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Apology not enough after a death at VA

By William R. Levesque, Times Staff Writer
In print: Friday, August 8, 2008

Mary Nicholl, 63, holds pictures memorializing Richard Stecher, 64, in their back yard in Tarpon Springs, which she said was his favorite spot for relaxing. Stecher died in VA care June 30, and Nicholl blames Haley VA Medical Center for his death.
	[DOUGLAS R. CLIFFORD | Times]

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TAMPA — The chief of staff at the nation's busiest veterans' hospital met last month with a woman whose longtime companion died at the facility. Then Dr. Edward Cutolo did something she found extraordinary.

He apologized.

Richard Stecher, 64, of Tarpon Springs died June 30 at the James A. Haley VA Medical Center after several "missed opportunities" to treat him, Haley documents show.

Stecher, a Coast Guard veteran, died primarily from complications caused by a perforated bowel obstruction. Minutes after emergency surgery, he suffered a heart attack and never regained consciousness.

But to Mary Nicholl, Stecher's live-in companion of 19 years, the care Haley provided before surgery amounted to gross inattention by a hospital where, she said, care was often chaotic and substandard.

"No veteran," Nicholl said, "should endure what Richie endured."

On Thursday, the Department of Veterans Affairs refused to discuss the case or its medical files on Stecher, given to Nicholl by Haley at her request.

"I am not going to rebut anything she says," Cutolo said Thursday.

A surgeon, a primary care physician and a gastroenterologist failed to adequately treat Stecher over two months, according to VA minutes of Cutolo's meeting with Nicholl.

VA records say Stecher should have been admitted after an April CAT scan but was not admitted until June 27, when the emergency surgery was performed.

Cutolo told Nicholl in a July 23 meeting that doctors were "misled" by his atypical symptoms, records show.

Short on personnel, the VA sent Stecher to a private company in April for a CAT scan. The results were viewed by a non-VA radiologist without access to previous VA scans for comparison, according to a VA document.

That communication gap, Nicholl said, may have led to the failure of Haley to recognize how seriously ill Stecher was. His primary care physician at the VA, located at a VA clinic in Pasco County, strongly suspected an obstruction, records show.

"To err is human and occasionally people do make mistakes," Cutolo said, declining to discuss Stecher specifically. "And sometimes something extremely complex is not examined to the full extent.

"That happens everywhere. Because we're such a large system, there are going to be unanticipated outcomes and opportunities to do things better," Cutolo said.

He characterized the 365-bed facility, which handled 1.6-million patient visits last year, as an outstanding hospital.

Cutolo declined to discuss why he apologized to Nicholl, an event documented in notes written by the VA and obtained by her. He said apologies are rare but not unprecedented after "unanticipated outcomes."

Nicholl and her son, Eddie Enright, 44, said they demanded the July meeting with Cutolo because they wanted answers. They both said Cutolo, who was not Stecher's physician, was extremely apologetic.

"Cutolo admitted it was their fault, they screwed up and they were going to put measures in place so it never happened again," Enright said. "They said he would still be alive if they had admitted him in April.

Cutolo "apologized over and over and over again."

Nicholl's description of Stecher's final three months is a sometimes bizarre portrait of patient care. Many elements of her story are not detailed in documents and, absent VA comment, remain unverifiable.

Stecher, a retired general manager of a New Jersey manufacturer, began getting sick early this year. He lost up to 50 pounds, had little appetite and his abdomen protruded markedly, Nicholl said.

"It was like he was carrying twins," Enright said.

Stecher began visiting Haley or the Pasco clinic regularly in March. Visit followed visit — up to a dozen or more, Nicholl said.

"He just kept getting sicker and sicker," she said.

On June 26, she said, she rushed Stecher to Haley because he was so sick. The next day, he received a barium enema for an X-ray of the intestine. Somehow, Nicholl said, Stecher suffered a perforated intestine during the procedure.

Attendants, she said, simply finished the procedure and tried to send him home. Nicholl alerted a physician's assistant who, she said, immediately saw how ill Stecher was.

That PA wrote a note, Nicholl said, saying Stecher needed immediate surgery or a procedure to decompress and clear the intestine. He handed her the note and told her to take it to the emergency room, she said.

The 63-year-old woman said she had to push Stecher alone to the ER on another floor in a wheelchair via Haley's slow and crowded public elevators, at least a 10-minute trip.

At the ER, the couple then waited 45 minutes, nobody taking Stecher's vitals, Nicholl said.

Finally, he was examined and rushed to the ultimately unsuccessful surgery.

Cutolo and a VA spokeswoman declined to discuss any portion of Nicholl's account, though she offered to sign any release freeing the VA's hands.

"I don't ever want this to happen to another veteran," said Nicholl, who said as a "common-law wife" she has no legal standing to sue. "Somebody should be held responsible."

William R. Levesque can be reached at (813) 226-3436 or levesque@sptimes.com