Report: Vet on Death Bed Ejected by VA

April 02, 2011

The Virginian-Pilot

HAMPTON — The Hampton VA Medical Center inappropriately discharged a terminally ill veteran from its emergency room and failed to provide him hospice care requested by his wife, a federal investigation has found.

Investigators from the U.S. Department of Veterans Affairs’ Office of Inspector General found that staff members at the Hampton center were unaware of a VA policy requiring that end-of-life care be provided when veterans and their families ask for it.

The investigators’ report, issued Wednesday, came in response to a confidential complaint about the treatment of the veteran, a man in his 50s, who came to the center in August ill with lung cancer that had spread to the brain.

Over three successive visits to the emergency room, the man’s condition steadily deteriorated. By the third visit, he was weak, confused, incontinent and required help from VA staff to get out of his car.

His wife told the staff she was having difficulty managing him and could no longer care for him at home.

Nevertheless, the emergency room doctor discharged him, saying he did not meet the hospital’s criteria for acute-care admission. When his wife asked about hospice care — which focuses on allowing patients to die with dignity, pain-free — she was told no hospice beds were available.

She took him home but, even with the help of a family member, was unable to get him out of the car. She called 911 and paramedics took him to a local private hospital, where he was admitted.

His doctor there contacted the VA and requested hospice care. The veteran was scheduled for admission to the VA’s hospice unit five days later.

Two days before the scheduled transfer date, he died.

The investigators found that the VA emergency room doctor did not do a complete evaluation of the veteran before discharging him, failing to document the significant decline in his condition the past three weeks. They also found that the VA staff missed numerous opportunities to initiate hospice care.

The investigators were unable to substantiate allegations that the veteran and his wife were treated rudely by the staff or that four hospice beds were available on the day of the veteran’s last visit to the emergency room.

In response to the investigation, the Hampton center has provided training for its entire clinical staff in the VA’s end-of-life care policies.

“The Hampton VA Medical Center takes great pride in its state-of-the-art palliative care facility and dedicated staff,” said Jennifer Askey, a spokeswoman. The facility’s emphasis is on “honoring patient and family choice,” she said.

Wow, I guess the VA will have a hard time trying to sweep this under the rug. Or will they? Every time this happens, they trot out the standard rejoinder. “We are providing training to our employees to avoid a recurrence of this unfortunate incident.” An unfortunate incident would be if your scoop of Haagen daz ice cream fell off your cone into the dirt. An unfortunate incident might be correctly picking all but one of the Powerball lotto numbers. However, an unfortunate incident should never entail losing your spouse.