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State's lawsuit against Veterans Administration contains errors

Roland “Dale” Dickerson of Largo said the VA delayed critical heart tests for more than two years that would have shown he needed immediate heart surgery.

DOUGLAS R. CLIFFORD | Times

Roland “Dale” Dickerson of Largo said the VA delayed critical heart tests for more than two years that would have shown he needed immediate heart surgery.

The state's lawsuit seeking the right to inspect Department of Veterans Affairs hospitals makes several startling claims about the care veteran Roland "Dale" Dickerson received at the C.W. Bill Young VA Medical Center.

The suit says the Young VA told Dickerson that a heart procedure showed he had a minimal narrowing of his coronary arteries when, in fact, he had a 69 percent blockage. That Dickerson had to get costly private health insurance to pay for heart surgery at a non-VA hospital. That he tried unsuccessfully to get the surgery at St. Petersburg General Hospital but was rejected because of the poor care he got at the VA.

None of these assertions is correct.

The lawsuit filed against the VA at the behest of Gov. Rick Scott contains significant errors about Dickerson's VA medical care, according to interviews and a Tampa Bay Times review of Dickerson's voluminous medical file. Those mistakes may raise questions about using unverified information in a suit that accuses the VA of errors in patient care. And it may fuel complaints by Scott's critics that the suit is an election-year political gambit.

Dickerson, 60, of Largo is one of two veterans named in the suit who are portrayed as examples of the kind of poor care that makes it necessary for the state to inspect VA facilities to protect patients. The VA, declining to comment for this article, has said the state lacks jurisdiction in federal hospitals.

Despite the lawsuit's errors, a review of Dickerson's medical records appears to support his accusation that the VA delayed for more than two years critical heart tests that would have pointed to the need for immediate heart surgery.

But the case presented in the records does not appear to be as clear-cut as the one depicted in the lawsuit.

The Florida Agency for Health Care Administration, which filed the suit, and Scott's office declined substantive comment for this article, citing medical confidentiality laws.

The state had previously acknowledged it did not review medical records before filing suit. Instead, state officials interviewed Dickerson for 90 minutes by telephone, said his wife, Debbie Dickerson. The second veteran in the suit, who lives in Hillsborough County, could not be reached for comment.

"Media stories continue to report new information about mismanagement at federal VA hospitals, which means our veterans continue to be harmed by their tactics and treatment delays," said AHCA spokeswoman Shelisha Coleman. "The agency filed suit for (the) right to gain access to VA hospitals so our expert surveyors could provide an objective, third-party review of the processes that continue to put Florida's veterans at risk day after day."

Dickerson, who served in the Army from 1972 to 1978, said the VA failed him.

"The VA nearly killed me," he said. "I was a walking heart attack waiting to happen."

•••

Dickerson, a retired maintenance manager, lived in Atlanta when, in 2010, his doctors at the Atlanta VA hospital scheduled a heart catheterization after tests pointed to possible heart problems.

During a catheterization, a long, thin tube is guided through blood vessels to the heart to diagnose problems such as the build-up of plaque that can block arteries and lead to a heart attack.

But Dickerson became seriously ill with a lung infection and the procedure could not be done before he and his wife moved to Florida in June 2010. The Dickersons said they assumed the procedure could be quickly scheduled at the Young VA (formerly called Bay Pines), their new hospital.

But the couple said doctors ignored their requests to perform the procedure. His doctor, Dale Dickerson said, would slap him on the back and say he had the heart of a 21-year-old.

In fact, after Dickerson became a Young VA patient, several radiology tests came back "abnormality, attention needed." Tests starting in late 2010 and continuing until 2012 showed Dickerson suffered from hardening of the coronary arteries and four-vessel coronary artery disease.

Not everything in the tests pointed to heart problems. Some tests measured how much blood the left ventricle of Dickerson's heart pumped with every heartbeat, called an ejection fraction. In 2010, tests at the Atlanta VA showed Dickerson had a 69 percent ejection fraction.

That number was normal.

The Dickersons, however, mistakenly thought the percentage was a 69 percent coronary blockage. The mistake later made it into the state's lawsuit.

Even so, tests at the Young VA from 2010 to 2012 pointed to heart abnormalities, but the Dickersons said doctors failed to order a heart catheterization to provide a definitive diagnosis.

A Young VA doctor later wrote in Dickerson's medical file that a 2011 test assessing heart function was "nearly normal." And he said Dickerson did not have chest pain. So a heart catheterization was deemed unnecessary.

The test he referred to, however, raised the possibility that Dickerson's heart muscle, in some circumstances, would not get enough oxygen, Dickerson's records show, a condition that can be life-threatening.

This "nearly normal" test was marked, "Abnormality, attention needed."

•••

An elevator ride may have saved Dickerson's life.

Frustrated with the VA's refusal to do a catheterization, the Dickersons discussed their anger in a Young VA elevator as they left another fruitless appointment in June 2012. They said they did not realize the hospital's chief of cardiology, Dr. Mazar Afaq, was riding with them.

They said he asked them for details. And he offered to help.

Things happened quickly. A coronary plaque CAT scan was done. It gives patients a score indicating whether they have a coronary blockage. A score of 400 or higher means a patient has a 90 percent chance of having a coronary blockage and a high chance of a heart attack.

Dickerson's score: 1,639 — a proverbial walking heart attack.

A catheterization confirmed severe coronary blockages.

Tampa General Hospital and its doctors ultimately performed successful quadruple-bypass surgery in August 2012 after the VA agreed to pay. The Young VA did not perform such surgeries, and the Dickersons said they did not trust the VA to do so anyway.

The Dickersons complained about their experience at the Young VA in an email to Scott's office, leading to their being named in the suit.

Some of the suit's errors are difficult to understand.

Dickerson never sought treatment at St. Petersburg General Hospital.

The Young VA did not perform a heart catheterization in 2010, so it is impossible that a catheterization showed a "minimum" blockage as the suit asserts.

Dickerson never obtained "costly private insurance" as the suit says. And the couple is not scrambling to pay Tampa General for the surgery since the VA agreed to pay the $220,000 bill, records show. The couple said they are left with a $1,800 co-payment they owe to the VA.

The Dickersons said they support the state's lawsuit, though they are a little perplexed by the errors.

"I think they were just in a hurry to get it filed in the court," said Debbie Dickerson, who noted she and her husband would eventually have to testify before trial in a deposition. "I can get everything right for them in the deposition."

Contact William R. Levesque at levesque@tampabay.com or (813) 226-3432. Follow @WilliamRLevesqu.

This story has been revised to reflect the following correction: A measurement of the percentage of blood the heart's left ventricle pumps with each beat is called the ejection fraction. A July 5 article about the state's lawsuit against the Department of Veterans Affairs was wrong on this point.

State's lawsuit against Veterans Administration contains errors 07/04/14 [Last modified: Sunday, July 6, 2014 6:45pm]
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