Two military veterans died under unusual circumstances in the span of eight months at a VA medical center in Lake City last year, including a 72-year-old man who caught fire while strapped to his nursing home bed.
The other veteran died after suffering an apparent heart attack, but the doctor on duty says he was unable to administer lifesaving procedures because he was wheelchair-bound.
Officials at the Department of Veterans Affairs reviewed the two cases, and they insist veterans are getting quality care at the medical center in the small north Florida city. But both episodes are spawning legal action against the department.
"If anybody saw how he was burned, they just wouldn't believe it," said Helen Srno, whose husband suffered the fatal burns last June. "They weren't supposed to let him smoke cigarettes or anything over there."
Edward A. Srno, a former World War II-era prisoner of war from Daytona Beach, died Aug. 2 from the severe burns he suffered at the Lake City center. After the death, the VA tightened restrictions against patients' smoking.
In the second controversial death, former VA doctor Joseph J. Warner says his disability prevented him from attempting to revive a 62-year-old man who suffered an apparent heart attack at the hospital in January 1996.
Warner asserts that VA managers knew his spinal condition, which sometimes limits him to a wheelchair, made him unable to perform rigorous medical procedures. He says they nonetheless assigned him responsibilities of medical officer of the day. Warner says his wife pushed him through the hospital in a wheelchair to perform his rounds.
"I had told them months earlier that I felt very uncomfortable and that one day an emergency would come," said Warner, who is part of a federal lawsuit against the VA and has also complained to the department's inspector general.
The two deaths are the latest troubling disclosures to hit Veterans Affairs and its system of providing benefits, health care and other services to veterans.
In recent months, the VA has confirmed that 12 top employees have been demoted or forced to retire because of sexual harassment allegations. Among them is the former director of the Fayetteville, N.C., VA hospital, who had sexually harassed an employee but was allowed to keep his six figure salary in a newly created job at the VA Medical Center at Bay Pines in Pinellas County.
Other auditors' reports have uncovered misspending by upper-echelon VA hospital officials, angering veterans and rank and file employees as the department downsizes and tries to accomplish more with less money.
Unlike those earlier problems with mismanagement, the disclosures coming out of Lake City involve a central mission of the VA _ providing health care for veterans.
In interviews last week, Dr. Robert Roswell, head of the VA service network that includes Florida, expressed sympathy for the families of the two patients who died at the Lake City facility. But he distinguished between the two cases.
In the Warner case, VA officials say, a second physician was present and had attempted to revive the patient. Roswell said Warner's allegations have as much to do with an ongoing personnel dispute as the patient's case.
"It was used as an excuse to say that this physician was not treated fairly," Roswell said.
In the case of Srno, VA officials refused to say whether anyone has been disciplined, though they confirm that tougher anti-smoking rules are intended to prevent patients from burning themselves.
"Any time a patient dies, there is an opportunity to learn from that experience," Roswell said.
The Srno case
Edward Srno came out of World War II with a disability from a mortar shell explosion. He also had been a prisoner of war. After his military service, he attended college for a time and went to work at a Navy finance center in Ohio, before retiring to Daytona Beach.
But in recent years, his health began to fail, and his wife turned to the VA for help. She says the department let her down.
At one point, while staying at a VA hospital in Florida, Srno somehow left the premises and wandered off, according to Mrs. Srno's attorney, Christopher Ambrose. Srno wound up at the family home in Daytona Beach, Ambrose said.
Later on, with her husband's health and his mind deteriorating, Mrs. Srno tried to care for him at home, but the task became too great. She decided to admit him into Lake City's VA nursing home in April.
"He was so ill, I couldn't take care of him," she said last week.
On the day of the fire, June 30, Srno was held in his bed by a vest-like restraint device called a "posey" used to protect patients from falling. Somehow, he caught himself on fire, apparently by a cigarette, VA officials said.
He was burned on his left side, said Mrs. Srno, recalling the photographs of the injury. "He went up in flames," she said. "He couldn't get out."
Srno was taken to Shands Teaching Hospital in Gainesville, and then to the Gainesville VA hospital, where he died Aug. 2.
In a brief interview, Mrs. Srno cried as she recalled her decision to put him in the VA nursing home. "I blame myself," she said.
