Daughters say patient safety compromised at Dallas VA Hospital

Patient safety at the Dallas Veterans Administration Hospital is again being called into question.

Considered to be the agency's worst facility in 2004, the Dallas VA Hospital has received more than 30 certification agency complaints in the last three years.

And now, there are two more.

Two daughters agreed to discuss the deaths of their fathers and the conditions they say no veteran should have to endure.

The Veterans Administration is the largest health care system in the nation, serving more than eight million veterans a year. VA officials in Washington D.C. pledge “to never compromise the safety, security or well-being of veterans."

Sydney Schoellman says the government has shattered that pledge.

Her father, Korean War veteran Gary Willingham, trusted his care to doctors at the Dallas VA hospital. In November 2010, Willingham went to the VA for what his daughter believed would be a short operation to remove a tumor from his neck.

But six hours after surgery began, Schoellman said two doctors finally emerged. "They never really admitted that anything went terribly wrong,” she said. "They kind of just padded around that."

Schoellman said what they did tell her is that her father had lost a lot of blood, and that they had accidentally clamped off his carotid artery for six minutes.

When she and her family were allowed to see Willingham, she said she was in shock.

"What we saw wasn't the man we grew up with," Schoellman said. "That wasn't the man that we'd seen how many hours earlier." With his carotid artery clamped and his brain starved of oxygen, Willingham had, in effect, suffered a debilitating stroke. Schoellman's once-energetic father was now bedridden and would spend the next year before he died unable to eat or drink on his own. Outraged, Schoellman started to dig, asking for the detailed surgical notes from the day of the operation.

"I was informed by one of the employees at the Dallas VA that I should get those records before they disappeared," she said. Deep in the surgical notes Schoellman said she found a disturbing revelation: The carotid artery had been clamped not for six minutes — as she said she was told — but for 15 minutes.

"If we had known it was 15 minutes, we wouldn't have allowed the things that went on. We would have let him end his life with dignity and the grace he lived it with before the surgery," Schoellman said.

Willingham's family has since filed a formal complaint and a legal claim against the Dallas VA for improper care. Tammie Wilson has also filed a complaint with the Dallas VA, saying her father — decorated Vietnam vet Gary McGrew — was stripped of his dignity as well.

Admitted to the Dallas VA this past February with two broken arms, Wilson said her father agonized for hours without pain medicine. "They just dawdled and dawdled, and it might have been six hours in-between," Wilson said. "I would just keep going out to the nurses' station saying, "Please, please!' They would respond slowly, if at all."

Wilson said no one seemed to be aware that her father was in his final stages in a fight with cancer. She said nurses were still trying to feed him in the minutes he was taking his last breaths.

"Here comes this nurse, stirring up the same pills and the same apple sauce he had spit out the night before because he couldn't even take a drink of water," Wilson said.

Administrators at the Dallas VA have declined to discuss either of the complaints with News 8, saying they either can't due to pending legal action or to lack of proper authorization.

They also say the complaints filed against them with the Joint Commission, the hospital accreditation agency, have been investigated and closed. They said the VA "maintains a safe and sanitary environment" and "invite families to discuss their concerns and complaints ... through several means available to them."

Schoellman said the only means left for her family is the courts, along with her ability to speak out for the veterans who cannot. "These are some of the greatest national treasures that we have, and they walk in every day, and these families are blindsided by the pain and the agony of losing someone at the hands of people who are never held accountable," Schoellman said.

Last fall, News 8 investigated complaints about quality of care at the Dallas VA. The Inspector General with the Veterans Administration last fall also found excessive wait times and irregularities with referrals and appointments.

Rep. Eddie Bernice Johnson (D-Dallas) said her office has also received complaints.

"While I am unable to comment directly on any information I have received from my constituents, many of these complaints pertain directly to the quality and timeliness of patient care," Johnson said. "The VA’s own Inspector General reports — which are public record — bear out the delays and shortcomings in patient care."

“I have repeatedly expressed my concerns to the VA in Dallas and in Washington D.C., in direct response to those complaints," the congresswoman added. "The single most important responsibility of the VA is to meet the health challenges that our veterans face. While I have worked directly with [VA] Secretary [Eric] Shinseki's office on numerous occasions within the past year, the VA at the local and federal levels have not responded impartially to these complaints. It has always been my hope that the leadership at the VA would have taken their own initiative to address these issues. I will do everything necessary to address the concerns of my constituents and patients of the VA North Texas Healthcare System. So long as the VA’s ability to meet those challenges remains in question, I will not rest until these issues are resolved.”

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Source: WFAA (AP, 6/10)

Despite Counsel, Amputee Hindered by Tort Laws

SAN ANTONIO — When Connie Spears arrived at a Christus Santa Rosa hospital emergency room in 2010 with severe leg pain, she told medical staff about her history of blood clots. Doctors sent her home with a far less serious diagnosis.

Days later, swollen and delusional, Spears was taken by ambulance to another hospital where doctors found a severe clot and extensive tissue damage. With her life on the line, they amputated both of her legs above the knee.

Nearly three years later, Spears says she is a victim not only of a medical mistake but also of Texas’ tort reform laws.

The massive tort reform package that Texas lawmakers approved in 2003 capped noneconomic damages a plaintiff can receive for medical malpractice at $250,000 and set a “willful and wanton” negligence standard — interpreted as intentionally harming the patient — for emergency care. It also required plaintiffs to find a practicing or teaching physician in the same specialty as the defendant to serve as an expert witness, and to demonstrate evidence of negligence ahead of a trial. Under the strengthened rules, if plaintiffs fail to produce adequate expert reports within 120 days of filing their cases, they are liable for defendants’ legal fees.

Spears said the laws obstructed her ability to find a malpractice lawyer and forced a judge to order her to pay thousands of dollars to cover some defendants’ legal bills. Her lawyers plan to challenge the constitutionality of the laws.

“How can that law be?” Spears asked. “Maybe the law was too loose before, but they went way too far the other way.”

Tort reform proponents say that such restrictions are the only way to curb frivolous lawsuits against health care providers, and that they have drawn more medical professionals to a state with exploding population growth.

“Our purpose had never been to have a procedural hurdle,” said Mike Hull, a lawyer for the pro-tort-reform Texas Alliance for Patient Access. “It had been to have the plaintiffs really get the case reviewed.”

For two years, Spears struggled to get legal representation, because several lawyers said they feared her case did not meet Texas’ new negligence standards. Justin Williams, a Corpus Christi lawyer who eventually took the case, said he believed it was so strong it might challenge the state’s tort reform laws. “Her life has basically been ruined by all of this, and there was just no way I could turn her down,” he said.

But the case fell apart under the new expert witness rules. After the first attempt at an expert witness report failed to identify the proper defendants, Williams said, he was unable to find another expert witness in a time frame that would satisfy Texas’ requirements.

Tina York, an attorney for Christus Santa Rosa, said it is unusual for a case to get dismissed because of problems with an expert witness report. The rules are in the statute, she said, to weed out plaintiffs who “can’t legally support their claim” from the beginning.

York said Christus Santa Rosa did not pursue compensation for its legal fees out of sympathy for Spears. But Spears said other defendants in the case had. With her retirement savings tapped and her husband out of work, she is afraid they will lose their home.

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Source: The Texas Tribune (Aaronson, 1/25)