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Were veterans' radiology tests wrongly canceled? VA includes Haley in national audit

JAMES BORCHUCK | Times (2014) Four radiology technicians say rules aren\u2019t being followed in scheduling tests at James A. Haley Veterans\u2019 Hospital\uFEFF in Tampa.
Published Jul. 9, 2018

TAMPA — Federal investigators are looking into allegations that officials at the James A. Haley Veterans' Hospital canceled hundreds of patient radiology exams without following safety guidelines and then tried to cover it up.

The exams had been ordered to determine patient health and had gone unfilled for more than 60 days. The allegations were made by four Haley radiology technicians who have filed a sexual harassment and intimidation lawsuit against the hospital.

In court documents and in complaints to investigative agencies, the four plaintiffs liken the cancellations to a 2014 scandal at the Phoenix veterans hospital, where patients died awaiting medical procedures. The delays in Phoenix were covered up through appointment documents.

The plaintiffs say the moves affected patient care at Haley. But it was unclear whether any patients were harmed by having their exams canceled. The plaintiffs make no such link, in part "because they are denied access to that information," said their attorney, Joseph Magri of Tampa.

Still, one of the plaintiffs said in a deposition that she reached out to a patient whose ultrasound test was overdue and learned that the patient had died. She did not know the cause of death.

The review of the allegations against Haley is part of a nationwide audit of radiology practices at Department of Veterans Affairs hospitals to determine whether the VA "processes radiology requests in a timely manner and appropriately manages canceled requests," said Michael Nacincik, a spokesman with the agency's Office of Inspector General.

The office launched the investigation on its own in February and expects to finish it by January. Haley is one of eight VA hospitals nationwide that investigators have contacted "to assess their local procedures and processes," Nacincik said.

Haley officials say concerns about radiology exams have been reviewed previously and found to have no basis.

In January 2017, the VA directed its hospitals nationwide to reduce a backlog of more than 300,000 radiology exams that had been ordered but not performed within 60 days. The reason for the directive, VA officials said, was that many of the overdue exams were no longer necessary.

But the orders came with safety guidelines: A radiologist or ordering physician must determine first whether the exams are still needed before cancelling them. The types of exams involved include CT scans, MRIs, ultrasounds and mammographies.

In court documents and in other complaints, the four radiology technicians said those guidelines are not followed at Haley. Instead, radiologists and physicians are merely sent a notice that a test has been canceled. The plaintiffs also allege that hospital officials tried to hide their moves by turning off printers that produce reports noting the cancellations.

VA officials tell a different story. Despite the specific language of the guidelines, Haley spokeswoman Karen Collins and Curt Cashour with the national VA insisted that notifying the radiologist or physician — rather than requiring their exam review — is sufficient.

In court documents, Haley officials acknowledged shutting off the printers but said they did so only to avoid confusion between exams that are current and those that have been cancelled.

The 2017 guidelines were crafted to determine medical necessity and whether further contact was necessary with patients, Cashour said.

"Moving forward, this process will ensure all orders in the system are active and clinically viable, thus eliminating the clutter of obsolete test requests in the VHA computer system," he said.

As a result of the new policy, the number of overdue orders had been reduced by 71 percent nationwide as of June 28, to 58,000. Haley, which had about 700 overdue orders as of September 2017, now has 438, Cashour said.

At a meeting in April with an official from the Office of Inspector General, Kara Mitchell-Davis, one of the four radiology technicians, turned over paperwork supporting the allegations against Haley, including appointments that were never completed, improperly scheduled or "tampered with," according to court documents.

A list of 1,234 patients that Mitchell-Davis provided shows veterans were not receiving diagnostic exams due to "short staffing and inept leadership in radiology," according to court documents.

The allegations about the radiology exams arise from a lawsuit filed in August 2016 by Mitchell-Davis and fellow radiology technicians Erin Tonkyro, Dana Strauser and Yenny Hernandez. They say they have been the victims of sexual harassment at Haley since 2008 and were retaliated against for complaining.

The hospital, in court documents, has denied those allegations and sought to have the case dismissed before trial.

Contact Howard Altman at haltman@tampabay.com or (813) 225-3112. Follow @haltman.

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