David Collins earned a lifetime of medical care in the jungles of Vietnam 45 years ago. But back home, where he fought for his life earlier this year, the Army veteran feels the VA medical system let him down.
Sitting in his Springfield apartment, Collins pulled out a calendar that led with the words “The VA and You, 2013.” He had circled the days he was urinating blood and noted his many calls to the VA starting in September.
He then pulled out a 2014 calendar covered with photos of his two children and six grandchildren. He pointed to the date he finally got an ultrasound, in January, then the day a West Chester Twp. urologist rushed him into surgery to remove his cancer-ridden bladder and most of his prostate. That was in March.
The surgery left him with pain and bladder control problems. But the six months it took to diagnose and treat his cancer left him with more than that: “I’m having trouble trusting the VA, and they’ve been my sole medical provider,” he said. “They’re all I got.”
During a year when concerns about delayed care have plagued U.S. Department of Veterans Affairs hospitals nationwide, Collins was one of several veterans who contacted the I-Team to complain about a potentially deadly type of delay: the diagnosis and treatment of cancer.
Research has shown that the time between cancer diagnosis and treatment has increased across the U.S. medical field in recent years, with wait times at VA centers four times the average. And veterans are at an increased risk for certain types of cancer, including lung cancer and cancers linked to exposure to Agent Orange.
This means veterans battling cancer — to which delayed treatment is a deadly ally — are on the front lines of the VA’s fight to improve care and reduce delays.
A year of reforms
“We have a lot to be proud of when it comes to cancer diagnosis and treatment at the Dayton VA,” agency spokesman Ted Froats wrote in a statement.
“Our medical team has shown an outstanding dedication when it comes to diagnosing and treating cancer for our veterans,” he added. “Our inpatient wait times are under 24 hours, outpatient biopsies and lab results are within two weeks, and our partnerships with the local community allow us to ensure that every veteran is diagnosed and treated in a timely manner.”
Froats said the agency recently opened a new radiology clinic at its Middletown location and added a women’s clinic in Dayton that offers mammograms and cervical cancer screenings. And recent reforms will allow for further improvements in wait times with the hiring of more surgeons, physicians and clerical staff.
Federal lawmakers this year unleashed billions of dollars in new funding to make it easier for veterans to get care paid for outside the VA, to hire more VA doctors and nurses and to build new medical centers.
This followed a summer of scandal centered largely on how long veterans were waiting for care. In May, this newspaper reported that “delay in treatment” was the description in 167 malpractice death claims settled by the VA nationally since 2001, costing taxpayers $36.4 million.
There were at least two claims related to cancer diagnosis at the Dayton VA in recent years. A pending $3.5 million claim from March 2013 alleges delayed treatment of a woman’s cervical cancer led to her death in 2012. A denied 2009 claim alleged a man died after the VA failed to diagnose his lung cancer.
Internal reviews by the VA inspector general’s office were unable to verify claims that veterans were dying because of systematic scheduling issues. But they did find that VA employees either accidentally or intentionally misrecorded appointment schedules to make wait times look better than they were.
Reviews found potential scheduling issues at the Cincinnati VA and the Richmond (Ind.) Community Based Outpatient Clinic — which falls under the Dayton VA — but generally found wait times at VA medical centers here are better than the national average.
A study released in 2011 by researchers at Northwestern University looked at more than 1.2 million patients who underwent cancer surgery for eight different kinds of cancer at 1,443 hospitals from 1995 to 2005. It found the time from diagnosis to treatment increased across the board, but was significantly longer at VA hospitals versus community hospitals.
The median time from diagnosis to treatment at community hospitals was seven days, compared to 28 days at VA centers.
“In my mind, it’s not surprising,” said David Bentram, associate professor of surgery at Northwestern and one of the study’s authors.
He said the VA is similar in some ways to single-payer health systems used by countries such as Canada and the United Kingdom, where wait times for treatment tend to be longer. Bentram said these types of systems can improve wait times if they make it a priority.
