NPR has an "interesting" story today on "All Things Considered" -- interesting in the sense of "discomforting and potentially troubling" -- about a woman whose husband passed away after routine gallbladder surgery at the VA hospital in Marion, Illinois. Turns out he was the third patient who died in as many weeks, under the same doctor's care -- a doctor who'd faced allegations of concern about patients' death in his care earlier in Massachusetts, where he worked previously, and at least two malpractice claims. The doctor, 69, who was born and educated in Bolivia, seems to have initially been a good doctor. However, NPR reports, "Problems on his record began to surface about 10 years ago. But he didn't need any state license to practice medicine for the VA. As a federal institution, the VA is exempt from state regulations."
NPR continues, "Before he was hired by the Marion VA in January 2006, the state medical board in Massachusetts was investigating [the doctor] for at least eight complaints against him alleging dangerously substandard care, including two deaths. But VA officials say they couldn't have known about that, because Massachusetts is one of several states that doesn't report such investigations until they are complete."
Sen. Richard Durbin (D-IL) says there were other warning signs, though. "The fact is, this doctor had two malpractice claims filed against him in Massachusetts and one disciplinary action taken by a hospital," Durbin said. "Regardless, he was still hired by the Veterans Administration."
The story also says that "whistle-blowers from within the Marion VA hospital...claim they had warned administrators for some time that [the doctor] was dangerous to patients," and changed some patient's records, while destroying others.
Now, according to NPR, "the Senate Committee on Veterans Affairs will hold a hearing in Washington on Tuesday on the Marion VA hospital's recent problems, and on broader concerns about the medical hiring and quality-control practices within the entire VA.
A second doctor at Marion has been suspended after it was discovered that he, too, had faced disciplinary action in another state. Some fear there could be other doctors with troubled pasts working in VA hospitals across the country."
At the risk of fear-mongering, this is exactly what we have to worry about. About a year and a half ago, I was looking through a Federal jobs register, and realized that psychiatrists in the VA earn about what systems analysts do -- but they're responsible for people's health and wellbeing, not to mention, considerable patient loads -- not computers or networks or software, inanimate objects, without a pulse. And psychiatrists have had to go to medical school, which is substantially expensive, and often leaves new doctors with debt for years and years to come in their professional lives. The salary I saw quoted at the time was $80,000* a year. Granted we're mixing "psychiatrists" and "doctors" here, but they both have M.D. degrees. What the NPR story and my own observation from the job search make me wonder is, how high quality is the care the VA is giving, and more importantly, what sort of doctors end up taking jobs that pay so little, when they're able to get jobs in other hospitals and in private practice that pay so much more? The VA wouldn't be the first institution in human history to cut corners on quality patient care, but seriously -- don't our veterans deserve better? Perhaps even most of the doctors in the VA system -- let's be charitable here -- are wonderful. But if situations like the one in Marion, Illinois illustrate anything, it's the need to check what the standards really are, in a system that's already overburdened.
Editor's note: some exceptional doctors chose to work in the VA system, including the eminent "Friend of Veterans" Jonathan Shay, M.D., Ph.D., recent winner of a MacArthur genius grant, and often positively remarked upon on this blog. At the very least, though, let's take the warning from this story, and a) scrutinize better who's delivering the care to our veterans and b) offer to pay them a decent wage so that we can attract more and potentially better candidates. Our veterans deserve it.
* While this salary seems extremely low, a fact-check tonight at USAJobs.opm.gov, "the Federal Government's official one-stop source for Federal jobs and employment information," produces several "staff psychiatrist" jobs paying $90,000.00. While some salaries seemed reasonable, others, such as occupational therapists and nursing assistants, two vital jobs to patient care, seemed extremely low, in terms of paying a living wage. Like much else having to do with veterans care, this topic invites more thorough investigation and adjustment to prevailing standards in the communities they serve.
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A post-script: as the news heats up, particularly in Illinois, on this particular topic, one related item
comes to mind. Years ago, Pulitzer Prize winning journalist, James B. Stewart, wrote a non-fiction book called Blind Eye: The Terrifying Story of a Doctor Who Got Away with Murder, and the subject of that book was Michael Swango, an Illinois native and fomer Marine, who served at various VA hospitals in the U.S., among other posts, leaving a trail of bodies in his wake. Swango was hired by several VA hospitals, even in the midst of concerns about his past. [He had a bad habit of poisoning co-workers, among other things.] So it does make you wonder how scrupulous the hiring practices are at the VA; or whether it can be considered somewhat of an "employer of last resort" for those unable to find assignments elsewhere. Let's hope not. While casting that aspersion risks doing a dis-service to the truly talented who chose sacrificially to work there; at the same time, it's important to raise the profile of care for the wounded, and not create (or sustain) the impression that we're just warehousing veterans anyway; any ol' candidate can do the job. Maybe that's the VA of the past -- let's hope it's not going to be the VA of the future. (For a look at Swango's crime resume, check this link to it at CourtTV.com.)
