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IOWA CITY - The Iowa City Veterans Affairs Medical Center is among nine VA hospitals nationally being audited after allegations staff canceled diagnostic tests without doctors' orders, which a whistleblower said could cause a veteran to miss a tumor or other ailment.
'This has become an extremely dangerous situation as veterans are not receiving the diagnostic exams for treatment or follow up to prior illnesses,” said Jeff Dettbarn, a former radiology technician at the Iowa City VA.
The Iowa City allegations are part of a nationwide audit to 'determine whether VHA processes radiology requests in a timely manner and appropriately managed canceled requests,” said Mike Nacincik, public affairs officer for the VA Office of Inspector General, which is conducting the review.
The audit also includes VA facilities in Cleveland, Dallas, Denver, Las Vegas, Los Angeles, Tampa and near St. Petersburg, Fla., and Salisbury, N.C., Nacincik said. The story was first reported by USA Today.
Dettbarn, 50, of North Liberty, had been an X-ray technician at the Iowa City VA for more than a decade in February 2017 when he started noticing a large number of canceled orders coming across the office printer in the radiology department. Physicians are the only ones allowed to issue or cancel orders for diagnostic tests, Dettbarn said.
He asked the patient safety department about the canceled orders and filed an electronic report.
But when the orders kept coming, Dettbarn raised the issue with the VA's compliance officer, who 'gave me a song and dance,” he said. 'Once again, it kept going.”
But on June 22, 2017, a patient came to the radiology department for a scan of a mass on his kidney, Dettbarn said. While the veteran had an appointment, there was no order so the patient had to wait nearly three hours for another order to be issued. Dettbarn pushed the issue with his supervisor, who eventually confirmed she'd canceled two orders for the patient, thinking they were duplicates, Dettbarn said.
He filed another electronic report on the issue. 'The following Monday, they accused me of undermining authority,” he said. 'They sent me to a different job.”
The Tampa Bay Times reported in July the VA had directed hospitals in January 2017 to reduce a backlog of more than 300,000 radiology exams ordered, but not performed within two months. VA officials said many of the overdue tests weren't necessary any longer.
But doctors were supposed to sign off on the cancellations to make sure the exams, including CT scans, MRIs, ultrasounds and mammographies, weren't needed, the Times reported.
Four radiology techs at the James A. Haley VA Hospital in Tampa alleged officials canceled orders without a doctor's permission and then tried to cover it up. The technicians also are involved in a sexual harassment and intimidation lawsuit against the hospital, the Times reported.
When Dettbarn read that story, he was relieved to know other people at VA facilities knew about this problem.
'I didn't know it was systemwide until that article in Tampa came out,” he said. 'I had no idea when I started it would turn into a nationwide issue.”
Iowa City VA spokesman Bryan Clark said the hospital recently had a visit from the Office of the Inspector General.
'While the OIG noted an increase in cancellations, it concurred that the Iowa City (VA Health Care System) is following national guidance in scheduling practices for radiology,” Clark said.
Clark said orders were canceled because they were 'obsolete, outdated, and/or duplicates, and the team did work diligently to remove these orders to improve quality and access to care in radiology.”
However, he acknowledged some exams were canceled without following policies or procedure.
'In those instances, appropriate personnel actions were taken to correct the behavior and staff reviewed the cancellations to ensure every order that required action was reviewed appropriately by a radiology provider,” he said.
He also said there was one incident in which a patient showed up for an appointment that had been canceled, but said the 'staff reacted quickly to ensure the patient got the care they needed immediately.”
U.S. Senators contacted
Dettbarn, who still works for the VA but in a different position with lower pay, said he sought help from U.S. Sens. Chuck Grassley and Joni Ernst. Grassley's staff never responded to him, but it's Dettbarn's understanding they did inquire at the hospital. Ernst's staff got him in touch with the Office of the Inspector General, he said.
When asked about the allegations this week, Ernst, herself a veteran, told a reporter that based on what she was aware of, it wasn't clear to her whether it was case of VA staff just not following procedure.
Grassley's staff did not respond to The Gazette's requests for comment Monday or Tuesday.
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James Q. Lynch of The Gazette contributed to this report.