Tuesday, July 25, 2017



Trump and civil rights

A prominent family member of the late Dr. Martin Luther King, Jr. is defending President Donald Trump from attacks by Congressman John Lewis (D-GA.)



“We have come a distance. We made progress. But there are forces in America trying to slow us down or take us back,” Lewis said Friday on low-rated CNN. “I think the person we have in Washington today is uncaring,” Lewis said, adding that he believes Trump “knows very, very little about the history and the struggle of the Civil Rights Movement.”

That drew a sharp response from Dr. Alveda King, pro-life civil activist and niece of Martin Luther King.

King says Trump is “leading the charge for civil rights today for the little unborn persons in the womb who have a right to live.”

“He has surrounded himself with African-American leaders,” King said. “At the African-American museum, for example, he was knowledgeable of much of the history of African-Americans.”

Lewis also believes the 2016 election was rigged with secret computers, and that Trump is not really the President.

“I truly believe to this day that this election was rigged in his favor,” Lewis told low-rated CNN.

SOURCE

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Disgraceful V.A. hospital in Manchester, N.H.

The Trump team has made a start on sorting out the V.A. but they have decades of rot to correct

This is what the US Department of Veterans Affairs says a four-star hospital looks like:

One operating room has been abandoned since last October because exterminators couldn’t get rid of the flies. Doctors had to cancel surgeries in another OR last month after they discovered what appeared to be rust or blood on two sets of surgical instruments that were supposedly sterile.

Thousands of patients, including some with life-threatening conditions, struggle to get any care at all because the program for setting up appointments with outside specialists has broken down. One man still hadn’t gotten an appointment to see an oncologist this spring, more than four weeks after a diagnosis of lung cancer, according to a hospital document obtained by the Globe.

And when patients from the Manchester Veterans Affairs Medical Center are referred to outside specialists, those physicians are sometimes dismayed by their condition and medical history. A Boston neurosurgeon lamented that several Manchester patients sent to him had suffered needless spinal damage, including paralysis, because the hospital had not provided proper care for a treatable spine condition called cervical myelopathy.

“Only in 3rd World countries is it common to see patients end up as disabled from myelopathy as the ones who have been showing up after referral from you,” wrote Dr. Chima Ohaegbulam , of New England Baptist Hospital, to a doctor at the Manchester VA in 2014.

But this hospital, the only one for military veterans in New Hampshire, is just 50 miles from Boston. And it’s supposedly one of the better VA hospitals in the country. Late last year, in fact, the veterans affairs department raised Manchester’s quality rating from three stars to four, putting it in the top third of the entire VA system.

Ratings can deceive. Inside the unassuming red-brick walls of the Manchester medical center is ground zero for an extraordinary rebellion led by doctors who say they have almost no say in how the hospital is run, lack tools to do their jobs, and witness chronic shortcomings in patient care. They say the four top administrators, only one of them a doctor, seem more concerned with performance ratings than in properly treating the roughly 25,000 veterans who go to Manchester for outpatient care and day surgery each year.

So far, 11 physicians and medical employees — including the hospital’s retiring chief of medicine, former chief of surgery, and former chief of radiology — have contacted a federal whistle-blower agency and the Globe Spotlight Team to say the Manchester VA is endangering patients. The US Office of the Special Counsel, the whistle-blower agency, has already found a “substantial likelihood” of legal violations, gross mismanagement, abuse of authority, and a danger to public health, according to a January letter to one of the doctors who alleged wrongdoing.

“I have never seen a hospital run this poorly — every day it gets worse and worse,” said Dr. Stewart Levenson, chief of medicine, an 18-year veteran of the hospital who is among the whistle-blowers. “I never thought I would be exposing the system like this. But I went through the system and got nowhere.”

On Thursday night, a spokesman for Veterans Affairs Secretary David J. Shulkin expressed concerns about the problems relayed by the Spotlight Team.

“These are serious allegations, and while we cannot comment on the specifics due to patient privacy issues, rest assured that we will look into them right away,” said the VA press secretary in Washington, D.C., Curt Cashour.

Remarkably, leaders of the Manchester VA have confirmed many of the problems, from the fly-infested operating room — “an episodic issue,” said one administrator — to thousands of patients waiting indefinitely for specialist care, which the leaders blamed on the private company hired by the federal government to set up veterans’ appointments outside the hospital.

In a recent hourlong interview with the Globe, hospital director Danielle Ocker and her chief of staff, Dr. James Schlosser, also acknowledged significant cuts in services, such as the elimination of cataract surgery, as well as administrative glitches that further limited care.

For example: The hospital ordered a $1 million nuclear medicine camera in 2015 to replace a balky one, but never installed it because it was too big for the examination room. Without a reliable camera, the hospital in February stopped offering nuclear stress tests for heart disease risk, and bone scans that can detect tumors. The building is expected to be remodeled for a new camera in 2018.

