VA letter left out details on veteran's care

TAMPA — Rep. Gus Bilirakis wanted answers about how the nation's busiest veterans hospital treated a Tarpon Springs man who died in the facility's care.

What Bilirakis, R-Palm Harbor, got was a letter from the James A. Haley VA Medical Center that did not include vital details about Richard Stecher's treatment.

The three-page letter dated July 24 did not disclose that:

• Haley's chief of staff had apologized to Stecher's companion, Mary Nicholl, the day before, telling her that three VA doctors "missed opportunities" to treat Stecher, 64, who died June 30 of a perforated bowel obstruction.

• Haley had concluded Stecher should have been admitted to the hospital in April after a CAT scan, two months before he was admitted.

• The VA sent Stecher for the April CAT scan at a private company because it was short of staff, and a non-VA radiologist who reviewed the results did not have access to previous scans for an important comparison.

A Department of Veterans Affairs regional lawyer, James Kelly, said on Friday that the VA was not attempting to keep any information from Bilirakis. "Nothing could be further from the truth," Kelly said.

After receiving the letter from Haley, Bilirakis wrote to Nicholl, who had sent the congressman a complaint about the poor care she thinks Stecher received at Haley.

"It is personally disappointing to me that this matter could not have been more favorably resolved," Bilirakis wrote.

Bilirakis then thanked her and apparently ended efforts to get more answers for Nicholl.

Bilirakis, a member of the House Veterans Affairs Committee, was traveling on Friday and could not be reached for comment on how the VA handled Stecher's case, which the St. Petersburg Times profiled on Friday.

His office said in a statement that it is unacceptable when a VA patient does not get the best care.

"But Congressman Bilirakis also knows the folks at the James Haley VA love our veterans and work tirelessly on their behalf," the statement said. "There are always two sides to every story and Gus, in the coming days and weeks, will follow up with everyone involved … and seek answers to the questions raised by the Times."

Authorship of the letter to Bilirakis remains unclear. It bears the name of Haley director Stephen Lucas. But the letter is signed by Haley's assistant director, and the VA cannot confirm which of the two wrote it or if it was written by a third person on Lucas' staff.

Kelly, the VA lawyer, said the letter to Bilirakis did not contain information about the July 23 meeting between Haley's chief of staff and Nicholl because the letter had been drafted before the meeting.

"It's very simple," Kelly said. "The meeting hadn't occurred yet. I know it doesn't make sense when you look at the dates on it."

Presumably, full information about Stecher's treatment would have been in Haley's hands at the time the letter was drafted. But Kelly noted that privacy laws and delays in Nicholl's appointment as personal representative of Stecher's estate made a more timely and therefore fuller disclosure to Bilirakis difficult.

"We not only come clean to families, but we're definitely transparent to all members of Congress," Kelly said.

Kelly also said that the VA was answering specific concerns by Nicholl and did not get into areas about which she hadn't specifically complained.

Asked why the VA did not provide Bilirakis with additional information after the meeting, Kelly said VA practice would have required a second official inquiry by Bilirakis for information before the VA forwarded anything else to him.

Kelly said Nicholl could have asked her congressman for more information but didn't.

"It's her right to go to a congressman to ask for information," Kelly said.

Nicholl, 63, who lived with Stecher for 19 years, said she has been frustrated by the layers of bureaucracy at the VA and what she sees as a lack of accountability.

"The VA did not want to bring attention to themselves and tried to brush me off as a quack to get rid of a politician," Nicholl said.

Stecher, a Coast Guard veteran, suffered for over two months, Nicholl said, as he repeatedly visited the VA.

Finally, after Stecher's bowel was perforated during a barium enema for an X-ray on June 27, Nicholl said, Haley admitted him and began emergency surgery to save his life.

But soon after, he suffered a heart attack, never regained consciousness and died when life support was removed on June 30.

Haley, citing privacy concerns, refused to discuss specifics of Stecher's care. Much of that information, however, is found in medical records Haley released to Nicholl this week.

Nicholl said she was granted the meeting with Haley's chief of staff, Dr. Edward Cutolo, after demanding an audience. Haley disputes this, saying it met with her normally as part of its practice of full disclosure to families.

Cutolo said on Thursday that Haley handled 1.6-million patient visits last year and provides outstanding care. He said all large medical systems suffer occasional "unanticipated outcomes."

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

VA letter left out details on veteran's care 08/08/08 [Last modified: Monday, August 11, 2008 3:16pm]

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