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sabra Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 03:17 PM
Original message
VA nurse fails to visit patients, lists dead patient as 'stable'

http://www.wcnc.com/sharedcontent/APStories/stories/D8NSPQI00.html

VA nurse fails to visit patients, lists dead patient as 'stable'
Associated Press

A nurse responsible for monitoring care of frail military veterans didn't visit patients as required for two years and filed one report that listed a dead patient in stable condition, according to a federal inspection obtained by The Charlotte Observer.

Inspectors reviewed records last year of 10 seriously ill veterans at Hefner VA Medical Center who were housed in private nursing homes, five of which "did not meet the minimum threshold standards for quality of care," according to a report issued in September by the VA Office of Inspector General.

The VA nurse was supposed to visit patients at least quarterly, but she failed to do so for more than two years and visited only on "rare occasions" when requested. Inspectors found some veterans had suffered "significant weight loss," though the nurse's notes listed all patients as stable — including one man who had died 12 days earlier, the report said.

The nurse, who wasn't named in the report, is still employed by the hospital but is no longer responsible for nursing home visits, Hefner VA Medical Center spokeswoman Carol Waters said in an e-mail Wednesday to the newspaper.

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ThomCat Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 03:20 PM
Response to Original message
1. One more sign of a broken, overextended system.
x(

How much do any of you want to bet that the Nurse was expected to fit those visits into a schedule that already required more than 40 hours per week?
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slackmaster Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 03:20 PM
Response to Original message
2. Why the fuck is she still employed?
Is it that hard to terminate a government employee?
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lakeguy Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 07:55 PM
Response to Reply #2
15. was this a gov. employee or one of the contractors
from a subsidiary of halliburton?
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maddezmom Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 03:23 PM
Response to Original message
3. soundls like FDCF in with children in state care
:mad:
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tk2kewl Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 03:24 PM
Response to Original message
4. In her defense...
Once your dead, I assume your vital signs remain pretty stable.
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Dancing_Dave Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 05:22 PM
Response to Reply #4
5. Yeah, dead is about as stable as you can get.
And Bushco has brought us plenty of that kind of "stability".
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saigon68 Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 08:06 PM
Response to Reply #5
16. The Vet didn't pass the cold mirror test
You know the one where you are hired, if the miror fogs up, after being slapped on your nose.
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uppityperson Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 05:28 PM
Response to Reply #4
7. Technically yes, he was very stable but the nurse needs to lose license
Disciplinary action against the nurse and the supervisors also. Appalling.
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rainbow4321 Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 05:26 PM
Response to Original message
6. WTF?? Why was she not turned into the state's Board of Nursing?
She has no business still being allowed to continue nursing!
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uppityperson Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 05:30 PM
Response to Reply #6
8. "It was poor charting" from article. Give me a break, "poor charting"??????
"It was poor charting. It wasn't as bad as it seems, though I know that sounds crazy," he said. "The feedback on her was very positive. We had over 1,700 employees, and somebody will drop the ball."

(cut)
The Department of Veterans Affairs contracts with private nursing homes when its hospitals are full or cannot provide specialized long-term care needed by some veterans.

"The nurse wasn't doing what she was supposed to be doing, clearly, but she was having the nurses at the nursing home send her information," Christa Sisterhen, associate director at the VA office that did the investigation, said Wednesday.

A separate investigation in 2005 found a history of neglectful care at the hospital, according to a report by the Office of the Medical Inspector. That report determined doctors and nurses had cut corners on treatment, manipulated records, and didn't talk enough with patients and families. Investigators also determined two veterans who died at the hospital had received inadequate care.

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lumberjack_jeff Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 07:11 PM
Response to Reply #8
11. Yup, poor charting. The checkbox for "dead" is right next to the one for "stable"
it's an honest mistake.

:sarcasm:
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rainbow4321 Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-16-07 08:09 AM
Response to Reply #8
22. "Sounds crazy"..
Edited on Fri Mar-16-07 08:09 AM by rainbow4321
F'n idiot...a first semester nursing student can tell this guy rule number one in nursing charting: if it was not charted, it was NOT DONE in the eyes of the courts when it comes to nursing. Nurses get fired/sued/become EX nurses in a heartbeat over their documentation or LACK of it. You don't get a chance to say "well, what I MEANT to chart was...".
"Drop the ball"...OK, wonder how this guy would feel if this particular nurse dropped the ball with one of HIS family members..like my daughter told me one time when I was talking about some incompetant co-worker (nurses) of mine: "Messing up at MY workplace means putting too much butter or salt on our customers' popcorn, messing up at YOUR work and somebody could DIE".
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uppityperson Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-16-07 08:38 PM
Response to Reply #22
26. And you don't chart that someone is alive without checking first.
Especially don't chart that you checked if you didn't.
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Ezlivin Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 05:43 PM
Response to Original message
9. If you get admitted to the VA you'd best have a friend/loved one to watch over you
When I was admitted to Tripler Army Medical Center with a broken back, the place was, let me put this charitably, behind the times (this was 1980). The beds were hand-cranked, there were no televisions in the room and the colors were very drab. My wife would drag my bed over to the sink, then slip me over to the side so she could wash my hair every few days. I still had blood caked on my head and in my hair after I came out of the ICU. She also cooked meals so that I wouldn't have to eat the "food" they served. She was my angel!

