An internal investigation by the Department of Veterans Affairs has found that one of its hospitals in Jackson, Miss., did not have enough doctors in its primary care unit, resulting in nurse practitioners' handling far too many patients, numerous complaints about delayed care and repeated violations of federal rules on prescribing narcotics.
The investigation found no evidence that care had been compromised in the primary care unit, the vital first stop for many patients. But it concluded that there were enough problems "to suggest there may be quality of care issues that require further review," a copy of the investigators' report says.
Although the investigation focuses on one hospital, its findings have broader implications because the veterans department, along with many private hospitals, is moving to increase the use of nurse practitioners to reduce costs.
The problems at the Jackson veterans hospital, known as the G. V. (Sonny) Montgomery Medical Center, will be among the topics discussed at a special field hearing of the House Committee on Veterans' Affairs in Pittsburgh on Monday.
The hearing will review accusations of mismanagement at several hospitals, including an inadequate response to an outbreak of Legionnaires' disease in Pittsburgh, the mishandling of mental health patients in Atlanta and the reuse of insulin pens in Buffalo that exposed patients to hepatitis. The panel members are expected to press department officials on why executives at those hospitals were given performance bonuses despite those problems.
The internal investigation into the Jackson medical center, completed in June, was prompted by concerns raised by hospital employees with the Office of Special Counsel, which handles federal whistle-blower complaints. The whistle-blower who complained about the primary care unit, Dr. Phyllis Hollenbeck, is scheduled to testify on Monday.
Among the most serious accusations made by Dr. Hollenbeck were that nurse practitioners without proper federal certification were writing narcotics prescriptions, and that the hospital asked doctors to write prescriptions for patients they had not seen. The investigators corroborated those accusations.
The department's investigators called on the hospital to "aggressively work to hire permanent full-time physicians" for the primary care unit. It also said the hospital should conduct an external quality-of-care review of all primary care at the medical center.
Although the internal investigation corroborated many of her accusations, Dr. Hollenbeck sent a scathing 35-page response to the report saying the department had failed to discipline any of the senior executives who allowed problems in the primary care unit to fester for years.
One senior official at the hospital, Dorothy White-Taylor, the associate director for patient care services, was removed from her position last year, but only because she was arrested on charges of fraudulently obtaining a prescription painkiller. Those charges have been dropped.
Ms. White-Taylor, who remains a department employee, received $61,250 in performance bonuses between 2003 and 2011, hospital records show.
"I do not believe that any of the people in leadership would tolerate going to a medical practice that ran like this — so once again, why do they think it is acceptable for the veterans?" Dr. Hollenbeck asked in her response.
In a statement, the Department of Veterans Affairs said that it welcomed the report's recommendations and that executives at the Jackson medical center were working on a plan to put them into place.
The department also recently conducted a second internal investigation into accusations raised by a former employee at the same hospital that a radiologist had failed to examine numerous radiological images but nevertheless marked them as "read."
The investigators failed to corroborate that accusation, the report says. It also did not find evidence supporting a related accusation by the same whistle-blower: that the radiologist's incomplete reading of images led to missed diagnoses of serious, often fatal conditions, including cancers and neck fractures.
But the report said that an independent review of 58 cases handled by the radiologist found that other practitioners might or would have handled 31 of those cases differently. Of those 31 cases, 8 were identified as having "moderate or high impact to patients." The investigators recommended that the hospital review those cases more closely and notify patients as appropriate.
The department's investigation additionally recommended that an external group review a broader cross section of the radiologist's cases between 2003 and 2007 to determine whether his error rate was high.
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