee chairman Sen. Daniel Akaka, D-Hawaii, to hold off on the hearing, calling it "premature and inappropriate when there's an investigation going."

Durbin doesn't sit on the committee but won special permission to ask questions during the hearing. He promised legislation to address the issues it raised. "The more I learn about circumstances at the Marion VA hospital, the more questions I have about how the Veterans Affairs Department manages staffing and quality control at its hospitals across the country," he said. "We need to make sure that these problems are not occurring elsewhere in other VA medical centers across the country."

Obama sits on the committee but did not attend. "Today's news serves as glaring evidence that the VA must do more to ensure quality of care for our veterans, and provide information about the scope of this problem nationwide," he said in a statement following the hearing.

The few senators at the hearing heard a chilling tale of Marion care from an Iraq war veteran. Lance Cpl. Steven McCarty recounted how, while on vacation after returning from active duty last spring, he checked into the Marion hospital emergency room with several symptoms, including diarrhea and vomiting. Doctors diagnosed appendicitis and scheduled surgery.

Surgeons found his appendix in better shape than they expected, and post-surgery, McCarty's symptoms worsened. Another Marion doctor diagnosed dysentery and prescribed antibiotics. McCarty was eventually discharged. Returning home to Texas, he visited another hospital, where doctors discovered his colon was perforated, removed two parts of it, and told McCarty he was lucky to be alive. He testified his colon doesn't function now, and that he can't work or redeploy.

"These wounds are not a result of insurgents," McCarty said, "they are the result of incompetence on American soil."

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