Newspaper - VA hospital workers complained about problems

KANSAS CITY, Mo. -- Mouse droppings sickened employees. Leaks from a dialysis unit coated an office below with a sticky goo. Sanitation warnings from employees and patients piled up at the Kansas City veteran's hospital for five years before officials began to act, The Kansas City Star reported Thursday.

Even then, the Veteran's Affairs department did not begin cleaning its hospital in earnest until this year, following a March report of a 1998 mouse and fly infestation.

The poor sanitation shocked retired nurse Alice Bullock when her brother-in-law was in the hospital awaiting gall bladder surgery in 1999. She found flies in his room, and her husband discovered a mousetrap under the bed.

From 1998 through early this year, patients filed more than 120 complaints about hospital conditions.

The patient advocate reported the complaints quarterly to senior administrators.

One patient expressed disgust that the "plastic light panels over my bed are infested with large dead flies."

Another complained about a filthy room, a toilet seat with feces on it and even blood on the floor.

Employees complained, too. The Star said VA documents it examined showed that employees told administrators of plumbing leaks in the dialysis center, rodent droppings in an employee canteen, and dust so thick on an anesthesia machine, an employee wrote his initials in it.

According to the Star:

--A March 2001 outbreak of bacterial infections in a medical ward was traced to poor housekeeping. Inadequately trained housekeepers, for example, failed to change water and wash mop heads frequently enough while cleaning among patients under isolation precautions.

--In 1999, two hospital employees developed stomach cramps after eating ice from a hospital ice machine. Employees found rodent feces in the ice.

--In July 1997, a hospital administrator found that a leak from the dialysis unit on the floor above had soaked his office.

"The result is smelly carpet and a very hard, sticky substance on my furniture and walls," he complained in an e-mail. "This is the third time this has happened."

The administrator expressed concern that he had developed "a headache, wheezing and watery eyes from being in my office."

Last summer, employees told the VA Inspector General's office that a faucet in the dialysis area had been leaking for 14 years.

--In October 1997 and January 1998, outside consultants performed mock surveys to prepare for visits by the Joint Commission on Accreditation of Healthcare Organizations. The mock surveys cited operating room cleanliness as a "major deficiency."

Soon after, hospital staff reported in an e-mail to administrators that the operating rooms were "in desperate need of more thorough cleaning."

Shelves in a cabinet for sterile materials were dirty. Dust was so thick on an anesthesia machine, an employee wrote his initials in it.

"There seems to be a question as to who cleans what. Therefore, some things just are not getting cleaned," staff reported.

Former hospital director Hugh Doran's e-mail response to the director of hospital facilities was: "WHAT IS GOING ON HERE???"

--In October 1999, doctors had to interrupt arthroscopic knee surgery because a wasp entered the operating room and broke the sterile field. Medical staff reported the incident to management.

Within weeks, staff reported two additional incidents in which a fly and a gnat entered the operating room. The insects appeared to have infiltrated the room through an opening above the ceiling lights, a VA document said. It took 43 days from the first complaint to seal off the operating room from insects.

Even as protests from staff and patients mounted, the hospital's leadership remained intent on cutting staff, current and former employees say. The number of hospital employees decreased by 29 percent from 1995 to 2001.

The hospital's continuing problems prompted Washington to order a shake-up in local VA administration and to launch investigations into sanitation and VA management in Kansas City. A $10 million overhaul of the hospital has started.

More housekeepers and supervisors are being hired, poorly maintained areas are being spruced up and top administrators are taking part in weekly hospital inspections.

"There's been significant improvement," said Kent Hill, who took over as hospital director in January. "But we know there's still work to do."

The VA once considered management in Kansas City so good that it awarded regional director Patricia Crosetti $82,800 in bonuses from 1997 through 2001 and gave Doran, who retired last June, a promotion and $18,800 in bonuses from 1997 through 2000, according to VA documents.

VA officials in Washington said investigations by the agency's inspector general should explain how maintenance and sanitation problems could continue for years without correction.

Meanwhile, Crosetti and her deputy director have been reassigned to other duties pending the outcome of the investigations.

A spokeswoman for the VA said Crosetti declined to comment about conditions at the Kansas City hospital.

As a result of the problems in Kansas City, directors of VA hospitals nationwide have been asked to sign a "Certificate of Compliance," vouching that their hospitals have been inspected and pest control and cleanliness measures have been addressed.