Health risks discovered at VA hospital in Washington DC

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(CNN) The Department of Veterans Affairs' inspector general says practices at the Washington VA Medical Center are putting "patients at unnecessary risk," and the VA has removed the director of the hospital from his position, assigning him to temporary administrative duties.

A report out Wednesday raised several concerns related to staffing shortages, dirty storage areas and failure to keep track of medical equipment, leading to shortages that could endanger patient health.
The report identified 18 dirty sterile storage areas out of 25 reviewed at the medical center, and found that more than $150 million in equipment had not been inventoried or accounted for in the past year, which led to medical procedures being canceled or delayed.

The VA's inspector general, Michael Missal, said his "lack of confidence" in the VA's ability to address the root causes of the issues and the urgent nature of the risk to patients made it necessary to release his interim findings before the investigation is complete, a rare step.
The VA responded to the report by removing the medical center director from his position and said more disciplinary actions may follow. The former director, Brian A. Hawkins, could not immediately be reached for comment by CNN. The VA initially named the facility's chief of staff as the acting medical director but reversed that decision later Wednesday and named Lawrence Connell, a VA policy adviser, to the position.
"VA is conducting a swift and comprehensive review into these findings. VA's top priority is to ensure that no patient has been harmed," the VA said.

The investigation began after a confidential source forwarded documents to the inspector general's office in March that described problems related to equipment and supplies at that Washington facility, according to the interim report.

The office then deployed a rapid response team to examine the allegations and found supply shortages within the medical center, such as a lack of equipment used to detect defects in scopes that could cause burns as well as a shortage in tubing needed to give patients oxygen, among other issues.
The medical center recorded 194 patient safety reports since 2014 related to unavailable equipment or supplies, the report found.

The shortages caused multiple medical procedures to be canceled or delayed. For example, four prostate biopsy surgeries were canceled due to a lack of biopsy guns, and a jaw procedure was postponed after a tray was removed from the facility due to outstanding invoices from a vendor.

A surgeon also used expired surgical equipment on a patient in 2016, and the inspector general found the VA facility had no effective system to manage its health care equipment and also had no plan to determine whether current stock had been recalled.

The report said the medical center's problems are compounded by staffing vacancies, which include a lack of health care providers, hospital managers and the human resources staffers needed to hire them.
The inspector general's office did not yet find any instances in which conditions at the Washington VA facility caused physical harm to patients but recommended the VA take immediate steps to organize supplies and expedite hiring.

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