DEATHS, WAITS, BEDSORES: HOW VA HOSPITALS RATE
When Navy veteran Phyllis Seleska, 66, arrived at the emergency room at the Department of Veterans Affairs hospital in Loma Linda, California, in August 2017, the waiting room was crowded with dozens of veterans, some in wheelchairs lined up to the entrance.
Seleska suffered throbbing pain after shattering her wrist but received no medication and had to wait more than seven hours to see a doctor, records show. By then, the orthopedics staff had gone home. A nurse strapped a Velcro splint on her wrist and told her to come back in the morning.
“I don’t know why it took so long to get back there to be told, ‘We can’t do anything to help you,’ ” said Seleska, who worked on the flight deck of aircraft carriers in both Iraq wars.
Her experience wasn’t unusual. At roughly 70 percent of VA hospitals, the median time between arrival in the emergency room and admission was
longer than at other hospitals, in some cases by hours, according to a USA TODAY analysis of the department’s data. That included Loma Linda, where the median wait is more than 71⁄2 hours.
The USA TODAY analysis provides the most comprehensive picture of how 146 VA medical centers compare with other health care facilities on an array of factors. The analysis is based on scores of spreadsheets the VA posted online in recent years containing comparisons of its centers with non-VA averages on everything from the ER wait times to infection rates and patient-survey results.
The analysis produced some positive findings for the VA. As of June 30, a majority of VA hospitals reported lower death rates than other facilities. Many VA medical centers stacked up better on prevention of post-surgical complications such as blood clots.
At the same time, dozens had higher rates of preventable infections and severe bedsores – a sign of potential neglect. Nearly every VA performed worse than other providers on industry-standard patient satisfaction surveys.
VA spokesman Curt Cashour said certain veterans may have conditions that make them more susceptible to complications, and “caution should be exercised” when drawing conclusions from the comparisons.
He said the VA “does recognize the need to improve the speed by which it can admit veterans to the inpatient unit,” but he said non-VA hospitals also struggle with long waits.
“VA provides some of the highestquality health care available today,” Cashour said.
The Department of Veterans Affairs has been buffeted by crises since 2014, when news reports revealed that patients died awaiting appointments at the Phoenix VA hospital. There were lethal lapses in Oklahoma City, patient safety failures in Memphis, Tennessee, and equipment and sterilization problems in Washington.
The USA TODAY analysis adds to evidence of uneven quality within the VA system. Some hospitals, such as those in Asheville, North Carolina, and Sioux Falls, South Dakota, excel on a wide range of measures while others, such as Memphis, lagged.
The Trump administration is considering rules to widen veterans’ access to outside health care paid for by the VA. That would deliver on a presidential campaign promise made by Donald Trump to expand health care choices for veterans. Critics warned that increasing VA-funded private health care would drain money from the department and lead to its privatization.
As the administration weighs the standards under which expanded nonVA options would be allowed, it considers variables such as wait times, distance and – for the first time – quality.
‘Scorecards’ for care
The VA began publishing online an array of spreadsheets it dubbed “scorecards” in the months after Trump took office. The quarterly assessments include comparisons on 65 measures.
USA TODAY compiled and analyzed the scorecards from June 30, the most recent available, and found that death rates after heart attack, heart failure and pneumonia were the same or lower than non-VA averages at two-thirds of VA medical centers.
Most VA hospitals had lower rates than other facilities for a majority of post-surgical complications such as hemorrhages, clots and death.
Nearly 50 VA hospitals had higher rates on at least three of four avoidable infections, such as potentially lifethreatening intestinal bacteria and bloodstream infections. More than half had higher rates of severe bedsores.
At some facilities, problems happened far more frequently than at other hospitals – VA or non-VA.
Cashour, the VA spokesman, said some quality measures are not risk-adjusted, so statistics could appear inflated. He said certain veterans, such as those with spinal cord injuries, are at higher risk of developing bedsores.
Though some hospital-quality specialists said adjusting rates for risk factors is typical in the industry, others said such steps are unnecessary for preventable infections and post-surgical complications.
Bill Finck, former chairman at the Leapfrog Group, a nonprofit hospital rating organization, said there should be zero – much like an airline aims to have zero crashes.
“You either give a person an … infection or you don’t,” said Finck, a longtime health care industry executive and Vietnam veteran who gets care at the Philadelphia VA. “Safety is safety.”
The VA hospital in Asheville was among the better performers on that front. The hospital had the same or lower rates on a majority of complications and infections than non-VA facilities.
“I can’t say enough about how good it is,” said David Hall, 65, a Vietnam veteran who has received care at the Asheville facility for years. “I wish the other VA hospitals could use their (example).”
The VA has tried for years to spread best practices from higher-performing hospitals to more troubled ones. In 2015, the agency launched a “diffusion of excellence” program to replicate successful programs across the country, including direct scheduling of eye and ear appointments and text messaging of appointment reminders. In 2017, the VA set up a tracking system at headquarters to identify problem facilities and dispatched teams to help them improve.
As of October, five VA hospitals ranked the lowest one star out of five for the third straight year in agency ratings, including in Loma Linda and Phoenix, the site of the wait-time scandal in 2014. The others were Memphis and the hospitals in Big Spring and El Paso, Texas.
VA spokesman Cashour said those hospitals have undergone “intensive improvement initiatives over the past year,” and each has “achieved significant gains in multiple areas.”
‘People are in pain’
On patient satisfaction surveys, veterans overall were less likely than nonVA patients to feel medical workers treated them with respect, the analysis found. They were less likely to recommend VA hospitals to others and rated their medical care providers lower.
The VA scorecards analyzed by USA TODAY feature questions for inpatients and outpatients about their experiences. Nearly every VA facility – 141 out of 146 – scored below other facilities on a majority of questions surveyed.
The Memphis VA hospital received lower ratings from patients than the median of non-VA providers on 27 of 30 questions – the worst of any VA facility.
Mary Alimenti, whose husband receives care at the Memphis VA – roughly 100 miles from their home in Huron, Tennessee – said hospital staff have been “really mean” and “don’t listen.”
“They don’t take the time that they need to with the vets,” she told USA TODAY. “It’s like, you know, you’ve got a line of cows, and they’re coming in and going right back out again.”
Cashour said the outpatient survey results are not adjusted for factors such as age. He said older patients on average give higher ratings than younger ones for the same care, and sicker patients give lower ratings than healthy ones.
Seleska, the veteran who waited more than seven hours in the Loma Linda VA emergency room, said she had no such confusion and wouldn’t recommend the hospital to anyone.
She isn’t looking to switch to non-VA care, even if the VA pays for it. She just wants the VA fixed. “All we’re asking is do your job,” Seleska said.
She reached out to patient advocates and administrators in Loma Linda, the VA inspector general’s office and even Trump’s new White House hotline for veterans – to no avail.
“This is what motivated me to … keep accelerating until I got somebody’s attention, anybody’s attention – because it’s not just me,” she said. “It’s my brothers and sisters over here. I mean, people are in pain.”