3/30/04 VA: Progress made in fixing Temple VA hospital problems

Progress has been made in correcting problems found in a medical inspection of the Olin E. Teague Veterans Center in Temple, Department of Veterans Affairs officials say.

Changes ranging from adding staff to new waterless hand-washing dispensers are a result of the VA addressing inadequacies at the facility, according to both an interview with a VA official responsible for implementing changes and a medical report released by the VA. That report is a result of a medical inspection of long-term care at the Temple facility made in December 2003. The probe was prompted by an undercover investigation by ABC News' "Primetime Thursday."

Gerard Husson was brought in by the VA in late January to temporarily head the Central Texas Veterans Health Care System that includes the VA hospitals in Temple and Waco. Husson, director of the Beckley, W.Va. VA Medical Center, led a team that put changes in place for long-term care at both hospitals. He said in a telephone interview that he visited the Temple facility last week on a follow-up visit and found work was under way to turn long-term VA care in Central Texas into a "state-of-the-art" operation.

"You'd be surprised at the progress that is being made," Husson said.

The VA produced the report on the medical inspection in Temple after the Tribune-Herald filed a federal Freedom of Information Act request in February. Among the problems found during the unannounced visit to the Temple hospital by VA medical inspectors on Dec. 9-10, 2003:

* The facility was not "conducive to a nursing home setting and maybe a potential safety risk."

* Concerns were raised over open food containers left at patients' bedsides because of the possibility of insects. Inspectors also were concerned over a prolonged scabies infection, a disease caused by parasitic mites that get under the skin, in the nursing home unit. The VA probe was not "in-depth enough," the report said, to draw overall conclusions about the nursing home's overall infection control program.

* Certain patient care issues were not being addressed, including bed sores.

* The use of restraints on patients was above the national VA average.

* Excessive use of overtime, totalling $88,000 in a one-year period, was found along with high rates of unplanned leave.

VA officials in the department's Washington, D.C., headquarters had ordered the review after a hospital employee worked with a reporter from the ABC News program, which conducted a hidden camera investigation. A "Primetime Thursday" program on VA problems, including those in Temple, is tentatively set to air on April 8.

"We are slated to run an hourlong program on next week's program," ABC spokesman Adam Pockriss said in a telephone interview on Monday. "It all depends on breaking news whether it actually runs then."

The report on the inspection was dated Jan. 23, 2004, but the VA pointed out in a letter to the Tribune-Herald accompanying the report that problems were already being corrected "long before" the report was finished.

A letter from Jeffrey E. Phillips, VA deputy assistant for public affairs, said an action plan was delivered to the department's top physician, Dr. Robert Roswell, on Dec. 19 and corrective measures were taken immediately.

Husson said a fundamental problem with the long-term care wards at the Temple VA hospital is that the facility was designed for acute patients and not long-term care. He said the safety risk referred to in the report was a lack of so-called "wander guards," or detectors to keep patients from wandering off. Husson said the wander guards were installed.

Measures also are under way to change room layouts in order to make it more like a home for the long-term residents than a hospital stay.

Phillips said efforts to prevent problems from infection and insects have included waterless hand-washing dispensers and antiseptic hand wipes on patients' food trays.

Patients in the Temple nursing home unit also are checked each week now for skin and wound care, Phillips said.

The use of restraints on patients was being given a second look as well, with a committee monitoring such use. Husson said that Temple facility was now "restraint-free." However, whether a patient is restrained is a decision left up to a doctor, he said.

"That's not to say they will never use a restraint," he said. "Restraints have a purpose and it's a clinical judgment."

Staff recruitment for long-term care at both Temple and Waco also is being boosted.

"We have established a higher ratio of staff to patients for this unit," said Husson, who said about 50 new staff members are being recruited, including nurses and nurses aides.

New admissions in Temple were temporarily halted until additional staff, including contract nurses, was hired. Husson said those requiring nursing home care were either put in a contract nursing facility or transferred to Waco. Liz Crossan, a spokeswoman for the Central Texas system, said the Temple long-term care unit began accepting patients again on March 22.

Changes fostered by the monthlong visit by Husson and his team were meant to address long-term care throughout the Central Texas area, including the Waco VA Hospital.

What actually happens in Waco depends on a decision by VA Secretary Anthony J. Principi as to the hospital's fate. The VA targeted the Waco hospital for closure last year. However, an independent commission studying VA health-care realignment rejected VA plans in February to contract out 117 nursing-home beds at Waco.

The CARES Commission, for Capital Asset Realignment for Enhanced Services, did follow most of the VA's recommendations to move psychiatric care to Temple and acute care to Austin.

The report the Tribune-Herald received contained a number of redactions — words that were blacked out— that the VA said were either because of privacy or medical issues. Among those redactions was the lead item under an outline of recommendations for management and leadership roles in the Central Texas system.

Changes in management included a new nursing director. A team of geriatric specialists that will include a physician overseeing the team also was named.

Phillips also noted that Dean Billik, who had been director of the Central Texas system, has retired. Robert Ratliff is the acting director.