The opinion of Dr. Stuart Finkel, an assistant clinical professor and board-certified gastroenterologist at New York City’s Mount Sinai Hospital, lends support to the detailed account the Augusta VA released Thursday to show how it cleared an endoscopy delay so significant that it led to three cancer patients dying and four other veterans being seriously harmed.
The Augusta VA said nearly half of the veterans whose screening and surveillance endoscopies were delayed (2,059) either did not require a procedure, declined treatment, moved and were advised to contact their care provider for further assessment, or didn’t respond to attempts by the hospital to make contact.
The Augusta VA said the remaining veterans who faced delays, including for diagnostic exams, had procedures performed either in-house (1,672) or at an outside facility under a purchased-care or fee agreement (201), or the veterans were provided a self-administered fecal screening test and scheduled for surgery if they received positive test results (574).
The hospital said 74 veterans who needed screening and/or surveillance endoscopies were scheduled for future appointments with a “clinically appropriate date” based on their needs.
Finkel said he has never heard of a delay in 4,580 consults in his more than 25 years in gastroenterology, but after doing some calculations, said it was possible the Augusta hospital could have performed 1,500 endoscopies in a month, at a rate of 48 to 50 procedures a day.
The Augusta VA said in a 2012 internal memo that it first opened a weekend clinic Sept. 15, 2012, to address gastrointestinal delays and planned to have the backlog cleared by Oct. 31.
“If you are allowing one procedure per hour, per room, you can certainly do 48 to 50 in an eight-hour shift,” said Finkel, a surgeon at Mount Sinai Hospital, one of the country’s oldest and largest teaching facilities, with a gastroenterology specialty ranked nationally in the top 10.
Finkel estimated that the Augusta hospital would need five or six operating rooms running at a time and multiple scopes available to surgeons for quality control purposes. He said for gastrointestinal exams, patients are seen in a holding area by a doctor, hooked to intravenous lines and monitors, sedated and scoped, then taken to a recovery area.
“They must have multiple instruments, cleaning one and using another during sterilization,” Finkel said. “The turnaround time for a colonoscopy – prepping the patient, doing the procedure and cleaning the instruments – is one hour.”
Mount Sinai’s gastrointestinal unit has two more full-time suites than the Augusta VA, but according to federal documents the Augusta hospital had as many 21 scopes on loan and lease to increase in-house capacity to a minimum of 30 exams per day in September 2012, with its daily goal scheduled to reach as many as 90 a day Oct. 15.
The sheer volume of endoscopies performed in one of the hospital’s busier programs has raised serious questions in the House Committee on Veterans Affairs, which is investigating delays in Augusta and Columbiaabout whether such a demand could be met.
Outside primary care, the Augusta VA’s gastrointestinal clinic has averaged 2,000 more patients annually than its cardiology program and about 4,000 more than neurology and orthopedics from 2007 to 2013.
In the past seven years, it has serviced 46,446 patients, which is 15,000 more than cardiology, 26,000 more than neurology and 31,000 more than orthopedics.
“I have one endoscopy suite in my office that I share with another doctor, and between the two of us, it’s a lot if we do eight procedures a day,” Finkel said.
An exact account of how delays were cleared comes after the Augusta VA conducted a review of patients’ medical records dating back to 2005, but it took three months to clarify the manner in which it treated the 4,580 gastrointestinal patients who were identified in the seven-year review as potentially having a delay in care.
Such a backlog was not represented in an account of all veterans served in the hospital’s gastrointestinal service line since 2007 that was provided to The Augusta Chronicle on Jan. 28 through a Freedom of Information Act request.
A Chronicle reporter met with Augusta VA spokesman Pete Scovill on Feb. 25 to clarify the data, which between 2011 and 2012, the years VA officials say the delays peaked, showed that service totals jumped by only 1,284 patients, climbing from a workload of 5,768 veterans to 7,051.
Scovill said he would try to arrange an interview with Bob Hamilton, the Augusta VA’s director, but said March 7 that he had written a summary of the information that what would be discussed during the meeting for the VA central office to review and decide whether to schedule a sit-down or release the statement.
The VA released the statement March 28, but the document didn’t provide specifics on how delays were cleared.
To make an exact count for how the delays were cleared, The Chronicle asked the Augusta VA on March 31 to provide specific data, but its request was declined April 4.
“Your request for further information … has been considered,” Scovill wrote in an e-mail. “At this time, we believe we have answered your questions in full.”
After The Chronicle appealed the hospital’s decision to five public affairs officials at the VA’s central office in Washington, an exact account was provided Thursday.
“The workload numbers referenced in the response to the FOIA request represent the full workload of patients seen in the Gastrointestinal Specialty Clinic during an overlapping, but separate period of years (2007-2014),” the document stated. “This workload included any service in the clinic, not just those referred for GI screenings, surveillance and follow-up or diagnostic testing. Additionally, many of the consults in question did not require scheduling into the GI clinic, having been resolved using clinically appropriate screening tools that are
less invasive and thus of lower risk.”
The statement said the Augusta VA’s “unprecedented, thorough review” illustrates the hospital’s “commitment to transparency.”
“The Department of Veterans Affairs takes seriously any issue that occurs at one of the more than 1,700 VA health care facilities across the country,” the statement read. “We at the VA care very deeply for every veteran we are privileged to serve. We offer our sincerest condolences to veterans who have been affected and those families who have lost a loved one.”