The Veterans Affairs Department last week continued to see its reputation for high-quality healthcare tarnished, with federal lawmakers challenging VA officials to explain how one of the most sophisticated systems in use today to check physician qualifications failed so spectacularly at one Illinois medical center.
While the final answer may be weeks away and ultimately unsatisfying, a handful of senators said they intend to probe just how far-reaching the quality-of-care problems may beand one Senate leader has pledged legislation to help stave off future problems. The situation also underscores the problems that hospitals of all types can face in maintaining credentials for physicians working in their facilities.
At a Capitol Hill hearing on the matter last week, Sen. Dick Durbin (D-Ill.) said he was disturbed by the allegations that a number of patient deaths at the 115-bed Marion (Ill.) VA Medical Center were linked to a single physician with a sketchy medical past.
Marion has served veterans honorably, Durbin said. Thats why this current situation is so troubling. A Durbin aide said that the senator will likely introduce legislation by early December.
At the hearing, the Senate Veterans Affairs Committee targeted the Marion medical center, which on Aug. 30 stopped performing complex surgeries after the VAs own internal tracking database found a sharp increase in the number of patient deaths there.
On Aug. 10, the surgical director at the Marion facility was told that the VAs National Surgical Quality Improvement Program had flagged the hospital because of an abnormal number of patient deaths.
The NSQIP system culls data from surgical outcomes to determine whether there are statistical deviations in mortality and morbidity rates, and as a result, a team of investigators was sent to the facility. The spike that the NSQIP found at Marion allegedly has been pinned to Jose Veizaga-Mendez, a surgeon who later resigned from the facility and who most recently lost his license to practice in another state.
Since then, a VA investigation has resulted in the reassignment of five senior members of the facility while three more surgeons have seen their privileges limited, according to VA officials who spoke at the hearing.
The agencys inspector generals office is investigating the medical center and the Joint Commission in September conducted an unannounced, for-cause survey at the facility. It is unclear, however, if that survey was related to the patient deaths there. The accrediting group found the facility to be in good standing.
Veizaga-Mendez had been allowed to practice at Marion up until August even though a routine background check would have shown a questionable past, Durbin said during the hearing. Last week, the Massachusetts Board of Registration in Medicine permanently barred the physician from practicing medicine there.
The VAs system for checking and rechecking a providers standing was supposed to have raised red flags. The VA uses a standardized electronic program separate from the NSQIP, called VetPro, which links to a number of other flagging systems.
Kathryn Enchelmayer, director of quality standards at the Veterans Health Administration, said at the hearing that the VAs system for checking credentials exceeds industry standards and likely is the envy of most of the healthcare industry.
When asked by Sen. Richard Burr (R-N.C.) whether the VAs official policy was followed at Marion, Gerald Cross, principal deputy undersecretary for health at the Veterans Health Administration, said so far, yes.
The VA realizes that accurate credentialing is a cornerstone to ensuring qualified healthcare providers are hired, Cross said.
At the VA, the credentialing officer gathers all primary source information on an individual. But thats just the starting point, he said. The VA checks credentials against the National Practitioner Data Bank, the Federation of State Medical Boards data, HHS list of excluded individuals and more.
VA officials at the hearing declined to discuss the Marion situation specifically pending ongoing investigations into the matter.
After the incidents at Marion, Enchelmayer said, a check of about 56,000 physicians and independent practitioners practicing within the system turned up VetPro red flags on some 17,000, or 30%, that require further investigation.
Enchelmayer pointed to that number as proof-positive that the system works. But it is still unclear as to why the system failed to red-flag Veizaga-Mendez.
In a letter sent last month to acting Secretary of Veterans Affairs Gordon Mansfield, Durbin and Sen. Barack Obama (D-Ill.) called the VAs process for conducting background checks far from adequate.
This is an extremely alarming situation that calls into question the adequacy of the oversight exercised by the VA as it evaluates and monitors those who provide care to our veterans, the senators wrote.
In addition, the case has shone a new light on what has been a pesky yet potentially dangerous problem for many hospitals.
Ruth Elzer, director of accreditation and compliance services at Compass Group, a Cincinnati-based consultancy, said that the credentialing and privileging process at most hospitals has become a thorny one, with hospital staff struggling to determine which physicians are qualified to perform an ever-growing list of procedures.
There are no nationally accepted measures for every single kind of subspecialty, Elzer said. Certain groups have made recommendations, but right now there isnt a central database, she said.
Adding to the problem, medical staffs are required to undergo re-privileging every two years, which is enough of a gap to potentially compound existing problems if there are any. If the deaths fall between that time, it may not show up until two years later, she said.