June 27, 2007

VA Hospital Broke Rule: Dorn Performed Heart Surgeries It Wasn’t Allowed to Do, Inspection

By Noelle Phillips, The State, Columbia, S.C.

Jun. 27--Dorn VA Medical Center was performing heart procedures it was not authorized to do, a recent U.S. Department of Veterans Affairs inspection found.

A report by the VA's Inspector General Office said Dorn did not have permission to open blocked arteries through cardiac catheterizations because it does not have an on-site cardiac surgery program.

Dorn should have requested an exemption from the VA before performing the surgeries, the inspector general's report said. The exemption would have required the hospital to complete a checklist of requirements before doing the surgeries and to have on-site visits by VA officials.

Dorn has since stopped performing the operations because the cardiologist left the hospital.

Overall, the inspector general did not find major deficiencies at Dorn.

Dorn has a cardiac catheterization lab where doctors use the procedure to diagnose heart problems, which is allowed by the VA.

The Dorn cardiologist did 15 procedures from July 1, 2004, to June 30, 2005, which was the period reviewed during the inspection. No major complications occurred, the inspector general's report said.

However, Dorn is not allowed to use catheterizations to install stents or to use balloons to open blocked arteries. Those procedures are more risky, and an on-site heart surgery unit is needed in case something goes wrong during a procedure, experts said.

The VA report also found Dorn did not have a proper backup plan for transporting patients to a local hospital's heart surgery unit in case something went wrong, the report found. Dorn was supposed to have a formal agreement in which patients could be transferred within an hour.

"This is a no-no," Lynn Bailey, a Columbia-based health care consultant, said about Dorn doing the procedures without approval.

The inspector general inspects VA hospitals every three years to review practices, safety and quality. The latest report was released in May and was based on a December inspection.

Military health care has been under scrutiny since a scandal over patient care erupted last winter at Walter Reed Army Hospital.

Two health care systems operate for the military. The VA takes care of veterans. Active-duty troops are cared for through a Department of Defense health system.

Dorn officials said the hospital is inspected dozens of times throughout the year by various agencies such as OSHA and The Joint Commission, a health care accreditation agency.

As for the latest inspection, Dr. Fred Boykin, Dorn's chief of staff, said hospital officials were not aware they needed a waiver from the VA to perform the catheterizations. The procedures were stopped when the cardiologist performing them moved to Denver, he said.

The hospital wants to hire two full-time cardiologists, Boykin said.

"We'd like to go back down that road some time and get to the point where we could do angioplasties and stents," he said. "At best, we're probably a year away from doing that."

When a new cardiologist is hired, Dorn will ask the VA for a waiver and will sign a formal agreement for patient transfers to a local heart surgery unit, he said.

Until then, Dorn will refer heart patients who need stents or balloons to the VA hospital in Charleston or to heart hospitals in Richland County, Boykin said.

Dorn is not the first hospital in South Carolina to be cited for performing unauthorized cardiac catheterizations.

In November 2004, Hilton Head Regional Medical Center was fined $24,000 by the S.C. Department of Health and Environmental Control for illegally performing the same heart procedures. The Hilton Head hospital did not have the required open-heart operating room to handle any emergencies that arise during a catheterization.

And, cardiac catheterizations were at the heart of a dispute between Lexington Medical Center and Palmetto and Providence hospitals in 2006.

Lexington wanted DHEC to grant a license for a heart surgery hospital. With a heart surgery unit, cardiologists could perform the catheterizations instead of referring patients to the two major hospitals in Richland County.

Catheterizations are common in heart health care and are profitable for hospitals, Bailey said.

Because Dorn is part of the VA health system, it is not regulated by DHEC. However, its physicians and other health care providers must be licensed in South Carolina.

Dorn's ability to provide cardiac catheterizations impacts overall health care services in the Midlands, Bailey said. When Dorn cannot serve a veteran, that patient is sent into the local community for care. Dorn provides health care for more than 68,000 veterans in 30 S.C. counties.

"You have to pay attention because as they do or do not have physicians, they send those cases back into the community," she said.

Reach Phillips at (803) 771-8307.


A Veterans Affairs inspection of Dorn VA Medical Center found the hospital was clean and safe for its patients.

And, a patient satisfaction survey included in the review showed Dorn's overall performance surpassed national and regional averages.

Every three years, the VA's inspector general surveys each hospital within the system to monitor its safety, cleanliness and patient care quality.

Dorn's most recent survey was conducted in December, and the report was released in May.

During the review, inspectors poured through hundreds of documents and visited the hospital, its outpatient clinics and nursing homes under contract to care for veterans.

Most of the report's recommendations address Dorn's record-keeping system and its procedures for reviewing its patient care.

For example, Dorn was slow in completing reports after something went wrong in patients' care. The reports are called "root cause analyses" and they are required in certain situations such as a patient falling or a medication error. The inspector general's report found 13 of 15 cases reviewed were not finished with 45 days. And, in one case where a patient died because of a medication error, the report was never done.

Since the inspector general's review, Dorn has added a second person to its staff to help write the reports, said Jean Hooper, director of quality management at Dorn.


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Copyright (c) 2007, The State, Columbia, S.C.

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