However, it appears that questions remain.According to the Virginian-Pilot, the investigation was prompted following the firing this past March of a doctor who was let go just prior to the end of her two-year probationary period at the Hampton VA Medical Center, allegedly for "poor interpersonal communication skills," according to the text of a written report by the inspector general's office of the US Department of Veteran's Affairs.
However, Dr. Pamela Gray alleges that her termination stemmed from her complaints about pressure to write prescriptions for narcotics she deemed as unnecessary.
The investigator's report cleared the hospital of any wrongdoing based—it seems—on the fact that the majority of doctors interviewed indicated they were not unduly pressured to prescribe narcotics to patients who did not need them (a suggestion of veterans medical malpractice).
However, a minority of doctors took an opposing view. Specifically, four of the 15 doctors interviewed admitted to investigators that they were pressured to write prescriptions that were not necessary.
"After extensive interviews with all stakeholders," the investigators wrote, "it is clear that among some...providers there is a perception of pressure to write narcotic prescriptions and a fear of retaliation if they fail to do so."
It should be noted that most complaints in general come from VA patients with chronic conditions who request pain medications that are refused.
It was not clear in the investigator's report just who was responsible for the alleged coercion. Patients with chronic pain conditions will often ask for pain meds a doctor feels is not necessary. However, it was not clear if the hospital was pressuring the doctors to prescribe the narcotics, or if that pressure was coming from the patients themselves.
It was revealed that one doctor and several staff members at the facility had been threatened by patients.
Dr. Gray also alleged that the hospital had improperly altered patient records to cover up the improper prescribing of narcotics. However, investigators did not find that to be the case, nor did they find any evidence of narcotics diverted from the hospital for resale—which would be illegal.
Still, the investigators found that of 16 doctors who left the center's employ from December 2008 through March of this year, three had "documented concerns with prescribing narcotics for patients with chronic pain issues."
VA hospital malpractice is always a serious allegation which, when litigated as necessary, will involve VA medical malpractice lawyers skilled and knowledgeable in the discipline of malpractice law. Any urging or coercion of a doctor to prescribe a narcotic to a VA patient beyond the realms of good medical practice could be interpreted as veteran medical malpractice.
READ MORE MALPRACTICE LEGAL NEWS
"It is important to understand that as a licensed, independent practitioner, each physician makes the clinical decision of prescribing any medication, as the report states. The Hampton administrative staff has no authority over clinical decisions made by physicians."
Gray, however, continues to believe that "providers are coerced to write prescriptions for narcotics that they know to be improper or excessive. If you don't go along with it, you have two options: Quit or be fired." In either scenario, VA hospital malpractice is always a possibility.
READER COMMENTS
Clara
on
Dr. Gray saw a serious problem, tried to provide solutions to resolve it and was harassed, hassled, humiliated and run out of town, unable to practice medicine. Her physician colleagues cheered her on from behind. They were terrified of just what happened to her, so refused to speak publicly. It's been going on for a long time.
Shelton
on
The VA is now my primary care and I can't get the meds for relief, nor can I get in for timely appointments.
Absolutely worst health care in my 42 years. Ironically, I used to work for the VA and I see waste that would make your blood boil
bob smith
on
bob smith
ps if you have any ideas on how to get this out to media, evts, etc. please let me know.
ah -- my research, including FOIAs to VA have gleaned this nugget: since beginning of War ion Terror, 2002 to present, more vets have died of "adverse events" (AKA medical errors) in VA hospitals than all the U.S. troops killed in Iraq plus Afghanistan.
John
on
What happened to your follow up article?
Brian
on
Are you going to have a follow up post or article about this anytime soon? :)
bob smith
on
714-718-0484
rwmacgowan@yahoo.com
September 21, 2010
ALERT TO VETERANS RECEIVING MEDICAL CARE AT COCHRAN VAMC, ST. LOUIS MO.
