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In the News
VA Inspector General Discovers Major Problems with Patient Care at the VA Medical Center in Marion, Illinois
A recent inspection conducted by the VA Office of Inspector General revealed major deficiencies in surgical care provided at the VA Medical Center in Marion, Illinois. Among other things, a team of inspectors from the Veterans Health Administrations (VHA’s) National Surgical Quality Improvement Program (NSQIP) discovered a mortality rate that was over four times the expected rate for the patient population receiving surgical care at the VAMC at Marion, Illinois. Significant deficiencies were noted in the quality of the medical center leadership, the peer review and physician privileging process as well as other Quality Management (QM) processes. The two-day audit by the Office of Inspector General determined that the surgical specialty care provided at the Marion VAMC “was in disarray.”
The complete report of the inspecting team’s findings can be found at VA Office of the Inspector General.
Health and Wellness
Congestive Heart Failure
In addition to maintaining close communication with your medical care providers, and cooperating with your doctors’ instructions and treatment plans for any condition, one of the best ways you can protect yourself or a loved one from an untoward medical outcome is to become familiar with the signals pointing to a possible need for urgent medical intervention. With that in mind, we invite you to spend a few minutes familiarizing yourself with medical topics of possible interest. This month’s discussion focuses on Congestive Heart Failure.
Congestive Heart Failure (CHF) is a failure of the pumping function of the heart which results in the failure to maintain blood circulation to other parts of the body. If the heart is not pumping blood adequately, pressures in the heart increase, causing blood to leak out of small blood vessels and into the tiny sacs in the lungs (alveoli) where blood oxygenation takes place. This leads to a collection of fluid in the lungs and to respiratory failure. Treatment of CHF has an estimated annual cost of $60 billion within the U.S. alone. More than 1 million hospital admissions per year are attributed to the primary diagnosis of acute worsening of CHF.
Today roughly 2% of the population is affected by Congestive Heart Failure (CHF), and this is twice the number seen 15 years earlier. It is the most frequent cause of hospitalization in patients older than 65 years. Rates of complication and death due to CHF are high, with an estimated 5 year survival rate of around 50%, despite recent advances in treatment. CHF patients die from sudden lethal disruptions to normal heart rhythm (arrhythmia's), respiratory failure from build up of fluid in the lungs (pulmonary edema), heart attacks from severely decreased oxygen supply, and toxic reactions to medication due to progressive liver and kidney disease which interferes with the body’s ability to safely absorb and make use of medications.
Anything that causes damage to heart tissue can lead to CHF. The list is long but includes congestive heart disease, viral damage to the heart, acute myocardial infarction (heart attack), heart infections (pericarditis, endocarditis, myocarditis), pulmonary emboli, long standing hypertension, heart valve disease, anemia, use of certain street drugs, long standing diabetes and other mechanisms.
With a decrease in pumping efficiency of the heart, there is a decrease in the volume of blood which the heart puts out with each stroke. The body in turn tries to maintain adequate blood supply by increasing the resistance in distant blood vessels. This in turn causes the heart to work harder to pump against that increased pressure, which then causes the heart to become enlarged (myocardial hypertrophy). In the end, the heart gets bigger but is less functional. Appropriate testing can detect this condition, which if not corrected becomes progressive and irreversible.
Classic conditions might include increasing swelling in the legs, increasing shortness of breath with activity (dyspnea on exertion), difficulty lying flat (orthopnea), sudden breathlessness upon wakening (paroxysmal nocturnal dyspnea), cough with frothy or pinkish sputum, shortness of breath at rest, and increasing weakness and dizziness. Some or all of these conditions in a patient with a history of CHF indicates an acute worsening of the condition.
A patient experiencing any such symptoms should seek prompt medical evaluation, and ask their doctors to rule out acute Congestive Heart Failure. Physicians may give consideration to running cardiac enzyme tests to rule out a heart attack. Evaluation may also include testing of liver enzymes. Arterial blood gases can be checked to evaluate for acute oxygen deprivation (hypoxemia) and life threatening blood clots in the lungs (pulmonary emboli). A chest x-ray is almost always obtained since CHF has a classic pattern on x-ray (enlarged heart, various amounts of increased fluid in the lungs (pulmonary edema and pleural effusions). Echocardiograms will establish left and right ventricular function, heart chamber size, wall thickness, and wall motion abnormalities. A test called a MUGA scan is a reliable study to determine overall heart function. Of course, an electrocardiogram should always be performed. Feel free to discuss the need for such tests with your doctor.
Patients experiencing a sudden worsening of CHF should be placed on high flow 100% oxygen, and should be monitored by pulse oxymetry while additional testing and care is provided at the direction of your physician.
Patients suffering from Congestive Heart Failure can be and have been injured due to, among other causes, the failure to distinguish CHF from other pulmonary (lung) diseases, failure to rapidly treat, failure to rapidly diagnose and treat the heart conditions that produced the CHF (the most common cause of CHF is coronary artery disease), failure to rapidly treat abnormal heart rhythms (cardiac arrhythmias), failure to rapidly treat build up of fluid in the lungs, and failure to initiate aggressive critical care support and intervention in those patients whose cardiac function and circulation is unstable.
While the majority of health care provided at hospitals and clinics across the United States meets world-leading standards for thoroughness and competence, avoidable mistakes do occur. If you believe that you or a loved one have suffered from negligent medical care in the course of treatment by government health care providers, including the VA, military services, or Indian health care clinics, then the attorneys of Rawls & McNelis, P.C. are prepared to assist.