Wednesday, May 04, 2011

Barry's latest fairy tale






"I'd like to pretend that I'm looking forward to today's hearing," declared US House Rep Bob Filner this morning as the House Veterans Affairs Committee, "but I'm not. These are not easy questions. And frankly, Mr. Chairman, the issues go beyond just the-the incidents themselves. They go to the communication within the VA. It took a long time for the right people to know what was going on in each of these incidents. It goes to communication with our VA patients. Sending a letter that says basically, 'You may have HIV,' is not the way to deal with these issues." Filner is the Ranking Member on the Committee but what was he talking about? HIV?
The VA's had several problems of contaiminating and infecting patients they were supposed to be treating. In his opening remarks, Filner noted several such incidents.
Ranking Member Bob Filner: In December 2008, we were notified of improper reprocessing of endoscopes which put thousands of veterans in Murfreesboro, Mountain Home Tennessee and Miami, Florida at possible risk of hepatitis and HIV. In February 2009, another 1,000 veterans in Augusta, Georgia received notifcations that they were at risk for hepatitis and HIV because of improper processing of ear, nose and throat endoscopes. In July 2010, this Committee held a field hearing in St. Louis, Missouri, a hearing you attended Mr. Chairman, along with many of our colleagues today after we had learned of lapses in protocol with the cleaning of dental equipment which put at risk 1,800 veterans.
Background, June of 2009, attorney Mike Ferrara (Cherry Hill Injury Board) was stating, "Since April, we've been letting people know about the medical errors at VA hospitals that have caused at least five patients to contract HIV from contaminated endoscopic equipment." Last June, CNN reported, "John Cochran VA Medical Center in St. Louis has recently mailed letters to 1,812 veterans telling them they could contract hepatitis B, hepatitis C and human immunodeficiency virus (HIV) after visiting the medical center for dental work, said Rep. Russ Carnahan." A field hearing took place (Congress holds a hearing outside of DC, they call it a field hearing -- think field trip) July 13, 2010 and Betsy Bruce (KTVI-TV) reported, "Petzel promised he would have a rapid response procedure for future medical concerns ready in a month. Chairman Filner interrupted telling him, 'Why not right now?'"
In the 2010 November mid-terms voters gave Republicans the majority in the House and Bob Filner became Ranking Member instead of Chair. At at the start of the hearing today, he would point out, "As far as I know, and maybe the panel can correct me, with all these incidents, we have never been told -- I don't think so, Mr. Chairman -- of any -- of any personnel changes as a result. The only way to send a message is firing or whatever."
Appearing before the Committee were two panels. The first panel was composed of VHS' Dr. Robert Petzel, Dr. John Daigh, Jr. (Assistant Inspector General for Healthcare Inspections, VA) and Randall Williamson, US Government Accountability Office's director of health care). The second panel was HHS's Dr. Michael Bell and HHS' Anthony Watson. Petzel began the hearing (reading his opening statement word for word) appearing combative. From that first panel, we'll note this exchange with Petzel and Committee Chair Jeff Miller and Ranking Member Bob Filner.
Committee Chair Jeff Miller: Let me -- and my time is run out -- but comments in your opening statement: continuous improvement, dozens and dozens of reviews annually, careful assessments, you talked about levels of oversight, I think GAO talked about inability to follow guidelines, the need for unfettered input for employees, they found disturbing deficiencies in systematic problems, you said you've begun a process of certification -- If you do all of those things, and your managers don't follow the rules, what do you do with those people?
Dr. Robert Petzel: We would discipline them.
Committee Chair Jeff Miller: Have you?
Dr. Robert Petzel: We have.
Committee Chair Jeff Miller: Have you fired anybody?
Dr. Robert Petzel: We have proposed removal in a number of instances and almost invariably the individual has resigned or retired as a result of the proposed removal.
Committee Chair Jeff Miller: Can you give us a number, I mean, of individuals that you've proposed removal of?
Dr. Robert Petzel: There are, I believe, 3 physician or dental level people that that's occurred with. Several chiefs of SPD where that's happened. We've also reprimanded individuals, suspensions and letters of counseling.
Committee Chair Jeff Miller: And I think one of the dentists was in his eighties, is that correct?
Dr. Robert Petzel: Close. Yes.
