On November 21, 2020, The Department of Veterans Affairs’ released a report investigating a 90-year-old patient who died after waiting over two hours in a VA hospital. While the patient’s name has not been released, the VA Office of Inspector General (OIG) stated that the patient died at the Jerry L. Pettis Memorial Veterans Hospital located in Southern California. According to the report, the patient died shortly after having their vital signs taken following the two-hour emergency room wait.
Details of the VA Inspector General Report
According to the VA report, the primary care nursing staff failed to provide adequate hand-off communication to the emergency department when the patient was recommended to receive treatment in the emergency room. While the OIG was unable to determine if this factor contributed to the wait time or care the patient received, the department stated that documentation and communication are critical to providing patient care. Additionally, the OIG noted that the primary care nurse failed to create a documented assessment of the patient’s condition. Similarly, the first responding nurse emergency room nurse was not required to obtain the patient’s vital signs under hospital policy.
Response of the VA Health System
Karandeep Sraon, the director of the Loma Linda Health Care System which oversees the Jerry L. Pettis hospital, stated that this incident does not reflect the quality of care that the health system provides to thousands of veterans in Southern California. Additionally, the hospital has proposed several changes to operations to prevent the occurrence of future incidents. This includes a new policy requiring that an emergency room nurse documents a patient’s vital signs within 10 minutes of arrival. However, a review of emergency room records in January found that the new policy only had a 65 percent compliance rate.
Other Documented Incidents at the Pettis Memorial Hospital
In addition to the November 2020 report, the VA has published two other recent reports that have identified health concerns at the Perris Memorial Hospital. This includes an incident in 2019 where the VA found that the hospital failed to provide cleaning staff with proper training, which may have led to an increase in deadly infections at the facility. A similar VA report found the Pettis Memorial Hospital administrators failed to inform hospital staff about Legionella bacteria found in the facility in 2017.
Contact an Experienced Medical Malpractice Attorney Today
If you or a loved one were injured due to negligence or reckless action, you might be able to receive compensation and hold negligent parties accountable. The knowledgeable medical malpractice lawyers at Karlin & Karlin have experience pursuing claims against the federal government and advocating for their clients in federal court. Our seasoned attorneys could examine your case and help you determine your options. Call us today to learn more.
