From: km@speedy.cs.pitt.edu (Ken Mitchum)
Newsgroups: sci.med
Subject: Re: TV Sensationalism [Re: 60 Minutes-Heart Disease & The French]
Date: 29 Jul 92 12:52:03 GMT
Reply-To: km@cs.pitt.edu (Ken Mitchum)
Organization: Computer Science Dept., University of Pittsburgh

In article <l7an0kINN1aq@news.bbn.com> levin@bbn.com (Joel B Levin) writes:
>
>I would be interested in your comments, if you have any (or can make
>any) on the 20/20 piece on VA hospitals (aside from the ethical issue,
>if any, of using hidden camera techniques).  [I don't remember which
>hospital they did that story on.]
>

I can comment as an individual - anyone who knows me know that I
certainly do not speak for the VA.

It has been awhile since I saw the 20/20 piece, but I have some
memories of it. It was about the Cleveland VA. The article was
very uneven, was certainly onesided, and some things were grossly
misportrayed. Overall, it seemed to me to be something put together
very quickly and without a lot of research. I say that because if
they had spent much time researching the VA system, they would
have found many more serious things to look at that make medical
care in the system very difficult at best. I basically view the
20/20 article as an unfortunate sideshow, unfortunate because it
led to a stonewalling from the VA in terms of public relations
which continues to this day, and because it really didn't touch
on the real issues.

As far as specifics: The incident of the disgruntled food employee
simply leaving the tray and being nasty to the patient is very
believable. The food employee is not supposed to feed the patient:
that is a job for a nurse or nurse assistant, and I find it less
believable that someone was not available for this. However, I
have seen incidents where staff attempted to punish certain 
patients by making life uncomfortable for them, so this may have
happened. The VA system is essentially civil service. This has
two major consequences: it is almost impossible to fire someone,
and it is also impossible to reward someone for good performance
in the usual fashion. Raises occur at fixed times and are
essentially independent of what kind of work an employee does.
Because of this, employees basically do what they want, and if
the job gets done, fine.

The handwashing (or lack thereof) was very believable, but is
very non-specific to the VA. Thousands of physicians and nurses
do not regularly wash their hands between patients and this
occurs at any hospital you look at. 

The complaints of the paramedic were not accurate. He stated that
people they bring into the VA after cardiac arrest should have
something like a 70% rate for successful resuscitation, and that
the VA was simply letting people die. The fact is that for cardiac
arrest outside the hospital, the success rate (survival, not simply
restoring a rhythm) is much, much, lower than this. I don't think
he understood that just because someone in the field gets some
kind of rhythm back that the patient is going to make it. If they
had done any second-checking on this, they would have found this
out. 

The director of the Cleveland VA has since been transferred to
the Butler, Pa. VA. He is one of only a few VA directors who
are actually MDs. Unfortunately, he froze in front of the TV
camera, and came across extremely poorly.

There was an article a few weeks later - I believe it was 20/20
again, which looked at homeless veterans. This one was totally
off the mark. They followed a homeless vet in NYC to the main
Manhattan VA, where he asked to be admitted. The fact was, there
was no medical reason to admit the man at the time, and he was
turned down. Unfortunately, he was given a very out of date list
of shelters. The implication of the article was that it is the
duty of the VA to admit every homeless veteran and house them.
This is not true - the Manhattan VA has no room for all the
homeless veterans, and that is not what the hospital is there
for. The hospital is there to take care of sick veterans.

There are many, many problems in the VA system, but the above
shows did not even get close to them. We need a return to the
old Edward R. Murrow and Walter Cronkite type of documentaries
which actually did take a close, objective look at some problems.
But you are not going to see that in the 1990s.

 -km