Committee Chair Jeff Miller: Mr. Filner.
Ranking Member Bob Filner: Dr. Petzel, you're here as the representative of the VA. We've gone through this before, sir. It seems to me your job here should have been -- and we have Congress people from all the districts that have been effected -- was to begin to restore some trust and confidence in your institution. I'd hate to take a poll. If I did, and I said, "How many people now have confidence everything is fine in your VA hospital?," I doubt if anyone would raise their hand. You said everything is fine. It's not true. Simply not true. You talk about all of these transparent procedures and these-these Journal --
New England Journal best practices, and yet every time something happens, we have disaster. We don't have a way of communicating. We don't have a way of dealing with the personal concerns. We don't have any knowledge that anybody's been reprimanded. Now you've got three. We've been going over this for years and now we've got three. And we still -- You have never told this committee those figures before as far as I know. But, Dr. Petzel, we've gone through this before. We've raised concerns in our opening statements. You read your opening statement as if we never said anything. So you never addressed issues of accountability, you never addressed issues of communication -- whether within your agency or with veterans or with this Committee.
I-I-I-I've gone through the time lines with almost every one of these [Congress] members here and their hospitals. You say panels get together to decide "should we disclose, what should we disclose, who should we --?" It looks to many of us like they get together to decide "What do we keep secret from our" -- You know, you keep shaking your head "no." But why did it take 8 weeks at St. Louis -- where Mr. Carnahan will raise the issues -- why did it take 8 weeks for that panel to decide, we're going to tell people that we have almost 2,000 people infected -- possibly infected with HIV? It took two months before you guys decided that. I would have -- And the Secretary [of the VA, Eric Shinseki] wasn't notified, as far as I know, in his words to me, in that whole period of time. So it sounds like you're sitting there deciding, "What's the minimal amount of information that we can give out so people don't get upset with us?" Rather than the maximum. I would have -- that first day -- I would have had the Secretary had a press conference that said, you know, "We have a possibly of X-hundred or thousands of people, we're going to get to you right away, we want to make sure this is happening." And put pressure on yourselves to become public. Because there's no pressure for you to do anything. We didn't know anything. The Secretary didn't know anything. I don't know if you knew anything. Because these guys are going, "How do we keep this secret for as long as possible? Maybe we don't have to disclose at all?" Because your question was: "Should we disclose?" Not how to do it. And then, as I said, your whole disclosure process is as if everybody knows all your acronyms and your-your initials for everything, all these SPDs and RMEs, as if the patients know what's going on. They get a letter. I've seen these letters. It says basically -- it's not this bald, but almost -- "You may have HIV." They get a letter. It may have even gone to a wrong address. For 1500 people, as I said to you earlier at a hearing, you should have had 1500 of your 250,000 employees, assigned each one to somebody, call them, call them, go visit them, find out where can they come back, when can they get their blood tests, treat them as if they may have HIV. And they're scared to death they're going to die and you send them a letter. And there's no one there necessarily to answer a phone call when they call back cause you don't have people working this like case managers and one person to five people. I think you should do one-on-one. But what you described as this open, transparent process does not come through. And everyone of these people [points to members of Congress] has constituents which I bet confirm what I just said. And even if it's perception and not reality, that, that's just as bad. That you took forever, you weren't very personal in your notification, you weren't very clear about what it is that they might have, you didn't follow up in a way that was very quick and then we don't know anything about accountability. We know nothing from basically what you said today. And you guys have got to develop a new system. Whether it's talk -- You know, we just killed Osama bin Laden and they notified 8 members of Congress and the Committee and they kept that. Well maybe you should notify all the Chair and Ranking Member of the Veterans Committees about what you're doing about your personnel. But there is no sense that you have done anything. And we don't know -- Nobody in Dayton, nobody in St. Louis, nobody in Miami, nobody in New Jersey, nobody in Tennessee knows anything about that accountability. And I doubt anybody in the system knows anything about it, so they don't think there's any accountability. So I wish you would address these issues. We've gone over them for several years. You and I have gone over these exact issues several times in hearings and you do the exact same thing. You give me a prepared statement. 'Everything's fine.' You move the discussion into these arcane things about SPDs and RMEs and you neglect the basic issues of communications and accountability that are at the heart of the confidence that our people have in your system. You may comment in any way you want.
