Survey rips VA nurses

Medical students say Dallas hospital staff incompetent; chief says problems are 'isolated'

10:20 PM CST on Monday, January 24, 2005
By DOUG J. SWANSON / The Dallas Morning News
http://www.dallasnews.com/s/dws/dn/latestnews/stories/012505dnmetbadcare.3d395.html  (must register to view original article)


Medical students at the Dallas veterans hospital, which was recently ranked the worst in the nation, say its patients have been neglected, abused and sometimes left alone to die by incompetent and uncaring nurses.

"I would hate to be a patient under the care of any of the nurses at this institution," one student wrote in response to an annual survey by the U.S. Department of Veterans Affairs.

Another characterized the quality of nursing at the Dallas medical center as "reprehensible," adding: "Patients are sometimes left to survive on their own without appropriate care."

The hospital's chief of nursing said in response Monday that only a "few people" on her 850-member staff performed so poorly.

"We have some isolated problems," said Burlean Huff. "I believe this is not systemic."

Most of the comments came from University of Texas Southwestern Medical School students and residents who trained last year at the Dallas VA hospital. They described observing firsthand a hospital in which some nurses and support staff members show little interest in caring for patients, even those in critical need of attention.

"It's sad to see how our veterans are treated," one wrote.

Gail Bentley, the hospital's associate chief of staff for education, said management had not been aware of the concerns until receiving results of the survey last month.

"We were shocked," she said Monday, adding that officials are developing a "written plan of action."

She added: "We don't think this represents the care we give, but it's a perception. So we have to respond to the perception."

The Dallas Morning News reported last week that the Veterans Affairs inspector general ranked the Dallas hospital as the worst veterans medical center in the country.

Hospital officials insisted then that they had eliminated problems with sanitation and patient care cited in the inspector general's report. They also played down the severity of that report's findings.

"At no time were patients in any danger or receiving care that was substandard," said Thomas Stranova, regional director for veterans health care.

But the remarks of medical students, released to the Dallas hospital's nursing staff late last week, tell a different story.

"Many times I have had patients urgently sick and 'crumping' [about to die], and nurses will not care and say, 'I'm busy, do it yourself' when you ask them for help," one student wrote. "Overall, the nursing staff and ancillary staff are pitifully poor and extremely below the quality of a regular hospital. PLEASE CLEAN THIS PLACE UP!!!"

Another student told of critically ill veterans abandoned until dead.

The Dallas VA hospital, the student said, is a place "where nurses do not evaluate their patient during a whole shift and then call a CODE when the patient is already 'stiff,' stating that 'they had just been out of the room.' "

To call a code means the patient has suffered cardiac or respiratory arrest.

Nursing chief Huff said that because such remarks were anonymous and not dated, she could not confirm the accuracy of the accounts.

"I would be hard-pressed to believe this ... is true," she said. "Some of these comments, I would have thought that had it happened, we would have heard about them."

The survey, covering numerous aspects of medical training, was conducted by the national veterans Office of Academic Affiliations. It does so each year, via e-mail, with students at veterans hospitals.

From the Dallas medical center, 162 students participated in the survey in April and May. Their responses were sent to Dallas hospital officials in December.

Last week, nursing chief Huff passed the written comments regarding nursing care to her staff in an eight-page memorandum. The comments on nursing came from several dozen medical students and residents, she said.

An employee of the Dallas VA sent a copy of her memo to the News, which authenticated the document with hospital officials.

Other medical student observations included:

"Medications were not given when requested. Blood draws were often not made."

"Ward nurses in general were extremely lazy. ... If you asked for a wound dressing changed, you were more likely to have the nurse give you their house and first-born child rather than do this task."

"I had times when I was completely appalled at the laziness and disregard for patient care evident in more than a few nursing employees. On more than one occasion, patients threatened to leave the hospital AMA [against medical advice] due to the rudeness of the nurse or blatant neglect."

"There are some great nursing staff, but many would never make it in an outside facility from what I can discern."

"I have encouraged members of my family who were in the armed forces to make sure that they have insurance so that they will not have to use the VA system."

"The nursing care is horrible, orders were not carried out even though they were in the system, patients were very often left in dirty diapers over night, and nurses often complained about having to do their jobs."

"Some [nurses] are excellent, some are scary incompetent and I worried about my patients when I left the hospital."

Nursing chief Huff said that she is proud of her staff, that many of them have won awards and that her 88-year-old father has received excellent care at the Dallas hospital. "I felt comfortable leaving my father in the care of these nurses," she said.

The Dallas medical center recorded 13,499 admissions last year, with an average daily patient census of 670.

Located in Oak Cliff, it serves veterans in 38 counties in Texas and two Oklahoma counties.

E-mail dswanson@dallasnews.com