I feel sorry for any veteran who uses the VA without having a loved one to watch their back. It's not so much indifference as it is a simple matter of proper staffing levels. And privatizing is an even greater problem, as the article illustrates.



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kiteinthewind Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 07:38 PM
Response to Reply #9
13. That should be the rule for any hospital, quite honestly, and I am a nurse
I always stay at the hospital anytime anyone from my family has to be admitted. In this case, she should lose her license, absolutely, but most hospitals, at least the ones around here, have such a horrendous nurse/patient ratio that you really do need to be that vigilent. It's kinda scary.
:-(
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Chovexani Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 07:11 PM
Response to Original message
10. The VA Hospital system has suffered horribly under ChimpCo
My mom was a VA nurse for 30 years, and is still part of the community (she's a dialysis nurse, and it tends to foster a lot more closer relationships among staff and patients). Funding has been slashed left and right, and last I heard they were talking about shutting down her hospital entirely--leaving the Manhattan VA as the only VA facility in the New York area. She was in charge of the home hemodialysis program and it's been all but eliminated in the years since she retired. There just isn't money.

I am willing to give this nurse the benefit of the doubt, if only because I've grown up around VA nurses and been around them my whole life. You won't find a more caring and dedicated group of health care workers. The problem is they simply don't have the resources; there is a terrible shortage of nurses in this country to begin with and the VA is suffering even more because of the budget cuts on top of it.

Are there bad apples? Certainly. But I think the VA itself is to blame here, and not the nurses. Most of them are doing the best they can with the resources they have.
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SnowGoose Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 07:48 PM
Response to Reply #10
14. I'm with you, Chovexani
A lot of people are letting their (understandable) outrage obscure the reality that we don't know all the facts.

Half my family's in nursing and my wife's a physician (an intern who has had to do rotations at the local VA). And after all I've seen, I wouldn't be inclined to jump at blaming the nurse (without knowing the whole story).

There are bad apples, as you say, and I wouldn't want to forget that.

However, the system itself is deeply flawed, and a knee-jerk reaction is just as likely to kick the wrong party as the right one. Things can get awfully fuzzy awfully fast in a big, bureaucratic hospital.
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Ilsa Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 07:38 PM
Response to Original message
12. And why is she the only to be checking on them? Don't they
have other nurses making these rounds to other nurses' patients to verify the quality of their work or make recommendations for patients?

She should lose her license for lying about visitations, lying on the charts, etc.
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VegasWolf Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 08:08 PM
Response to Original message
17. If they die here in a VA hospital they can't be counted as an OIL WAR death. nt
Edited on Thu Mar-15-07 08:46 PM by VegasWolf
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Miss Chybil Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Mar-15-07 10:14 PM
Response to Original message
18. Take her license! nt
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OneBlueSky Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-16-07 02:57 AM
Response to Original message
19. she was supposed to visit them quarterly??? . . . that hardly seems adequate . . .
to monitor the needs of these veterans . . . in fact, it borders on criminal neglect . . .

of course, she didn't even make those visits, so whatever the requirements were is moot . . .
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The Flaming Red Head Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-16-07 07:28 AM
Response to Original message
20. What does this say about the private nursing homes?
I think the nursing homes ought to be held accountable as much as the nurse. They shouldn’t even have to have some one check to make sure they are providing adequate care, as much as they cost, they should be already be giving acceptable levels of care to all their patients.
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AngryAmish Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-16-07 07:37 AM
Response to Original message
21. What if he was just pinin'?
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yellowcanine Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-16-07 09:18 AM
Response to Original message
23. This is really bad of me but the Monty Python parrot skit comes to mind....
"'e's not dead, 'e's just resting. Wonderful plumage!"
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foo_bar Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-16-07 11:41 PM
Response to Reply #23
28. "Not at all. See you on Thursday!"
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rocktivity Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-16-07 10:11 AM
Response to Original message
24. In all fairness to the nurse
Dead patients are as "stable" as they can get.

:evilgrin:
rocknation
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Le Taz Hot Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-16-07 10:22 AM
Response to Original message
25. While there is no excuse for her actions, can I just say
that I know several VA nurses and they are good, caring, professional people who regularly go WAY above and beyond the call of duty. We need to remember that.
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politicat Donating Member (1000+ posts) Send PM | Profile | Ignore Fri Mar-16-07 11:15 PM
Response to Original message
27. Another symptom of the VA's financial woes, sadly.
Denver VA Hospital has been on a hiring freeze for four years, even though the client load has tripled -- Denver is THE orthopedic center for Montana, Idaho, Utah, Wyoming, the western side of North and South Dakota, New Mexico, Nebraska and Kansas. That's a LOT of people, and a lot of returning vets.

I've watched a friend who is a phlebotomist for VA here work 60 and 80 hour weeks (and she's on salary) because they can't hire. I've seen another friend who is a volunteer phlebotomist there (volunteer because it's nearly impossible to get hired without serious volunteer hours) work her 40 hour a week job and then spend another 40 at VA. VA wants to hire her, but hiring freezes are what they are.

So if she wasn't doing the traveling, I'm not surprised. VA doesn't actually pay for that kind of thing (they don't pay mileage) and if she had a client load as high as some I've seen, her chances of getting to each nursing home is pretty slim.

It's not a case of one bad apple... it's a case of a rotten system.
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