Patients at Area VA Hospital Denied Soft Foods

• Robert W. Smith, Independent Veterans Advocate, Portland Oregon 714-718-0484 rwmacgowan@yahoo.com September 21, 2010 ALERT TO VETERANS RECEIVING MEDICAL CARE AT COCHRAN VAMC, ST. LOUIS MO. The March 1, 2010 issue of MIT News has an article titled, “Second Opinion? Diagnosing Doctors” (the article is available on the internet). Of concern to veterans receiving care in VA hospitals is the following quotation: “To reach this conclusion, Doyle — along with his colleagues Steven Ewer of the University of Wisconsin and Todd Wagner of Stanford University — examined roughly 70,000 treatment episodes involving 30,000 patients, spread over 13 years, at a Veterans Affairs hospital in a large city in the United States. The hospital’s practices naturally lent themselves to a comparison of doctor quality since the institution randomly assigned patients to two separate teams of physicians and residents, which had markedly different medical backgrounds. One of these teams (dubbed “Program A” by the researchers) consisted of members trained at an elite U.S. medical school, which sometimes boasts the nation’s highest average MCAT scores among its incoming students. The other group (“Program B”) has members trained at a middle-ranked medical school. Medical residents with Program A had medical board-certification scores that on average placed them in the top quarter of the national results, while the Program B doctors had scores placing them in the bottom fifth of U.S. residency programs. (The researchers agreed to keep the identities of the VA hospital and medical schools anonymous.)” In other words, more than 15,000 veterans were deliberately assigned to a group where they received care from doctors and physicians who were inferior to the other treatment group, and they were kept in the dark about this. They were, in effect, guinea pigs in a large-scale experiment in which they never gave their informed consent. And there were consequences: veterans assigned to “Program B” had suffered longer without proper diagnosis or treatment, than the veterans in “Program A”. If you substitute the words “congressmen” for veterans, you can see where this might raise a fuss. Considering that people die in VA hospitals every day of preventable medical errors, you can imagine how those “congressmen” whose family members died in such a manner, and who later became informed that their loved ones had been assigned to “Program B” might feel. Outraged and betrayed are two words that come to mind. When the VA researcher involved in the study, and two senior VA administrators were queried about “Program A” and “Program B” they all refused to name the VA hospital where this experiment is still, apparently, operational, stating that it was, to quote the VA researcher Todd Wagner, “Confidential”. No patient names have been disclosed, so there can be no justification for keeping secret the name of the hospital. The MIT News summary is of a research article titled “ Returns to Physician Human Capital: Analyzing Patients Randomized to Physician Teams,” by Joseph J. Doyle, MIT & NBER; Steven M. Ewer, M.D. University of Wisconsin—Madison; and Todd H. Wagner, VA Palo Alto and Stanford. November 2008 . http://www.law.harvard.edu/programs/petrie-flom/PDFs/doyle-paper.pdfhttp://www.law.harvard.edu/programs/petrie-flom/PDFs/doyle-paper.pdf I looked here for the answer as to the name of the “Confidential” VA hospital where the research was/is taking place. Within the text excerpted from the article, I have entered my own comments; they are in enlarged and capitalized, bold print which is set within brackets. “This study considers a VA hospital in a large urban area that has affiliations with two medical schools. [ONLY THREE VA HOSPITALS HAVE TWO MEDICAL SCHOOLS AFFILIATED WITH THEM: NORTHAMPTON (MASS.), SEPULVEDA (CA), AND ST. LOUIS (MO). ] “This VA hospital is a full-service teaching hospital that provides over 3,500 surgical procedures each year. It has an intensive care unit and what are considered excellent laboratory facilities, including the ability to conduct magnetic resonance imaging and angiography. In addition to the main hospital, there are some smaller satellite hospitals elsewhere in the city that handle mental health, substance use treatment and