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St. Pete veteran dies after VA's delay in cancer diagnosis

ST. PETERSBURG — Navy veteran Horace J. Lalley suffered urinary tract problems for years with symptoms he regularly reported to doctors at the C.W. Bill Young VA Medical Center.

Blood in his urine. A burning sensation and pain when he went to the bathroom. Frequent urination at night.

The diagnosis again and again: urinary tract infection. But doctors were wrong. In fact, a malignancy was growing in Lalley's bladder.

Lalley's family says the Department of Veterans Affairs hospital missed important clues about Lalley's bladder cancer, including significant bleeding, and failed to order timely radiological scans and other tests that would have led to an accurate diagnosis.

By the time Lalley was referred to a urologist and scans completed by May 2012, it was too late. The veteran had end-stage bladder cancer.

Lalley died on Oct. 23, 2012. He was 76.

Jason Dangel, a spokesman for the Young VA, said Friday that the hospital, formerly known as Bay Pines, was not aware of allegations of improper care in the Lalley case until contacted by the Tampa Bay Times. He said facility physicians would conduct a "thorough review" to determine if Lalley's care was deficient.

The VA nationally is under intense scrutiny after reports of preventable deaths due to delayed treatment at VA facilities. Some veteran groups and lawmakers have demanded VA Secretary Eric Shinseki resign.

In Tampa Bay, the agency has said there have been no veteran deaths involving a narrow category of cases — patients who were not timely referred to a specialist for gastrointestinal cancers. The VA reports 23 such deaths nationally.

But Lalley's case suggests a wider review in Tampa Bay and around the nation may identify additional deaths that have escaped scrutiny.

"If it happened to my dad, it's probably happened to others," said Lalley's daughter, Denise Voyles, 52, of Largo. "It wasn't like he didn't go to the doctor. It's not like he didn't seek care. He did. Repeatedly."

Dangel said the facility has had no preventable deaths linked to delays in getting consults with specialists.

"Early diagnosis of cancer and other medical conditions does not always occur," said Dangel. "As hard as trained medical professionals work to ensure the very best outcomes for patients, deaths will occur. This is true inside and outside the VA."

Last month, Gov. Rick Scott ordered the Florida Agency for Health Care Administration to inspect VA hospitals in the state because of concerns about inadequate care. The state inspectors were turned away, the VA says, because they have no jurisdiction in a federal hospital.

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Lalley, who was a retired grocery sales broker, loved the Young VA and its health care professionals.

"That was the only hospital where he wanted to go," Voyles said. "My dad loved going there so he could talk to other veterans about being in the service. He just loved it. And he thought he was getting wonderful care."

A review of Lalley's medical records show he suffered from persistent symptoms that his primary care doctor said were caused by urinary tract infections, or UTIs.

Lalley's symptoms go back more than a decade. On Nov. 9, 2004, Lalley "woke up urinating bright red blood," according to his medical file. He visited the VA hospital, and his doctor noted Lalley had a "history of UTIs several years ago."

But by his next visit, Lalley's symptoms had abated. A note from a Dec. 16, 2004, exam noted his UTI had "resolved."

A CAT scan of his abdomen on Jan. 23, 2005 — his last such scan before 2012 — showed no problems. But the VA did not order a cystoscopy, a procedure in which a flexible tube with a camera is inserted into a patient's bladder. A tissue sample can be collected for biopsy during the procedure.

A cystoscopy is done in cases of suspected bladder cancer.

"Consider all patients with (blood visible in urine) to have bladder cancer until proven otherwise," said a 2009 summary of bladder cancer and its treatment by Dr. David Steinberg of the University of Chicago Medical Center and other physicians.

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Lalley's symptoms kept returning, according to medical records. In 2006, he experienced burning urination and was treated with antibiotics for a urinary infection.

In 2009, he told his doctor about a frequent need to urinate at night. On May 24, 2010, Lalley said he had experienced the urgent and frequent need to urinate and "for many years getting worse," his medical file shows.

On Aug. 6, 2010, Lalley reported blood in his urine for three days. Aug. 12, 2011: "usual UTI signs/symptoms" with pain, burning and frequent urination. Diagnosis: Urinary tract infection. Jan. 23, 2012: "Reports worsening urinary symptoms." Feb. 24, 2012: "Continues to have" blood in urine.

Through the years, the VA ordered urinalysis several times. Lalley's family said these tests pointed to glaring abnormalities.

"I firmly believe that based on the results of the urine tests, a urology consult should have been requested anywhere from 11/9/2004 to 9/13/2011," Dr. Saul Weinstein, who reviewed Lalley's medical records, said in a report to a lawyer who reviewed the case for the family.

Weinstein said bacteria or nitrates are often found in urine samples of those with UTIs. But in Lalley's samples, the nitrates were often missing and bacteria was low or nonexistent.

The VA's records emphasize the importance of proper follow-up on patients with frequent urinary tract infections.

"Males with a UTI or other persons with recurrent infections need to have further evaluation to look for treatable causes," says a sheet of instructions given to VA patients diagnosed with UTIs. "These infections are sometimes an indication of a more significant urinary tract disease."

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Lalley's doctor ordered a urology consult and scans in March 2012. In May 2012, while Lalley was waiting for the tests, he began hemorrhaging and was rushed to the emergency room.

"The urologist came down and told us, 'I'm almost certain your father has bladder cancer,' " said Voyles. On May 17, doctors confirmed Stage IV bladder cancer.

Lalley underwent surgery and chemotherapy, but the cancer was terminal. He died at a VA hospice, five days after his 54th wedding anniversary. His wife, Lillie Lalley, 81, said her husband felt a sharp sense of betrayal.

"He was angry," she said. "He told me he wanted us to sue the VA. I hate to think of anybody else going through what my husband went through."

A lawyer who reviewed the case told the family there was clear negligence, but he decided not to take the case given the difficulty in successfully suing the VA.

The couple's daughter, Voyles, said the VA has many excellent physicians, but the system is overstressed. She said it is important to her family that her father's death not be in vain. So they agreed to tell his story.

"If this helps veterans not go through the same thing," Voyles said, "then that's what my dad would have wanted."

William R. Levesque can be reached at levesque@tampabay.com or (813) 226-3432.

St. Pete veteran dies after VA's delay in cancer diagnosis 05/23/14 [Last modified: Friday, May 23, 2014 11:10pm]

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