Study Finds High Death Rates at 44 Hospitals Serving Veterans

A Department of Veterans Affairs study released Tuesday reports “significantly elevated” death rates for patients at 44 veterans hospitals and “likely quality of care problems” at 22 of the medical centers.

The study, based on a detailed analysis of selected cases, said the quality of care problems were most pronounced at hospitals in Tuskegee, Ala., and Battle Creek, Mich.

In the Tuskegee center, the report said that three of 12 cases, 25% of those studied, were judged to have “likely quality of care problems.” At Battle Creek, likely problems were found in 12 of 59 cases, or about 20%.

Problems in 1% of Cases

Hospitals with likely problems in 1% of cases or higher were listed.

The report concluded that the 44 medical centers had “significantly elevated mortality rates for at least one of four” patient categories.

The VA hospital at Loma Linda, Calif., was among hospitals on both lists. The report said that in 165 cases evaluated there were “likely quality of care problems” in eight cases at Loma Linda, a 5% rate.

Dr. Irvin Kuhn, in charge of quality assurance at the Jerry L. Pettis Memorial Veterans Administration Hospital in Loma Linda, said in a telephone interview Tuesday that hospital officials are reviewing records to determine whether the number of deaths deemed problematical is statistically significant or just “a blip.”

He said the deaths appear to have been avoidable in the short run, but in the long run the patients were dying of various conditions, including cancer, heart disease and liver disease. “I think that in some of these cases we certainly could have done better, yes,” Kuhn said.

The new mortality report is based on a review of 1,771 deaths in 1986 among patients at the 172 veterans hospitals around the country. Records for the dead patients were reviewed by several levels of evaluators and judged against a scale of predicted death based on several factors, such as patient age, condition, nature of the illness and type of care.

Evaluators ordered 123 of the 1,771 cases to be reviewed. And the groups of peer reviewers found 90 cases at 22 centers in which the care given was not consistent with current medical practice.

There were 15 hospitals with lower-than-predicted mortality rates, including the Wadsworth VA Hospital in West Los Angeles, and the VA hospital at Palo Alto, Calif.

Veterans Affairs Secretary Edward J. Derwinski ordered the report released but said in a letter to Congress that the report “did not represent a particularly effective use of VA resources.”

He said the report carries the qualifying note that “no general statement about the quality of care within (Veterans Affairs) can be drawn from these findings.”

Nonetheless, Derwinski said, “we must try to do better.”