Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SATURDAY, January 15, 1994 TAG: 9401150262
SECTION: VIRGINIA PAGE: A1 EDITION: METRO
SOURCE: LESLIE TAYLOR STAFF WRITER
DATELINE: LENGTH: Medium
In a report released this week, the General Accounting Office urged that, given the significant numbers, such patients - most of them psychiatric cases - be monitored more closely.
"While it is unreasonable to expect that the VA will be able to completely stop all psychiatric and other high-risk patients from leaving . . . without authority, the VA can and should take steps to reduce the number of such incidents from occuring," the GAO said.
The congressional investigative office found that 6,918 of the "high risk" patients were found unharmed, 34 were dead, 19 were injured and, as of June 1, 25 were unaccounted for. None of those still unaccounted for were patients of the Salem medical center, the GAO said.
The Department of Veterans Affairs "must identify patients who have the potential to leave without permission early in their hospital stay, and these patients must be closely monitored either through direct staff observation, electronic detection devices or both," it said.
In May 1992, Sen. Charles Robb, D-Va., and then-Sen. Alan Cranston, D-Calif., who was chairman of the Senate Committee on Veterans Affairs, requested that the GAO investigate missing-patient reporting and search procedures. Their request came four days after the discovery of the skeletal remains of a Salem VA Medical Center patient who had been missing since 1977.
The GAO's investigation focused on the period between Oct. 1, 1990, and Sept. 30, 1992, and on VA medical centers in Salem; Oklahoma City; Dayton, Ohio; Palo Alto, Calif.; and West Los Angeles, Calif.
The GAO focused on the Oklahoma City, Dayton, Palo Alto and West Los Angeles facilities because they had 62 percent of the missing patients unaccounted for in a 1992 systemwide survey of VA medical centers. The Salem facility was added because the bodies of two missing patients were found in March 1992 and a third was found two months later.
The GAO found that none of the facilties was taking sufficient steps to prevent high-risk patients from leaving their treatment settings without the knowledge and approval of staff.
"Our review of patient records showed that physicians and nurses at these centers are not consistently assessing a patient's potential for leaving without authorization when they take a patient's medical history upon admission to the facility," the GAO said.
The GAO described high-risk patients as those who are legally committed, have a legal guardian, are considered to be a danger to themselves or others, or lack the cognitive ability to make decisions.
The report found that 114 searches for patients were conducted at the Salem center during the two years studied, 10th-highest in the nation. The Dayton facility had the most searches, 354.
The family of one of the veterans whose body was found in Salem in March 1992 has filed a $3 million lawsuit against the medical center. The family claims that lax supervision, poor treatment and inadequate search procedures allowed Leonard Cunningham to walk out of his building unquestioned, kill himself on the center's grounds and then remain unaccounted for for more than a month.
The suit claims doctors continued to prescribe medication for Cunningham for a month, unaware that his body was hanging from a nearby tree.
The Salem facility overhauled its missing-patient search procedure after the discovery of Cunningham's body and those of two other patients. Yet six months later - in December 1992 - the body of a 60-year-old patient who had wandered off was found on medical center grounds. That patient had died of exposure.
The GAO said in its report that it requested written comments from the Department of Veterans Affairs but none were provided. The GAO did meet with agency officials to discuss the draft report and made changes where appropriate.
"VA officials generally agreed with our recommendations but said the conclusions significantly overstate the missing-person issue," the GAO said.
The VA operates the largest health-care delivery system in the United States. In fiscal year 1992, more than 935,000 patients were treated in VA medical centers on an inpatient basis.
by CNB