Fly infestation in VA operating rooms — another example of chaos within agency

The Hill

In Lord of the Flies, William Golding states that “the best ideas are the simplest.” Allowing veterans to receive care at the facility of their choosing — whether that facility is run by the VA or not — seems like a simple idea. Unfortunately, like many ideas routed in politics, this simple idea has succumbed to partisan bickering that has left the VA much like the fictional island in Golding’s novel.  

For starters, the melee surrounding the departure of former Secretary David Shulkin and the disastrous failed nomination of Ronny Jackson to replace him, has left the VA without a leader to govern the agency. Lord of the Flies analogies abound regarding disastrous attempts to self-govern as numerous other senior leaders at the VA have recently departed amidst the chaos and uncertainty.

And, now VA’s lack of leadership has caused some medical centers to succumb to actual flies.

The West Los Angeles VA Medical Center, which is no stranger to controversy, is the latest VA facility shown to have a serious problem with flies in its surgical suites. According to entomologists, phorid flies, such as those verified to be problematic in LA, are “attracted to open wounds . . .where they look to lay eggs. They can also transmit dirt, bacteria and other unsavory morsels, causing increased health risks to the already wounded.”

This is just the latest in a string of controversies for the 400-acre medical campus, which has also been criticized in recent years for failing to properly utilizing the property to combat homeless veterans issues and for wasting precious resources on questionable medical experiments on narcoleptic dogs.

Thus, when news recently broke that the facility had to cancel over 80 surgeries over a course of 22 days because it could not eradicate flies from its operating rooms, sadly, few were surprised. The issue surrounding flies and other unsanitary conditions at VA medical centers around the country adds a disturbing element to an already abysmalhistory of delayed care for veterans and further iterates the point that strong leadership is necessary to steer the Department away from disaster.

Last year, similar reports emerged from the Manchester VA medical center that an operating room had to be permanently closed because exterminators could not get rid of flies. And, just last week, photos emerged from the George E. Wahlen VA Medical Center in Salt Lake City showing an overflowing trash can, dirty sink, and haphazard countertops in a room where veteran Christopher Wilson was set to receive injections for a service-related injury.

The irony of the news in LA, as well as Salt Lake City and Manchester, is that, simultaneously, several employees of the RAND Corporation published a report in the Journal of General Internal Medicine concluding that “VA hospitals performed similarly or better than the non-VA systems on most of the nationally recognized measures of inpatient and outpatient care quality.” (It is of note that the same authors published essentially the same report in 2016).

This conclusion is problematic, because the RAND studies are based on VA’s self-reported quality statistics. For example, according to CBS News Los Angeles, fly traps at the West LA VA medical center have been present for two years, but the problem was not reported during standard quality checks at the facility during that time simply because VA chose not to do so.

The VA’s history of manipulating self-reported data is well-documented. For example, a 2017 VA OIG report found that the number of veterans required to wait for than 30-days for a medical appointment were “significantly higher than the wait time data that VHA’s electronic scheduling system showed. Among other consequences, the inaccurate wait time data resulted in a significant number of veterans not being eligible for treatment through Choice.”

Similarly, a 2015 GAO report concluded that “VA data reliability continues to be a high-risk area” due to VA’s “reliance on facilities’ self-reported data, which lack independent validation and are often inaccurate or incomplete.”

That finding was reiterated in a 2017 GAO report, which noted that limited progress was made in VA’s ability to report accurate data.

Further, VA self-rated its Manchester facility a “four-star veterans’ hospital” (out of five), despite flies in the operating room, blood or rust discovered on supposedly sterile surgical instruments and improper care causing needless complications described as only common “in third world countries.”

By contrast, non-VA hospitals are subject to more objective quality measures and performance standards, including certification by the Joint Commission. When the Joint Commission was engaged to evaluate the VAin 2016, infection prevention and control were immediately identified as the most common areas requiring improvement, specifically regarding cleaning and sterilizing surgical environments. As the recent stories in Los Angeles, Salt Lake City and Manchester reveal, these recommendations have clearly not been implemented.

Although staff at the West LA VA Medical Center stated that no veterans were harmed as a result of its fly-infested operating rooms, this may unfortunately be another self-reported and unverified statistic courtesy of the VA.

It seems rather simple, but as the debate over the future of veterans’ health-care rages on, allowing veterans the choice of going to a sanitary operating room free of insects seems like something we should all be able to agree on.

Rory E. Riley-Topping served as a litigation staff attorney for the National Veterans Legal Services Program (NVLSP), where she represented veterans and their survivors before the U.S. Court of Appeals for Veterans Claims. She also served as the staff director and counsel for the House Committee on Veterans’ Affairs, Subcommittee on Disability Assistance and Memorial Affairs for former Chairman Jeff Miller (R-Fla.). You can find her n Twitter: @RileyTopping.

http://thehill.com/opinion/healthcare/385985-fly-infestation-in-va-operating-rooms-another-example-of-chaos-within