The top health official at the U.S. Department of Veterans Affairs on Monday visited the embattled Buffalo VA Medical Center, the subject of a scathing report released days earlier that found administrative lapses at the hospital led to months-long delays for veterans in need of care.
While Dr. Shereef Elnahal, the VA’s undersecretary for health, did not speak to the media, he did meet with Reps. Tim Kennedy, a Buffalo Democrat and member of the House Veterans Affairs Committee, and Nick Langworthy, a Republican who represents Buffalo suburbs and the Southern Tier and was the first to publicly call attention to the problems at the local VA hospital in August.
In a joint statement, Kennedy and Langworthy said they have “full confidence” in Elnahal’s commitment to restoring trust in the Buffalo VA and preventing future failures in patient care referrals.
“We’re already seeing meaningful improvements, and through continued congressional oversight, we’ll guarantee these changes are fully implemented and that veterans always come first,” the statement read. “Throughout this process, the hardworking medical staff at the Buffalo VA and their community partners have continued to show their dedication to our veterans – they deserve a new state-of-the-art facility and strong leadership that can help them fulfill our promise of world-class care for our veterans.”
The VA already has made leadership changes in Buffalo. A month before the report was issued, the VA transferred Michael J. Swartz, executive director of the VA Western New York Healthcare System, and Dr. Philippe Jaoude, the system’s chief of staff, to positions where they no longer deal with patients. Shawn De Fries, associate director of VA Finger Lakes Healthcare System, is the interim medical center director in Buffalo.
Over 54 pages, the report paints a picture of a VA Western New York Healthcare System where local system administrators failed to address lengthy scheduling delays for patients with serious health conditions, even when staff repeatedly tried to alert leadership of how the lapses were affecting veterans.
The report from the Department of Veterans Affairs Inspector General examined 42 cases in which patient care was delayed. Investigators found that in nine of those cases, the delays in referring patients to doctors outside the Buffalo VA Medical Center affected the patient’s clinical status or condition.
It took community care staff anywhere from 21 days to 285 days to schedule each of the 42 outside appointments, even though those appointments are supposed to be scheduled within seven days once a referral is approved.
The inspector general determined that VA Western New York Healthcare System administrators and leaders in the community care department failed to address these scheduling delays, even when staff repeatedly tried to notify leadership of the issue and how it was affecting patients.
In an interview with the inspector general, the hospital’s community care manager acknowledged receiving alerts from community care nurses about consults that had been delayed, particularly during late 2022 and early 2023 during what the manager called the consult backlog “chaos.” The manager also acknowledged delays in responding to patient advocate complaints, noting that the notifications were getting lost while the manager juggled multiple things.
“It’s not that I didn’t handle them,” the manager said. “I just didn’t do them timely.”
Longtime veterans advocate Patrick Welch, a U.S. Marine Corps retiree, took issue with that comment from the manager.
“It is my opinion that this comment reflects the tip of the iceberg. And that below the water line, there exists a much deeper issue in regard to morale and accountability,” said Welch, who has been a patient of the Buffalo VA since 1966. “No health care system is perfect, but I find it very disturbing that 58 years after I entered the VA health care system, veterans are still fighting for proper care.”
Left waiting
The report closely examined four cases – including one in which a veteran died waiting for radiation therapy – without disclosing patient identities. Veterans labeled Patients A, B and C in the report were examples of patients whose clinical status or condition were affected by the referral delays, while Patient D’s delayed referral affected the provider’s management of the veteran’s condition.
Patient A, for example, had Stage 4 esophageal cancer, but was never scheduled for radiation therapy, which would have decreased pain in the patient’s final months in 2023.
Patient B, meanwhile, was diagnosed in late 2022 with Stage 1 lung cancer. The oncology chief recommended radiation therapy and placed a request for a community care consult. The request was received the next day by the community care staff, and the oncology chief approved the consult that same day.
Still, community care staff did not schedule the consult appointment until more than 10 weeks later.
The most extreme delay cited among the four patients was in the case of Patient C, a patient in their mid-20s who experienced ongoing seizures while waiting nearly 10 months for an appointment.
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With Patient C having persistent seizures, a neurologist in late 2022 placed a community care consult for long-term electroencephalogram monitoring (LTM), a prerequisite for neurosurgical evaluation that was needed before the patient could be considered for possible epilepsy surgery.
But the community care medical director mistakenly discontinued the consult request about 120 days after it was first requested. The referring neurologist ordered the referral for the LTM again after the doctor sent an email to community care staff. The doctor’s email said the delay was “not acceptable” and was affecting patient care.
About 300 days after the consult was first requested, the appointment was finally scheduled, and the patient had the needed monitoring done in fall 2023.
Patient D waited almost as long as Patient C.
After Patient D reported a loss of vision in the left eye, a primary care provider placed an order with community care to schedule a computer tomography angiography, a CT scan done in combination with an injection of special dye to assess potential blockages in the arteries.
But it wasn’t until 18 days after the scan was ordered that the chief of radiology approved the consult, and that was only after two community care registered nurses alerted the radiology chief to the request’s urgency.
Seven weeks after the scan was requested, the primary care doctor noticed that the scan still had not been scheduled.
“I understand and appreciate the enormous workload that your department has but I am dismayed that the CTA ... has been sitting there this long despite the request to expedite,” the primary care doctor wrote to the community care staff in an email.
More than 280 days after the doctor ordered the scan, the appointment was scheduled. Patient D had the scan done in summer 2023, and the imaging revealed progression of a blockage in an artery that supplies blood to the brain and face.
News Washington Bureau Chief Jerry Zremski contributed to this story.
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