The March 1, 2010 issue of MIT News has an article titled, “Second Opinion? Diagnosing Doctors†(the article is available on the internet). Of concern to veterans receiving care in VA hospitals is the following quotation:
“To reach this conclusion, Doyle — along with his colleagues Steven Ewer of the University of Wisconsin and Todd Wagner of Stanford University — examined roughly 70,000 treatment episodes involving 30,000 patients, spread over 13 years, at a Veterans Affairs hospital in a large city in the United States. The hospital’s practices naturally lent themselves to a comparison of doctor quality since the institution randomly assigned patients to two separate teams of physicians and residents, which had markedly different medical backgrounds.
One of these teams (dubbed “Program A†by the researchers) consisted of members trained at an elite U.S. medical school, which sometimes boasts the nation’s highest average MCAT scores among its incoming students. The other group (“Program Bâ€) has members trained at a middle-ranked medical school. Medical residents with Program A had medical board-certification scores that on average placed them in the top quarter of the national results, while the Program B doctors had scores placing them in the bottom fifth of U.S. residency programs. (The researchers agreed to keep the identities of the VA hospital and medical schools anonymous.)â€
In other words, more than 15,000 veterans were deliberately assigned to a group where they received care from doctors and physicians who were inferior to the other treatment group, and they were kept in the dark about this. They were, in effect, guinea pigs in a large-scale experiment in which they never gave their informed consent. And there were consequences: veterans assigned to “Program B†had suffered longer without proper diagnosis or treatment, than the veterans in “Program Aâ€. If you substitute the words “congressmen†for veterans, you can see where this might raise a fuss. Considering that people die in VA hospitals every day of preventable medical errors, you can imagine how those “congressmen†whose family members died in such a manner, and who later became informed that their loved ones had been assigned to “Program B†might feel. Outraged and betrayed are two words that come to mind.
When the VA researcher involved in the study, and two senior VA administrators were queried about “Program A†and “Program B†they all refused to name the VA hospital where this experiment is still, apparently, operational, stating that it was, to quote the VA researcher Todd Wagner, “Confidentialâ€. No patient names have been disclosed, so there can be no justification for keeping secret the name of the hospital.
The MIT News summary is of a research article titled “ Returns to Physician Human Capital:
Analyzing Patients Randomized to Physician Teams,†by Joseph J. Doyle, MIT & NBER; Steven M. Ewer, M.D. University of Wisconsin—Madison; and Todd H. Wagner, VA Palo Alto and Stanford.
November 2008 . http://www.law.harvard.edu/programs/petrie-flom/PDFs/doyle-paper.pdfhttp://www.law.harvard.edu/programs/petrie-flom/PDFs/doyle-paper.pdf
I looked here for the answer as to the name of the “Confidential†VA hospital where the research was/is taking place. Within the text excerpted from the article, I have entered my own comments; they are in enlarged and capitalized, bold print which is set within brackets.
“This study considers a VA hospital in a large urban area that has affiliations with
two medical schools.
[ONLY THREE VA HOSPITALS HAVE TWO MEDICAL SCHOOLS AFFILIATED WITH THEM: NORTHAMPTON (MASS.), SEPULVEDA (CA), AND ST. LOUIS (MO). ]
“This VA hospital is a full-service teaching hospital that provides over 3,500 surgical procedures each year. It has an intensive care unit and what are considered excellent laboratory facilities, including the ability to conduct magnetic resonance imaging and angiography. In addition to the main hospital, there are some smaller satellite hospitals elsewhere in the city that handle mental health, substance use
treatment and long term care.
The variation in the medical and surgical residency training programs between the
two institutions that serve this VA hospital is compelling: one is regarded as a top
program in the U.S., whereas the other is ranked lower in the quality distribution. In the
remainder of the paper, the higher-ranked institution will be referred to as Program A,
and the lower-ranked institution will be referred to as Program B.
To establish the difference in credentials, Table 1 reports some summary characteristics of the two programs. First, the residency programs are affiliated with two different medical schools where the attending physicians that supervise and train the residents are faculty members. These medical schools differ in their rankings. Some years, the school affiliated with Program A is the top school in the nation when ranked by the incoming students’ MCAT scores, and it is always near the top.