“They’ve focused on improving care,” he said. “I think they just need to add this to the list.”
Bentram’s study didn’t conclude what caused the delay discrepancies, or whether they had any impact on survival rates.
“Timeliness for its own sake is part of high-quality healthcare,” he said.
Dayton VA officials say inpatients often get in for biopsies, colonoscopies and ultrasounds within 24 hours.
And they say outpatient wait times are “well within suggested guidelines.” Colonoscopies are conducted within 7.5 weeks, on average. Ultrasounds are within 30 days. Most biopsies are within 1 or 2 weeks.
“Research indicates wait times below 90 days have no significant impact on cancer survival rates,” Froats said.
Death after diagnosis
Navy veteran Larry Thompson’s headaches started after a semi-truck accident in March. As a self-employed truck driver, he didn’t have health insurance. His sister Pam Wells went with him to the Dayton VA medical center.
“They were throwing pills at him like no tomorrow,” she said.
By Father’s Day, in June, he told his sister he was experiencing blurred vision and memory problems. The next day, she took him to Miami Valley Hospital, where within four hours he was diagnosed with brain and lung cancer.
“She (the doctor) said you have four brain tumors. You have cancer of the lungs. That’s where it started and then it grew into the tumors,” Wells said. “He was very depressed, and then he got very bad. He just said, ‘Why couldn’t they have found this?’ ”
Thompson had brain surgery immediately, which removed a tumor the size of an orange, she said.
She showed medical records that said he received lung X-rays several times, most recently in January. The VA diagnosed him with thyroid problems and had a CT scan of his head scheduled in May in advance of thyroid surgery. But he stormed out of the hospital before the CT scan, she said, because he didn’t like how the nurses were treating him.
He died of a heart attack in August after undergoing a series of radiation treatments.
Sitting in her Bellbrook home, Wells was surrounded by a pile of medical bills totaling more than $200,000. The VA refuses to pay them. Wells said VA officials told her the problem was he didn’t show up for his appointments.
She produced a photo of her brother in his Cracker Jack Navy uniform. He served on the USS Kearsarge aircraft carrier in the late 1960s. Another photo showed his Honor Flight trip this year to see the Vietnam Veterans Memorial in Washington.
“I feel like the United States government has let him down,” Wells said. “He gave his service to us and our service to him is crappy treatment and just negligence.”
Choosing private sector
Several veterans interviewed for this story said they felt like they had to go outside the VA system to get timely treatment.
Larry Williams, a 78-year-old Army veteran who lives in Huber Heights, said his VA doctor told him early last year that his six-month prostate checkup was worrisome.
“He said it might be cancer,” Williams said. “He checked the schedule … and said the bad news is I can’t get you an appointment (with an oncologist) for two months.”
Williams said he couldn’t wait — “the word cancer scares everybody automatically” — so he went to Good Samaritan Hospital and got in within a week. He was diagnosed with prostate cancer and underwent nine weeks of radiation that beat the cancer into remission.
Timothy Hammond had a similar story. He said he had a history of digestive problems and asked for a colonoscopy at every six-month VA checkup for two years, but it was never scheduled. He finally went to a digestive center in Huber Heights last year and got in within a week. Six polyps were discovered; four were precancerous.
“If they (the VA) need help they should’ve asked for it,” he said. “If they knew they didn’t have the manpower or whatever, they should have told me.”
‘A death sentence’
Dayton malpractice attorney Stephen O’Keefe is representing a Marine Corps veteran from Englewood who went to the VA last March with a black line under his fingernail. After it was misdiagnosed as a fungal infection for more than a year, the veteran went to a doctor at Good Samaritan Hospital who diagnosed it as skin cancer.
The veteran underwent several surgeries and currently is injecting himself with chemotherapy three times a week as he battles aggressive melanoma. His doctor confirmed the details of his diagnosis.
“It could’ve been cured, but now they’ve given me a death sentence,” he said, giving his name only as Bill.
