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Fort Wayne’s VA Medical Center has temporarily halted all complex abdominal surgeries, including colon and gallbladder surgeries, pending a review of its surgical program.
On Wednesday, a three-person team from the Office of the Medical Inspector arrived at the hospital. The three left Friday morning after talking with staff and hospital administrators about issues that led the VA Hospital on Oct. 15 to put a hold on certain major surgeries.
The Office of the Medical Inspector, part of the Department of Veterans Affairs, independently investigates health care issues raised by veterans and other stakeholders, according to its Web site. Representatives from the office don’t do media interviews, but VA officials say the visit follows an internal review of processes and systems and an outside peer review of care in the surgical program.
“Pending release of the team’s final report, its preliminary report concluded that the (VA Northern Indiana Healthcare System’s) processes for reviewing concerns and incidents were in good order, that specific recent reviews produced accurate reports, and that proposed improvement plans were appropriate,” the VA Medical Center said Friday in a statement. “These plans focus on communication among team members and across disciplines.”
A patient’s death in August prompted the initial internal review, said Cathi Spivey-Paul, director of the hospital. Apart from the date of death – Aug. 21 – she didn’t provide any information about the surgical patient or specific circumstances surrounding that person’s death.
The death triggered an automatic peer review done by a surgeon outside the VA Medical Center. That review found that most experienced, competent practitioners might have managed the case differently in one or more aspects, Spivey-Paul said. But it didn’t determine that the surgeon involved – whom she didn’t name – provided inappropriate care, she said.
VA officials didn’t provide specific figures but said that surgical department morbidity and mortality rates are within the normal expected range, which accounts for factors such as patient age and condition. The department rates – not broken down by doctor – include surgeries done by chief of surgery Dr. Charles Gardner, who joined the hospital in November 2006, and Dr. Timothy Pelfrey, a surgeon hired in January. The two are the only physicians who were performing complex abdominal surgeries at the VA Hospital.
Spivey-Paul said she expects that Gardner and Pelfrey will return to performing complex abdominal surgeries in the future and says she’s looking forward to infrastructure improvements at the hospital.
After the surgical patient death in August, outside consultants – a general surgeon and an operating room nurse manager – were also brought in to determine what improvements are needed.
Their recommendations, which were consistent with internal findings, included increasing nursing staff in the recovery area, intensive care unit and for outpatient procedures.
After signing off on the recommendations, Spivey-Paul halted complex abdominal surgeries in mid-October to provide time for “rebuilding” the department, she said. For the previous 10 months, about four or five of those operations were performed per month.
The hospital plans to add equipment and staff to address issues, but it hasn’t yet determined when it will resume performing those surgeries.
In a statement Friday, the VA said that the “pause in complex abdominal surgeries is expected to continue for a few more months” while plans for improvement are implemented.
Since January, the hospital has spent nearly $600,000 on new equipment for its surgery programs, with a laparoscope one of its priciest purchases. Its most pressing staffing need is anesthesiology support, officials say.
In the meantime, patients requiring operations not offered by the hospital will be referred to another VA facility or a local hospital. The continuum of care won’t stop because certain services are on hold, Spivey-Paul said.
“The VA will take care of … individual patient needs.”
mschroeder@jg.net