[THE MEDICAL SCHOOL WITH THE HIGHEST MCAT SCORES FOR INCOMING STUDENTS IN 2007 (I have given 2007 data as 2008 data would not have been available to the researchers at the time of their report) WAS WASHINGTON UNIVERSITY SCHOOL OF MEDICINE, IN ST. LOUIS, AT 12.5 AVERAGE SCORE; IT ALSO IS “ALWAYS NEAR THE TOP†EACH YEAR IN MCAT RANKINGS.]
“In comparison, the lower-ranked program that serves this VA hospital is near the median of medical schools.
[ST. LOUIS UNIVERSITY SCHOOL OF MEDICINE RANKED NEAR THE MEDIAN, AT 10.4 AVERAGE MCAT SCORE.]
“Another commonly used measure to compare medical schools is funding from the National Institutes of Health (NIH). This ranking identifies the major research-oriented medical schools, again with some of the most prestigious schools near the top. The medical school associated with Program A is again among the top schools in the U.S.,
[WASHINGTON UNIV. SCHOOL OF MEDICINE RANKED #8 IN NIH FUNDING FOR 2007, AND #4 IN 2008.]
whereas the lower-ranked program has an NIH funding level that is generally less than
three out of every four medical schools.
[ST. LOUIS UNIV. SCHOOL OF MEDICINE RANKED #95 IN NIH FUNDING IN 2007, WHICH IS NEAR THE MEDIAN OF THE TOTAL NUMBER OF U.S. MEDICAL SCHOOLS. THE MEDICAL SCHOOLS ASSOCIATED WITH THE OTHER TWO VA HOSPITALS WITH 2 AFFILIATED MEDICAL SCHOOLS EACH RANKED AS FOLLOWS: SEPULVEDA VA: UCLA #9 AND UNIV. OF SO. CALIF. #39; NORTHAMPTON VA: U. OF MASS. #51 AND DARTMOUTH #72. WHILE UCLA WAS A TOP RANKED NIH GRANT RECIPIENT, U. OF SO. CAL. WAS WELL ABOVE THE MEDIAN. CONVERSELY, WHILE DARTMOUTH WAS NEAR THE MEDIAN, U. OF MASS. WAS NO WAY NEAR BEING A TOP RANKED NIH GRANT RECIPIENT.]
“Second, each training program is affiliated with another teaching hospital in the same city, in addition to the VA hospital. Program A’s “parent hospital†is ranked among the top 10 hospitals in the country according the U.S. News and World Report Honor Roll rankings of hospitals.
[WASH. UNIV. SCHOOL OF MEDICINE'S HOSPITAL, BARNES-JEWISH HOSPITAL/WASHINGTON UNIVERSITY, WAS RATED #9 BEST U.S. HOSPITAL IN 2007.]
“Out of 15 specialties ranked by U.S. News, Program A’s hospital is among the top 10 hospitals in the country for nearly half of them, and among the top 20 in nearly all of them (U.S. News & World Report, 2007).
[WASH. UNIV. SCHOOL OF MEDICINE'S HOSPITAL WAS AMONG THE TOP 20 IN ALL FIFTEEN SPECIALTY AREAS, AND AMONG THE TOP 10 IN NEARLY HALF.]
Meanwhile, Program B’s parent hospital is not a member of this Honor Roll overall or ranked among
the top hospitals in terms of subspecialties.â€
[ST. LOUIS UNIV. SCHOOL OF MED. WAS NOT IN THE TOP 10 NOR IN THE TOP 20.]
It is evident beyond a reasonable doubt that St. Louis VAMC is the hospital system referred to in the study. The two main divisions of St. Louis VAMC are Cochran VA hospital and Jefferson Barracks, which is primarily a domiciliary. Therefore, the answer is: Cochran VA hospital. I contacted both the hospital director's office and the public affairs person for the hospital. They would not confirm, but also would not deny, that Cochran was the hospital alluded to in the research paper and MIT News. Veterans receiving treatment in the St. Louis VA hospital, knowing what they have been unknowingly subjected to at Cochran VA hospital might now make more informed decisions as to where to receive their medical care.