He said he’s filing an administrative claim against the VA for his family.
“They need to pay for what they’ve done to me. And if I’m dying, which I am … they need to take care of my family,” he said. “All of the things I had planned in the future, with my wife, my kids, my grandkids, they need to take care of that now because I can’t.”
He is confident that veterans would get better care if it were easier for them to take their VA benefits to community hospitals instead of trying to keep all of their treatment at the VA.
VA officials say they treat roughly 300 veterans with cancer each year. This number has stayed steady for the past five years. Patients are referred to outside doctors if they can’t get VA appointments fast enough or if they need specialty care the VA doesn’t provide.
“We are able to treat the vast majority of cancers at our facility,” Froats said.
‘A timely manner’
Attorney Max Kinman of Mason represents veterans making claims against the VA, including Collins.
“I think it’s a very strong claim in terms of delay of care,” he said of Collins’ case.
Kinman said it appears to him that the VA excels at treating combat wounds and soldiers returning from Iraq and Afghanistan. But it falls short on lifestyle and aging issues faced by veterans from earlier wars.
“Those are the guys that are often ignored,” he said.
Collins said the Dayton VA looked into his case. His voice rose as he recalled the phone call he received from a patient advocate.
“She said my treatment in that period had been acted on … in a timely manner,” he said. “I’m not (suing the VA) for the money, I’m doing it to wake them up.”
Collins produced a hand-written note from his private-sector urologist that said he should’ve had an ultrasound within two days of when he started passing blood, and should’ve had surgery within a week of finding the mass.
“All the (VA) doctors said they can’t prove my condition got worse (because of the delay), but being Grade 3 carcinoma, it damn sure didn’t get any better,” he said.
A 2012 report by the VA Office of Inspector General noted delayed treatment of a veteran’s skin cancer at the Louis Stokes VA Medical Center in Cleveland.
The report said the veteran, who had a history of skin cancer, went to the VA with a 1-centimeter lesion behind his ear in August 2011. He received a biopsy in 19 days, then it took another 56 days to get in to the dermatology clinic. By the time his surgery was scheduled in January 2012, the lesion had grown to 4 centimeters.
Inspectors noted the delay, but said “we did not substantiate that the delay affected the patient’s prognosis or necessitated more extensive surgical treatment and follow-up.”
Elizabeth Koelker, head of oncology at Kettering Health Network, would not comment on the VA’s practices but said her network believes “early detection is the best medicine.”
She said Stage 1 colon cancer, for example, has a 74 percent survival rate. But if it progresses to Stage 4, the survival rate drops to 6 percent.
KHN has nine oncologists and three radiation oncologists, she said. And once there is an indication of cancer “we can typically see them within a few days.”
“We understand that from the point of potential diagnosis, there’s a lot of fear and anxiety with patients wondering what’s next,” she said. “We have the best opportunity to impact out patients … when we can capture their diagnosis early.”
Froats said the preliminary findings of a current internal study show the Dayton VA “compared favorably” with non-VA area hospitals in its treatment of lung cancer. The VA is planning additional studies on other types of cancer.
“For the volume of people they handle it’s amazing to me they’re not backlogged more than they are,” said Denny Brown, a Navy veteran in Logan County who credits the VA with saving his life with chemotherapy and cancer surgeries in 2011.
“I’m cancer-free,” he said.
And while a delay caused suffering and complications for Collins, the VA referred him to a urologist in West Chester. After his last appointment with that doctor, he came home to his one-bedroom efficiency and sank into the armchair in his living room. He wore a T-shirt that said “American Strong” on it.
The phone rang. It was his ex-wife asking if he wanted to go to a Christmas show put on by his 11-year-old granddaughter and her classmates. He said he was too tired, then pepped up as he told her the prognosis he just received.
“I got good news,” he told her. “I don’t have to go through any more chemo or radiation.”
His cancer is in remission, he said. The battle isn’t over, but he hopes the worst is behind him.
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