Report details delays, lack of care at PHX VA

Posted at 4:12 AM, Sep 18, 2015
and last updated 2015-09-18 07:12:41-04

New information on mismanagement at the Phoenix VA was released Thursday morning, pointing to the hospital’s emergency department.

The Special Counsel wrapped up its investigation and sent a letter to President Obama confirming what a former emergency room doctor has claimed all along.

Dr. Katherine Mitchell says she started seeing lapses in care from emergency triage nurses as far back as 2009. “Strokes were missed,” says Mitchell. “Heart attacks were missed. Blood infections were missed repeatedly over and over again.”

The investigation points to one instance where a patient, with a history of strokes, waited in the hospital’s emergency department for eight hours. At least 120 other cases experienced dangerous delays in care because of lapses in triage. The report says at some points, the hospital had no emergency department nurses with adequate triage training. “It’s a specific skill set,” says Mitchell. “You have to be taught by someone through a course or by someone who has completed a course and is certified to be able to teach. Those things didn’t happen at the Phoenix VA so poorly trained nurses were training poorly trained nurses.”

ABC15 reached out to the Phoenix VA Hospital for a response to the report. The hospital sent us this statement.

“Every Registered Nurse (RN) who triages patients must complete training on the ESI (Emergency Severity Index) tool which is used throughout the country to triage patients. Additionally, we have developed local training on ESI and nurses are tested on it. We have reworked the competency assessments for all RNs in the Emergency Department and have added nurse educators to the Emergency Department to ensure RNs are well versed in Emergency Department procedures.”