Patients: VA improvements not enough

06:57 AM CDT on Thursday, June 2, 2005
By DOUG J. SWANSON / The Dallas Morning News  (must register to view original article)

Terry O'Brien, a 23-year-old ex-Coast Guardsman with leukemia, said he received plenty of attention during his recent stay at the Dallas veterans hospital from the fleas, not the medical staff.

"I was scared to stay there," Mr. O'Brien said. "I felt like I would die there."

After four days in April at the Dallas Veterans Affairs Medical Center a stay that he and his parents say was marked by vermin and neglect Mr. O'Brien collected his belongings and left. He went immediately to Medical City Dallas Hospital.

"It was like going to the Four Seasons from the E. coli Lodge," said his mother, Anna O'Brien.

He is scheduled to undergo a bone marrow transplant today at Medical City.

VA hospital officials say their treatment of Mr. O'Brien met or exceeded their standards. They deny his allegations, which come as the VA trumpets vast improvements at the much-criticized medical center.

Allen Clark, public affairs officer for the VA hospital, said Mr. O'Brien might have expected too much. "He had certain expectations that may have been laid on him by the people at Medical City," Mr. Clark said. "This one didn't look as nice as Medical City."

Mr. O'Brien's father, Bob O'Brien, said his concerns went far beyond appearances. "I think you get better care at a homeless shelter than you get over there," he said.

Such accusations are nothing new for the Dallas veterans medical center, which has been beset by complaints and critical government reports over the past seven months.

Earlier this year The Dallas Morning News published accounts by patients and doctors of abuse and neglect at the Dallas VA. Bedridden patients told of spending hours calling for help and being ignored.

Officials say they have addressed nearly all the problems. Mr. O'Brien's unhappy departure from the VA came two weeks before Jonathan Perlin, undersecretary for health for the Department of Veterans Affairs, praised the hospital's improved performance.

In an April 29 speech to hospital staff, Dr. Perlin said they had managed "one of the most remarkable turnarounds in our department's history."

Dr. Perlin alluded to a Veterans Affairs Inspector General's report from last year that called the hospital dirty, dangerous to patients and badly managed. "I think the inspector general, if he visited today, would find a very different facility from the one he saw last year," Dr. Perlin said.

That was not Mr. O'Brien's experience. "They just wouldn't take care of me at all," he said.

He spoke from his bed Wednesday at Medical City, hollow-eyed and bald from chemotherapy. He has a four-leaf clover tattooed on his left arm and a scorpion on his right. With the Coast Guard, he was assigned to search-and-rescue operations in Cape May, N.J.

Mr. O'Brien left the Guard last summer. Because military medical staff had failed to discover his illness in its initial stages, he said, he has 100 percent service-connected disability status.

Living with his parents in the East Texas town of Tatum, he received chemotherapy at the VA hospital in Shreveport early this year. When his condition worsened in March, his family physician recommended that he go to Medical City.

But his parents soon discovered that his Medicaid coverage had lapsed. Mr. O'Brien then went to the Dallas VA, where he had full benefits.

He and his mother arrived at the Oak Cliff hospital on the evening of April 12. The ambulance crew took them to his room on the seventh floor, his mother said.

"We stood there for two and a half hours before anyone came down to acknowledge we were there," said Mrs. O'Brien, who works as a phlebotomist for an East Texas physician. "Terry finally had to make his own bed."

VA spokesman Mr. Clark denied that the patient had to make his own bed. "That's totally wrong," he said. "That's all there is to it."

Mr. O'Brien said he soon encountered other problems, such as an attendant who gave him injections of medications. "She set all the needles on the bed," he said. "One fell on the floor, and she picked it right back up and used it."

Mr. Clark said he found it "very difficult to imagine" that such a situation would occur.

His doctor at Medical City, concerned about fever and the effects of his powerful medications, told Mr. O'Brien his vital signs must be checked every four hours. At the Dallas VA, the policy is to check them at least once every 8-hour shift.

When Mr. O'Brien complained to nurses, he said, "they'd tell me, 'You help us. You call us every four hours to remind us.' "

That didn't work either, he said. "There was six or seven hours that I'd go without seeing a nurse," he said.

Hospital records show that Mr. O'Brien's vital signs were checked 14 times over a 68-hour period, said Mr. Clark, the spokesman. All were within normal ranges, he said.

Mr. O'Brien also complained that nurses often monitored him only by peering through the small window in his door.

Mr. Clark said the patient had asked to be left alone as much as possible because of his compromised immune system. "It was obvious he did not want anybody around any more than necessary," Mr. Clark said.

Not so, said Mr. O'Brien. "I asked them to come in," he said. "They just weren't taking care of me at all."

When a flea bit him and he found other fleas in his bed, Mr. O'Brien said, attendants covered his floor with flypaper.

Spokesman Clark said that only one flea was reported to be found and that bed linens were changed immediately. A single flea does not constitute a major sanitation problem, he said.

Mr. O'Brien left the Dallas VA on the fourth day of his stay and returned to Medical City at the urging of private doctors.

He has been covered by private insurance since May 1, but bills from his uncovered period at Medical City exceed $200,000. His father has asked the VA to pay at least part of that. A VA spokesman said that request is under review.

Betty Bolin Brown, director of the Dallas veterans hospital, told Mr. O'Brien in a recent letter, "I am disappointed to hear that you have chosen to receive your transplant at Medical City. ...We have all the services you currently require."

And spokesman Mr. Clark said the Dallas VA strives to give quality care to all veterans, but "we are especially concerned about the newer vets."

On Friday Mr. O'Brien suffered a major seizure in his room at Medical City. "It was Code Blue, he stopped breathing, everything," his father said. "The nurse was right here. If he'd been at the VA, he'd be dead.

"No more than they were coming in the room at the VA?" his father said. "It could have been hours and hours before they found him."