Tuesday, August 17, 2010

Veterans Medical Followups Delayed at Portland VA Medical Center , VAOIG Report

Veterans Health Administration Review of Alleged Use of Unauthorized Wait Lists at the Portland VA Medical Center

Report Number 10-01857-225, 8/17/2010
Summary

This review determined the validity of an allegation that senior officials in Veterans Integrated Service Network 20 (VISN) instructed employees at the Portland VA Medical Center to use unauthorized wait lists to hide access and scheduling problems.

Although we did not substantiate the allegation, we did find that the Portland VA Medical Center’s automated recall system failed to generate and distribute postcards to over 2,900 patients that remind them to call the medical center and schedule their follow-up eye appointments. This resulted in an average delay in care of 128 days. To address this issue, Portland VA Medical Center staff stated that in September 2009, they revised the reminder postcards to enable the recall system to print the postcards and started monitoring transmission reports to ensure the recall system mailed the postcards.

We recommended that the VISN Director ensure that the Portland VA Medical Center Director reexamine the list of patients that did not receive a reminder postcard and ensure each patient was contacted to remind them to schedule their follow-up care. The VISN Director and Portland VA Medical Center Director agreed with our findings and recommendations and stated they have scheduled or seen all patients that did not receive a reminder postcard.

Grant Issued to Study Prescription Opiod Use Among Veterans

Well it sure appears that the VA is attempting to get ahead of the curve on this issue.
The use of the word abuse here seems to imply a willful act on the veterans part, thereby that veteran would not be eligible for compensation, see study prescription drug abuse among Iraq and Afghanistan war veterans

New VA-opioid-prescribing guidelines will be released this year.

Full Article at: UAMS to study prescription drug abuse by war veterans
Posted on 16 August 2010

Arkansas News Bureau

LITTLE ROCK — The University of Arkansas for Medical Sciences will use money from a $288,714 federal grant to study prescription drug abuse among Iraq and Afghanistan war veterans, officials announced today.

Researchers at UAMS and Central Arkansas Veterans Health Care System will study six years of data from the U.S. Department of Veterans Affairs.

The study will evaluate the effectiveness of VA policies on prescribing painkillers known as opioids, said UAMS assistant professor Teresa Hudson. New VA-opioid-prescribing guidelines will be released this year.

More than half the tens of thousands of veterans diagnosed with pain could receive treatment that would involve opioid painkillers."

Physicians at "Sonny" Montgomery VA Medical Center Call for Director's Resignation

Full Article at: VA doctors want boss out, 'Shouldn't be director,' union leader says

Jerry Mitchell

A group of physicians working at the G.V. "Sonny" Montgomery VA Medical Center in Jackson is calling for the resignation of Medical Director Linda Watson and questioning her competence.

"It's fair to say physicians are pretty much outdone with the director and the leadership here," said Joseph Simon, president of the National Federation of Federal Employees, Local 589, representing VA physicians that serve in non-supervisory positions. "She shouldn't be director of the hospital."

"The call for Watson's resignation comes after a U.S. District Court jury last week awarded retroactive pay raises to three radiologists who had complained of a hostile work environment at the Jackson VA. The jury did not award any other damages.

The radiologists - Brighid McIntire, Linda Finnegan and Margaret Hatten - had sued alleging they were discriminated against and were judged by the quantity of their work rather than the quality of their work.

"We claimed, and the jury believed, their pay was tied into productivity," said their attorney, Dennis Horn.

"The radiologists testified that two years later they discovered 52 cases of failure to diagnose significant disease that had been missed in analyzing tests."

"Simon and another Local 589 leader sent a July 10 letter to Eric Shinseki, secretary of the U.S. Department of Veteran Affairs, on behalf of the physicians they represent, saying, "Physician trust in our current facility leadership's character and competence is now beyond repair. Our leadership has created a culture of privilege and intimidation. Medical providers are viewed as objects to be manipulated to achieve performance targets by any means necessary."

Athlete's Head Injuries Linked to ALS

Full Article at: Report: Scientists link ALS, athlete head injuries
"Dr. Ann McKee said in an interview with the television magazine show that she found toxic proteins in the spinal cords of three athletes who had suffered head injuries and then later died of Lou Gehrig's disease, or ALS. Those same proteins have been found in the brains of athletes with chronic traumatic encephalopathy (CTE), a disease linked to head injuries that causes cognitive decline, abnormal behavior and dementia."

The findings are to be published in the Journal of Neuropathology and Experimental Neurology, Abstract Abstractpubmed, see below.

"McKee, a neurology professor at Boston University who has studied CTE in athletes, noticed that an unusually high number of football players seemed to be affected by ALS. The disease attacks nerve cells in the brain and spinal cord, and destroys the ability to move and speak.?

Abstractpubmed
J Neuropathol Exp Neurol. 2009 Jul;68(7):709-35.
Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury.

McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte ET, Gavett BE, Budson AE, Santini VE, Lee HS, Kubilus CA, Stern RA.

Department of Neurology, Center for the Study of Traumatic Encephalopathy, Boston University School of Medicine, Boston, MA, USA. amckee@bu.edu
Abstract

Since the 1920s, it has been known that the repetitive brain trauma associated with boxing may produce a progressive neurological deterioration, originally termed dementia pugilistica, and more recently, chronic traumatic encephalopathy (CTE). We review 48 cases of neuropathologically verified CTE recorded in the literature and document the detailed findings of CTE in 3 profession althletes, 1 football player and 2 boxers. Clinically, CTE is associated with memory disturbances, behavioral and personality changes, parkinsonism, and speech and gait abnormalities. Neuropathologically, CTE is characterized by atrophy of the cerebral hemispheres, medial temporal lobe, thalamus, mammillary bodies, and brainstem, with ventricular dilatation and a fenestrated cavum septum pellucidum. Microscopically, there are extensive tau-immunoreactive neurofibrillary tangles, astrocytic tangles, and spindle-shaped and threadlike neurites throughout the brain. The neurofibrillary degeneration of CTE is distinguished from other tauopathies by preferential involvement of the superficial cortical layers, irregular patchy distribution in the frontal and temporal cortices, propensity for sulcal depths, prominent perivascular, periventricular, and subpial distribution, and marked accumulation of tau-immunoreactive astrocytes. Deposition of beta-amyloid, most commonly as diffuse plaques, occurs in fewer than half the cases. Chronic traumatic encephalopathy is a neuropathologically distinct slowly progressive tauopathy with a clear environmental etiology.