Dr. Robert Petzel: Uh, thank you, Mr. Filner. The, uhm . . . What I want to do is, uh, first talk about our, uh, notification process. The, uh, the process by which we determine who ought to be notified or who might be at risk, as I said before, is an industry standard. I will stand by that process under any circumstance. It takes some time but it is transparent and it is weighted heavily in the favor of --
Ranking Member Bob Filner: Nobody knew about St. Louis for 8 weeks.
Dr. Robert Petzel: I'm --
Ranking Member Bob Filner: Eight weeks.
Robert Petzel: Sir.
Ranking Member Bob Filner: And I'm if that's industry standard, we shouldn't be following industry standard.
Dr. Robert Petzel: Sir, I'm not talking about the communication, I'm talking about the process that we go through. It is very thorough and it's weighted on the side of being abundantly cautious to be sure that we take into account every possible risk. The process by which we disclose to patients involves letters, phone calls and case managers. Particularly in the instance of St. Louis, every single individual that was effected was called, they were offered a case manager, there was a case manager that involved -- in fact, in some instances, the leadership of the medical center. I will admit that we've learned figuratively since --
Ranking Member Bob Filner: Sir, that conflicts exactly with what you said to me at St. Louis. The Chairman was there, Mr. Carnahan was there, Mr. Lacy -- Clay [US House Rep William Lacy Clay] was there, sorry, sir. Mr.[John] Shimkus was there. You never mentioned the word case manager, you never mentioned mentioned that they were called. Is that right, Russ? [Carnahan nods his head in agreement.] We-we went through this discussion with you. The first word I said to you was case manager. I said to you, "Why don't you have case managers?" You said, "Yeah, we'll look at that." We're both going to review your testimony in St. Louis because it's contrary to what you just said now.
Petzel never grasped it -- or never showed any indication that he did. He came in combative and remained that way throughout leading to the larger question of why VA Secretary Eric Shinseki has not either asked for Petzel's resignation or relieved him of his duties? Even when Committee Member US House Rep Phil Roe -- also Dr. Roe, and that's medical or we wouldn't note the "Dr." -- attempted to walk through reality with Petzel, Petzel refused to budge, refused to see the light. He wanted to bicker and dicker and bluster. "I can assure you that in the private sector, had this occurred," US House Rep Roe noted, "like this just occurred, and a medical legal case had resulted out of it, you just get your pencil out and start writing commas and zeroes, I can tell you, and get the check book out because this private system would not tolerate this." It went beyond Petzel's apparent grasp.
US House Rep Phil Roe: One of the things that we have to sell in medicine is trust. Our patients need to trust us. They need to trust the VA that that's where the quality of care and transparency, Mr. Filner is absolutely 100% correct. I can assure you that when I had a problem go wrong in my shop when I practiced medicine, not the clerk that answered the phone made the call to the patient, I made the call to the patient. I called them up. I explained to them. I had them come in and tell them what was going on. And I can tell you, with 1500 people, that could have been in a large institution with multiple people, I would have had the highest level people contacting someone when they think they have HIV or a potential life threatening condition.
Petzel wanted the Committee to know that they'd learned a lot since 2008. These are not steps you learn late in your career. What Rep Roe was referring to is learned early in your medical career. That Petzel and the VA have to play catch up is an indictment of the lack of leadership and accountability. And let's talk about the three Petzel thinks they 'forced out' -- resigned or retired. Is there anything following them around? Since they weren't fired, it's doubtful. The nearly 80-year-old is presumably retired; however, he may be doing some part-time work. Is there anything following him or the other two around alerting other medical facilities to the problem at the VA that resulted in the person leaving the VA? The answer's no. By allowing them to resign or retire, the answer is no. So not only did they put veterans at risk, but who knows who they're putting at risk currently.
If you're not getting how combative Petzel was, we'll note US House Rep Bill Johnson. Johnson, a Republican from Ohio, is always very low key in the Veterans Affairs Committee hearing. Quoting Petzel's own words to him, to ask a question, Johnson was greeted with Petzel insisting he hadn't said that (he had) and cutting Johnson off repeatedly. When Petzel came up for air, Johnson noted his time was up, that he agreed with Filner and, "If there's anything that it appears the VA is expert in it's talking around these problems and kicking the ball down the stream."

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