Inspectors: Long waits at North Las Vegas VA hospital not unusual

Sandi Niccum, 78, waited 63 minutes before an initial check by a triage nurse for abdominal pain, then was sent to continue waiting without being rechecked periodically before finally seeing a physician. Hospital workers failed to reassess her condition during the long wait, as they are required to do on an hourly basis, according to a 19-page report by the Department of Veterans Affairs Office of Inspector General.

“We concluded a wait of this length was, at a minimum, challenging for this patient,” according to the report. “However, mitigating this long wait was the fact that numerous other patients who were assessed to be in more urgent need of attention were in the ED (emergency department) at the same time.”

All told, Niccum spent five hours and six minutes in the emergency room of the hospital. She went to the medical center on doctor’s orders originally to have testing and X-rays done but was referred to the emergency room after a mix-up in the radiology orders.

After being seen at 9:28 p.m., Niccum, who was a diabetic, was given a prescription for pain medication and went home. She returned to the hospital two days later for the recommended testing that showed symptoms of cancer, colitis and a perforated appendix.

Niccum died on Nov. 15 at a local hospice after a bout with a colon disorder. The Navy veteran had racked up 5,000 volunteer service hours helping veterans and staff at VA facilities.

Inspectors said they found “no relationship between the length of the patient’s wait and her subsequent clinical course.”

Rep. Jeff Miller, R-Fla., chairman of the House Committee on Veterans Affairs, and Rep. Dina Titus, D-Nev., requested the VA’s inspector general investigate the hospital’s care of Niccum, a veterans volunteer whose ordeal was reported by the Las Vegas Review-Journal in November.

The resulting report shows an emergency department struggling with patient flow.

The hospital’s target is for less than 10 percent of emergency patients to have a waiting time of more than six hours. Investigators found the facility met that target only one day during the week they examined.

Dee Redwine, who accompanied Niccum to the medical center and stayed by her side that evening, said she was disappointed by the report, which she believes does not adequately capture her friend’s pain and confusion while awaiting care. She contends it glosses over rude and dismissive conduct by hospital staff toward Niccum during her struggles.

Investigators were hampered because no security video exists from that evening of the emergency room, the pharmacy or the radiology department. The VA said footage is recorded but routinely erased after 30 days, and was gone by the time the probe was initiated in December.

Inspectors said they contacted a police chief at another VA medical center who confirmed erasing footage after 30 days was consistent with practice at his center.

Consequently, “We did not substantiate the allegations of staff disrespect,” said the report, which was signed by John D. Daigh Jr., assistant inspector general for healthcare inspections. Daigh suggested the hospital take the opportunity to examine its customer service practices.

“I am very disappointed,” Redwine said. “Not having the tape and not having any documentation, I didn’t expect anything better to come from the review because the records were not there for them to see how we were treated and what happened.

“They are just reviewing VA practice and I was there with an individual with a serious problem,” Redwine said. “We were there until almost 11 o’clock at night with a diabetic who was dying at the time and I didn’t know that at the time.”

Rep. Steven Horsford, D-Nev., said the findings “are disturbing.”

“I agree with the report’s recommendations to the facility director: plans must be developed to prevent unacceptably long wait times and emergency department patients’ conditions should be monitored and updated if must they wait,” Horsford said. “Unfortunately, Sandi Niccum did not receive the type of treatment she deserved, and that is just wrong.”

The VA in a statement said the report “reaffirmed the quality and dedication to mission the staff of the VA Southern Nevada Healthcare System demonstrates.

“The allegations of staff disrespect were not substantiated nor were there any findings suggesting improper care was delivered,” it said. “Our staff stands ready to meet the commitment to serve our Veterans and willingness to improve where there is opportunity. We thank all of the Veterans who have given us the honor to serve them at the VA Southern Nevada Healthcare System”

But Titus said the report illustrated what had become clear to the VA and to its Southern Nevada patients: The emergency department is too small at the $1 billion medical center that was praised as state-of-the-art when it opened in August 2012. The VA has embarked on an expansion that will add 14 beds to the ER for a total of 25 at a cost of $16 million.

Titus, who sits on the House Veterans Affairs Committee, said she has spoken with doctors at the hospital who have conveyed concerns about staffing and management practices that she continues to investigate.

“We need to look at the whole operation of the emergency room, including its size, equipment, staffing and management,” Titus said. “Overall we need to put an emphasis on better customer service and patient care, and we can do that with certain metrics and with a new attitude.”

Titus said she has received a pledge from local VA Director Isabel Duff. “They are going to try to have that new attitude so that nothing like this ever happens again.”

Auditors who reviewed hospital records from the day Niccum checked in at the emergency room counted nine patients whose need was rated Level 2 on the Emergency Severity Index as determined by triage nurses prioritizing care. Niccum was rated a Level 3, lower on the index. Level 2 patients waited between two and four hours before seeing a doctor, investigators found.

Thirteen patients including Niccum were rated Level 3. Five of them were admitted to the hospital, transferred to another facility or left without being seen. Of the remaining eight, the length of stay in the emergency room ranged from 1 hour and 26 minutes to 7 hours and 19 minutes.

Checking back, inspectors said they were told by hospital managers the percentage of patients with waiting times greater than six hours “has improved.” It was about 14 percent at the end of December, they said.

Review-Journal writer Keith Rogers contributed to this report. Contact Stephens Washington Bureau Chief Steve Tetreault at STetreault@stephensmedia.com or 202-783-1760. Find him on Twitter: @STetreaultDC.