But Ocker and Schlosser expressed surprise that so many members of the medical staff have reported the hospital’s problems to federal investigators. They said the hospital is addressing shortcomings and that patient safety has not been compromised. Ocker, a nurse, contended that Manchester boasts “a zero infection rate” in the operating rooms — a hospital spokeswoman said the unblemished record dates back to 2011 — and shared a veteran’s recent letter praising Manchester VA care.

Ocker also said she wanted medical staff to know that she and other leaders take their concerns seriously.

“My feeling is that if there are issues that we need to address, or if there are concerns, that we need to hear about them,” she said.

In many ways, the Manchester VA is under investigation because doctors became convinced that Ocker and other leaders were not listening. A number of problems date back years before Ocker arrived in 2015, and often reflected lapses in care that occurred when Manchester referred veterans to other VA hospitals or when multiple hospitals failed to coordinate follow-up treatment. But they are coming to the forefront now, in large measure, because one outspoken doctor went public about many patients that he believed had gotten subpar care. Patients like Robert McWhinnie.

McWhinnie, a Korean War veteran who lives in the small New Hampshire town of Gilmanton, relied mainly on a wheelchair to get around when he first visited Dr. William “Ed” Kois, head of Manchester VA’s spinal cord clinic, in July 2016. McWhinnie, who was 84 at the time, had long been a vigorous man who built much of the furniture in his house from maple trees on his land. But then his legs and arms grew weak, he had difficulty talking, and he became incontinent.

Kois immediately got alarmed when reading McWhinnie’s medical records.

They showed that the retired telephone cable splicer had undergone two surgeries at the VA hospital in Jamaica Plain to remove a tumor from his spine in 1995 but that the surgeon could not remove all of it, according to a copy of the records that his family shared with the Globe.

Over the next 21 years, McWhinnie went to the Manchester VA dozens of times for treatment of a variety of ailments. But no one had done imaging to find out if the tumor was growing again, even though regular monitoring was the standard of care after surgery on this type of tumor, according to his lawyer, Mark Abramson.

At least as far back as 2007, McWhinnie was gradually losing the ability to walk, the records indicate, something that could have been caused by a tumor pressing on his spine.

Kois “took one look at Bob, and he said, ‘Oh, my God, this is a disgrace. This man should have been taken care of,’ ” recalled McWhinnie’s wife of 63 years, Janice McWhinnie.

So Kois ordered an MRI and an X-ray and, sure enough, the tumor was choking McWhinnie’s upper, or cervical, spine. It had also grown too big to remove.

“They ignored him basically for 20 years and allowed this thing to grow and grow and grow,” said Abramson, who recently wrote the VA in Manchester and in Boston that his client intends to sue for negligence.

Hospital officials declined to comment, citing potential litigation.

For Kois, McWhinnie’s condition was sickeningly familiar. In his five years at the VA, Kois has compiled a list of at least 80 Manchester patients who were suffering from advanced and potentially crippling nerve compression in the neck, or myelopathy. Some, like McWhinnie, had undergone surgery at other VA hospitals and then relied on Manchester for subsequent care.

Kois said he complained about the situation to administrators and other doctors. He even organized a September 2015 conference at Manchester, where he told a roomful of doctors and other VA staff that patients were getting substandard spinal care.

Ocker herself gave introductory remarks at the conference. Yet, in the interview with the Globe, she said she only became aware of Kois’s concerns more than a year later when she heard that they were part of the federal investigation. She said she left Kois’s conference after welcoming guests and was never briefed on the content of his presentation.

“I did not hear that,” she said of Kois’s allegations.

Kois found a far more receptive audience the following year at the federal Office of the Special Counsel, which made his contentions about poor care a central part of its inquiry. After finding a “substantial likelihood” of wrongdoing, the office recommended a full-fledged investigation by the Veterans Affairs Office of Medical Inspector, which began in January.

The VA medical care system, which is used by about 6 million military veterans each year, has been stumbling since 2014. News stories reported that the Phoenix VA Health Care System had engaged in an elaborate scheme to hide the fact that sick veterans were waiting months to see a doctor, and that some had died before they could be seen.

As similar allegations surfaced at other VA hospitals and tens of thousands of veterans around the country were found to be waiting months for care, Veterans Affairs Secretary Eric K. Shinseki resigned.

“I can’t explain the lack of integrity among some of the leaders of our health care facilities,” he said, shortly before stepping down.

But Shinseki’s departure did not stop the drumbeat of scandal. Last year, nearly three dozen whistle-blowers charged that the VA hospital in Cincinnati had made budget cuts that forced out experienced surgeons, reduced access to care, and endangered patients’ safety. The head of the VA’s Ohio-based regional network then retired, and the Cincinnati hospital’s chief of staff was suspended and later indicted on criminal charges.

Now President Trump’s appointee as VA secretary, Shulkin, is vowing to stabilize the health care system. “We are still in critical condition and require intensive care,” Shulkin said at a May press briefing. Last month, Trump signed a bill into law to make it easier for whistle-blowers to come forward and for employees to be fired for misconduct.

SOURCE

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1 comment:

Paul Weber said...

Anyone who thinks the VA can be fixed needs to ask themselves this question - How long was the neglect going on to get this bad? Seriously, how long?