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Carnahan, Clay probe VA officials over Cochran's problems

This article first appeared in the St. Louis Beacon, May 3, 2011 - WASHINGTON - Armed with a new report, U.S. House members -- including Reps. Russ Carnahan and William Lacy Clay, both D-St. Louis -- grilled the top Veterans Department health official Tuesday about continued problems at John Cochran VA Medical Center and other veterans' hospitals around the country.

"How many times do our veterans have to fall in the same [medical care] pothole before we fix it?" Carnahan demanded of the Veterans Department's undersecretary for health, Robert A. Petzel. While he said he was encouraged that Cochran's leaders are developing "a turnaround plan," Carnahan complained that "a lot of problems are still lingering."

Clay asked about equipment sterilization, low employee morale and patient dissatisfaction at Cochran, which is in his congressional district, and then surprised Petzel and others by suggesting that "a voucher system" might be needed to provide proper medical care to St. Louis veterans if Cochran's problems cannot be solved.

"If we cannot improve conditions [at Cochran], perhaps it is time for the St. Louis region to try perhaps a voucher system" to allow veterans "to receive medical attention at our two world-class medical facilities" in St. Louis. If the VA system cannot provide the best care, Clay said, "perhaps we need to look at another medical system."

Petzel told Clay that won't be needed. He contended that Cochran and other veterans hospitals around the country were being improved -- in terms of medical equipment sterilization, oversight procedures and patient satisfaction. "There's very good evidence that things are changing in St. Louis" for the better, Petzel told the congressmen.

Petzel said that Cochran's top management has been developing a plan to improve equipment procedures, morale and the impression that patients have of the hospital. "We hear from service organizations that the atmosphere [at Cochran] has changed -- that this is a better place to work, a happier place to work."

Gao Report Cites 'weaknesses' in Oversight and Policies

But the report issued Tuesday by the Government Accountability Office cited continuing problems based on an analysis of medical equipment policies and practices at Cochran and five other veterans' hospitals.

Investigators found that "weaknesses exist in VA's policies for [sterilizing reusable medical equipment] that create potential safety risks to veterans." It said conflicting guidances had led to confusion about training to clean properly certain medical devices that can transmit infections.

"Much remains to be done" to improve Veterans Department policies and oversight related to medical equipment, the GAO's health care director, Randall B. Williamson, told the House Veterans' Affairs Committee.

The Veterans Department's assistant inspector general for health care, John D. Daigh Jr., while noting some improvements, said that VA hospitals "can perform better" in the area of medical equipment. He summarized a March report by his office confirming that Cochran had problems with the pre-treatment and cleaning of dental instruments, adding that managers did not "assure that corrective actions were consistently implemented."

The report said that hospital officials had acted correctly in notifying 1,812 dental patients last summer of possible risk of infectious disease, even though "the occurrence of a patient-to-patient transmission of a blood-bourne infectious disease ... was unlikely."

Veterans 'voucher' Concept Debated

Clay's voucher suggestion was similar to an idea floated in March by U.S. Rep. Todd Akin, R-Town and Country, to find ways to provide top-quality medical care to veterans at other hospitals in St. Louis. In a commentary published in the Beacon, Akin wrote that he was "not convinced that throwing more money at Cochran will fix the problem."

Akin added: "Can we use the great, private medical institutions around St. Louis to provide care to our veterans? This may not be easy, but it may be a simple and better solution than trying to fix a chronically ill VA medical center."

After Tuesday's hearing, Clay told the Beacon that the concept of providing vouchers to some veterans "is not an original idea of mine. But I think it's a good idea. It's something we need to look at if they cannot deliver quality care to St. Louis veterans at John Cochran. We need to look at what other options veterans should have to get quality health care in the dignified way that they deserve."

Before pursuing any specific plan, Clay said he wants to see if the VA can turn around Cochran. "We should know that pretty soon by the patient satisfaction survey" conducted there, Clay said. "If they are not able to turn it around, we may need to ask the VA to participate in a program that creates a voucher system."

But Jimmie L. Foster, national commander of the American Legion, has criticized the voucher concept. In a Beacon commentary responding to Akin's proposal, Foster argued that: "It is the federal government that sends our veterans to war, and it is the federal government that should provide a health-care system that meets their specific needs."

While he did not comment on the voucher idea, Carnahan said he is pushing -- with input from his Veterans Advisory Panel in St. Louis -- for better patient care at Cochran and other VA medical centers.

Carnahan said he hoped that Cochran's current director would succeed in improving medical care and morale at the hospital with a new plan that is being developed. "We may have the best scientific procedures in the world," he said, "but if it doesn't [improve] the human impact on veterans, it's not a good system."

Rob Koenig is an award-winning journalist and author. He worked at the STL Beacon until 2013.