Ambrose, her attorney, asserted that his investigation has found that the nursing home staff was not familiar with all the policies regulating patients who smoke.
Even before the fire, patients were prohibited from smoking in their rooms, a VA restriction that is often met with protests from older veterans who remember when their C rations included cigarettes. At Lake City's VA nursing home, patients are allowed to smoke in a designated room. Cigarettes are kept at the nurses' station.
"The veteran tragically chose to not follow that rule," said Roswell, director of the VA network that includes Florida.
"We don't know where he got those cigarettes," said Alline Norman, the medical center director at Lake City.
Under a new policy, a nursing staff member must accompany a patient who wants to smoke to a designated room. The staffer is then supposed to light the cigarette for the patient, Norman said.
Secondly, smoke detectors are installed in the individual rooms of "risk" smokers, she said.
"I think we're doing everything we can to prevent it from happening," Norman said. "We were already meeting all the requirements (of hospital accrediting groups), and we've added even more."
Norman would not disclose if any employee was disciplined as a result of the Srno fire.
The Warner incident
The second questionable death occurred about seven months before Srno passed away. It involved, a doctor says, a 62-year-old man who was admitted into the Lake City hospital with pneumonia.
The man stayed overnight, and on the second day of his stay he had what doctors later told the family was a heart attack.
Dr. Joseph Warner says he was the medical officer of the day, and so he responded. But he did so by wheelchair, he said, because his spinal disability limited his movement severely.
According to Warner, one doctor at the hospital attempted to "intubate" the patient to revive him, but was unable to perform the procedure. The procedure, in which a tube is inserted through the mouth to open an airway, is often a difficult one for any physician, but Warner said his disability meant he was unable to give it a try and offer this patient a second chance.
"I couldn't even attempt it," Warner said in an interview. "He attempted it and couldn't do it. Of course, I'm there in a wheelchair and couldn't do a thing."
The man died. Though Warner did not identify the patient by name in his written complaints to VA officials, public records indicate the man who died apparently was Warren Carl Mizell.
Mary Mizell, his wife of nearly 40 years, said her husband was a Korea-era veteran who had recently retired from his job as the owner of a cab company in the small Florida town of Live Oak.
When he entered the hospital, she knew he was sick but didn't believe he was deathly ill. She was some nine years older than her husband.
"It was such a shock," she said in a telephone interview Friday.
Her family, she said, had been suspicious about the care he received at the hospital, after his sudden death. "My daughter said, "Oh how I wish we hadn't sent him there,'
" Mrs. Mizell recalled.
But Friday was the first time she heard about the questions surrounding her husband's death. Despite Warner's complaints to the VA about this case, no one had contacted her until a Times reporter called.
"They didn't tell me anything about this," she said.
Warner said he regrets being unable to attempt to revive the patient, though he said that the patient might have died anyway. Why, then, did he even put himself in the position of responsibility in the first place?
"The answer was simple: I was ordered to do so," Warner said. "It was not being done without protest. The administration was on notice for many months."
The January episode came after a long dispute between hospital managers and Warner, a 43-year-old neurologist who had worked for the VA since 1984.
He said VA officials assigned him to the medical officer of the day duties as an act of reprisal. He had testified in an equal employment case involving former Lake City VA chief of staff Donald Issac.
Warner is now one of five current and former VA employees who are suing the VA and alleging that Issac, a dentist, was not qualified to be chief of staff at Lake City because he was not a medical doctor.
In another chapter of the dispute, Warner also alleges that VA officials improperly removed some 50 brains he kept in a laboratory at the Lake City facility. He complains that he was ultimately pushed out of his VA job.
Warner has taken his complaints to U.S. Rep. Karen Thurman, D-Dunnellon, and the VA's inspector general, the department's watchdog.
Dr. Warner left the VA in July. Issac, the acting chief of staff, has retired. Roswell, head of the VA's network of hospitals in Florida, said a recent review of Issac's tenure turned up no overall "impairment" of the quality of care provided to veterans at the Lake City VA Medical Center.
_ Times Researcher Kitty Bennett contributed to this report. Staff writer David Dahl can be reached by telephone at (202) 463-0576 or by e-mail at dahlsptimes.com