long term care. The variation in the medical and surgical residency training programs between the two institutions that serve this VA hospital is compelling: one is regarded as a top program in the U.S., whereas the other is ranked lower in the quality distribution. In the remainder of the paper, the higher-ranked institution will be referred to as Program A, and the lower-ranked institution will be referred to as Program B. To establish the difference in credentials, Table 1 reports some summary characteristics of the two programs. First, the residency programs are affiliated with two different medical schools where the attending physicians that supervise and train the residents are faculty members. These medical schools differ in their rankings. Some years, the school affiliated with Program A is the top school in the nation when ranked by the incoming students’ MCAT scores, and it is always near the top. [THE MEDICAL SCHOOL WITH THE HIGHEST MCAT SCORES FOR INCOMING STUDENTS IN 2007 (I have given 2007 data as 2008 data would not have been available to the researchers at the time of their report) WAS WASHINGTON UNIVERSITY SCHOOL OF MEDICINE, IN ST. LOUIS, AT 12.5 AVERAGE SCORE; IT ALSO IS “ALWAYS NEAR THE TOP” EACH YEAR IN MCAT RANKINGS.] “In comparison, the lower-ranked program that serves this VA hospital is near the median of medical schools. [ST. LOUIS UNIVERSITY SCHOOL OF MEDICINE RANKED NEAR THE MEDIAN, AT 10.4 AVERAGE MCAT SCORE.] “Another commonly used measure to compare medical schools is funding from the National Institutes of Health (NIH). This ranking identifies the major research-oriented medical schools, again with some of the most prestigious schools near the top. The medical school associated with Program A is again among the top schools in the U.S., [WASHINGTON UNIV. SCHOOL OF MEDICINE RANKED #8 IN NIH FUNDING FOR 2007, AND #4 IN 2008.] whereas the lower-ranked program has an NIH funding level that is generally less than three out of every four medical schools. [ST. LOUIS UNIV. SCHOOL OF MEDICINE RANKED #95 IN NIH FUNDING IN 2007, WHICH IS NEAR THE MEDIAN OF THE TOTAL NUMBER OF U.S. MEDICAL SCHOOLS. THE MEDICAL SCHOOLS ASSOCIATED WITH THE OTHER TWO VA HOSPITALS WITH 2 AFFILIATED MEDICAL SCHOOLS EACH RANKED AS FOLLOWS: SEPULVEDA VA: UCLA #9 AND UNIV. OF SO. CALIF. #39; NORTHAMPTON VA: U. OF MASS. #51 AND DARTMOUTH #72. WHILE UCLA WAS A TOP RANKED NIH GRANT RECIPIENT, U. OF SO. CAL. WAS WELL ABOVE THE MEDIAN. CONVERSELY, WHILE DARTMOUTH WAS NEAR THE MEDIAN, U. OF MASS. WAS NO WAY NEAR BEING A TOP RANKED NIH GRANT RECIPIENT.] “Second, each training program is affiliated with another teaching hospital in the same city, in addition to the VA hospital. Program A’s “parent hospital” is ranked among the top 10 hospitals in the country according the U.S. News and World Report Honor Roll rankings of hospitals. [WASH. UNIV. SCHOOL OF MEDICINE'S HOSPITAL, BARNES-JEWISH HOSPITAL/WASHINGTON UNIVERSITY, WAS RATED #9 BEST U.S. HOSPITAL IN 2007.] “Out of 15 specialties ranked by U.S. News, Program A’s hospital is among the top 10 hospitals in the country for nearly half of them, and among the top 20 in nearly all of them (U.S. News & World Report, 2007). [WASH. UNIV. SCHOOL OF MEDICINE'S HOSPITAL WAS AMONG THE TOP 20 IN ALL FIFTEEN SPECIALTY AREAS, AND AMONG THE TOP 10 IN NEARLY HALF.] Meanwhile, Program B’s parent hospital is not a member of this Honor Roll overall or ranked among the top hospitals in terms of subspecialties.” [ST. LOUIS UNIV. SCHOOL OF MED. WAS NOT IN THE TOP 10 NOR IN THE TOP 20.] It is evident beyond a reasonable doubt that St. Louis VAMC is the hospital system referred to in the study. The two main divisions of St. Louis VAMC are Cochran VA hospital and Jefferson Barracks, which is primarily a domiciliary. Therefore, the answer is: Cochran VA hospital. I contacted both the hospital director's office and the public affairs person for the hospital. They would not confirm, but also would not deny, that Cochran was the hospital alluded to in the research paper and MIT News. Veterans receiving treatment in the St. Louis VA hospital, knowing what they have been unknowingly subjected to at Cochran VA hospital might now make more informed decisions as to where to receive their medical care.

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