Feds get allegations about Dole VA patient-care concerns

Federal officials have received detailed information from a former analyst at Robert J. Dole VA Medical Center in Wichita alleging safety risks and patient-care problems.

The allegations describe serious staff and supply shortages and a process that obscures the fact that surgeries are being delayed.

It’s too early in the process to know whether the federal government will find enough merit in the allegations to launch a full investigation.

The allegations are in a copy of a draft letter from a staff attorney with the Office of Special Counsel, which reviews whistleblower complaints from federal employees. An OSC attorney e-mailed the letter on Wednesday to Nathan McClure, who had been assigned as an analyst to Dole VA. The letter outlines and details his allegations. McClure, who shared the letter with The Eagle on Friday, said he considers himself a whistleblower. He said he worked at Dole VA from October 2014 until April 17, 2015, when he was fired. He oversaw a project to improve orthopedic service, the letter says.

In a statement Friday, Dole VA spokeswoman Sharon Lien said: “These allegations were initiated in 2014 and have been thoroughly investigated and all allegations were found to be unsubstantiated. We continue to provide adequate staffing in our operating room and have dedicated purchase and logistic specialists ordering supplies to deliver the best health care possible. … We have been found compliant by the Office of the Inspector General (OIG) … and possess no inappropriate wait lists.”

The Dole VA statement added: “We continue to review our wait lists weekly to determine the most appropriate and expedient way to ensure our patients are seen for the care they need, deserve, and have earned.”

Wait times disputed

According to the Office of Special Counsel e-mail sent to McClure, his allegations describe a system at Dole VA where “surgical patients are entered into inappropriate wait lists in order to shorten reported wait times.” Under the process he alleged, patients are not put on the official waiting list until 30 days before the surgery. The official wait time gets shortened.

But patients were actually waiting on average more than 70 days for hand surgery, and amputee patients waited more than 140 days, according to him.

“Mr. McClure stated that this (process) served to obscure the true wait time for cataract surgery at Dole VA, which averaged 300 days,” according to the draft letter.

When McClure raised concerns about wait lists to a nurse manager and a chief of surgery, the doctor told McClure to “only focus on the things (he) can change,” the letter said.

The allegations say that McClure “noted that he found many instances where patients were provided a surgery date, completed a pre-surgery appointment with a provider, and then arrived the day of their surgery only to be informed that there was no surgery for them on that date.” McClure said it was often because of a lack of medical supplies, such as gloves or IV tubing, or failure to order prosthetics.

Anesthesiologist concern

The staffing-shortage allegation focuses on a lack of anesthesiologists.

According to the letter, McClure “discovered that there were multiple instances where there was no anesthesiologist available … to cover the fourth operating room, creating a risk to patients.” He described an incident “in which a patient who crashed required emergency treatment and no anesthesiologist was available.” It caused another surgery to be delayed so the anesthesiologist could help the emergency patient. If the scheduled surgery had been already under way, “there would have been no anesthesiologist to treat the emergency patient,” it said.

“He reported his concerns … but was again told focus on the things he can change.”

Having to stash supplies

Some of the most detailed allegations deal with what is called “serious supply shortages,” including sterile light strips and other sterile items involved in surgeries. A lack of sterile strips — used to cover operating room light handles — can interfere with patient care, the letter said.

“If a light with no sterile strip is moved by a provider during a procedure, the provider is required to step out and scrub back in to the procedure. Sterile light strips ensure that this is not necessary.”

McClure said that if an operating room lacked sterile light strips, an extra staff member had to be assigned to move the light as needed.

Because of shortages, Dole VA “has resorted to borrowing supplies from other local hospitals,” the letter said. McClure said that the chief of surgery sent residents to pick up supplies, “including stopping on the side of the road (to) take supplies from employees of other hospitals.”

In March 2015, it said, the operating room nurse manager “stated that this happened so often that Dole VAMC was not longer able to borrow from many local facilities.”

Another problem: The situation makes it impossible to properly track the source and sterility of supplies from other facilities, the letter said.

Because of the shortages, many nurses stash supplies in lockers so they will have them when needed, it said.

McClure attributed the shortages to improper use of tracking software installed in December 2014 and failure to assign specific staff to track supplies.

The process

McClure said Friday that the letter to him from the Office of Special Counsel, although a draft, accurately reflected his allegations. According to an e-mail, the attorney was checking with McClure to make sure that the letter accurately reflected his allegations, and he e-mailed back that it did. The attorney said in another e-mail to McClure, “I will let you know as soon as we have approval from management to refer this matter.”

OSC spokesman Nick Schwellenbach said Friday that he couldn’t talk about a specific case.

In general, according to the OSC website, if OSC decides that allegations bear investigation, it orders the agency involved to investigate. OSC reviews the investigation and lets the whistleblower see what the investigation found.

This story was originally published April 15, 2016 at 6:06 PM with the headline "Feds get allegations about Dole VA patient-care concerns."