Brown and Turner: Establish Regional Task Force to Ensure Patient Safety at Dayton VA

Following Reports of Neglect and Violations at Dayton VA Medical Center, Brown and Turner Urges Shinseki to Create Dedicated Task Force

WASHINGTON, D.C. — Following reports of two patients who tested positive for hepatitis B due to improper infection control practices at the Dayton VA Medical Center’s dental clinic, U.S. Sen. Sherrod Brown (D-OH) and U.S. Rep. Mike Turner (OH-3) today urged U.S. Department of Veterans Affairs (VA) Secretary Eric Shinseki to establish a dedicated task force to investigate issues surrounding misconduct at the Dayton VA Medical Center and make recommendations to prevent this situation from happening in Dayton and across the nation.

“We must determine how the VA allowed patient care to erode to the point where hundreds of patients in Dayton had to be tested for diseases due to exposure to blood-borne pathogens,” Brown said. “Establishing a regional taskforce will reassure our veterans that the VA remains dedicated to their care and patient safety while providing them with a seat at the table and the opportunity to participate in the improvement of the VA system.”

”Since learning of this outrageous occurrence at the Dayton VA, it’s become apparent that there is a larger issue at hand within this facility, the VISN 10 Network, and perhaps nationally. A regional taskforce will place a finer microscope on the VA and its culture, which has allowed this failure to occur. We owe it to our veterans to take every step necessary to ensure they get the care that they deserve and rightfully have earned,” said Turner.

This task force would review all of Veterans Integrated Service Network 10’s (VISN 10) facilities, activities, and services to help identify how procedural lapses allowed this situation to happen, and what measures can be taken to prevent similar scenarios moving forward. VISN 10 includes Ohio and portions of Indiana and Kentucky.

Brown and Turner proposed that the task force include health care professionals, VA medical professionals and employees, veterans, and leaders in the veteran community to perform a collaborative, tough, and fair look at VISN 10 to provide invaluable insight to the VA and policy makers. The task force’s findings would improve VISN 10’s services at all VA facilities.

Brown and Turner have been working with the Dayton VA, Sec. Shinseki, and the Senate and House Veterans Committees since first learning of allegations of unhygienic practices at the Dayton VA Health Clinic. Last month, Brown called for a thorough organizational review by the VA and concrete changes at the Dayton VA Medical Center. This call follows a recent visit by Congressman Turner and House Veterans Affairs Chairman Jeff Miller to the Dayton facility.

In February, the Dayton VAMC issued a report indicating that several employees may have known for years that a practitioner was using unhygienic practices— exposing veterans to blood-borne pathogens through non-sterilized dental equipment. In response, Brown joined U.S. Sen. Rob Portman (R-OH), and U.S. Rep. Mike Turner (OH-03) in writing to Shinseki to request increased oversight and a more expansive investigation.

Brown wrote to Sen. Patty Murray (D-WA), Chairman of the Senate Committee on Veterans’ Affairs, to request a hearing to investigate this situation and identify preventive actions that would ensure that a situation like this never arises again. Turner has also written to the Chairman of the House Veterans Affairs Committee requesting hearings into the issues surrounding the VA’s Dental safety practices nationally. Last year, Brown sent a letter to U.S. Department of Veterans Affairs Sec. Eric Shinseki urging the VA to investigate the complaints at the VAMC. Brown and Turner have spoken with Shinseki and VAMC officials repeatedly urging them to correct any issues and install effective leadership.

Full text of the letter is below. 
April 7, 2011
The Honorable Eric K. Shinseki
Secretary
Department of Veterans Affairs
Washington, DC 20501
Dear Mr. Secretary:
As we have previously discussed, the egregious violations of medical standards of practice at the Dayton VA Medical Center’s Dental Clinic are unacceptable, as is the time it took for the Department of Veterans Affairs (VA) to be informed of the violations and begin to correct them.  As the VA and the Senate Committee on Veterans Affairs continue to investigate this situation, I call on you to take additional steps in accordance with your authority as Secretary.  
We must determine how, for more than 18 years, the VA allowed patient care to erode to the point where hundreds of patients at Dayton had to be tested for Hepatitis B, Hepatitis C, and HIV because they were exposed to blood borne pathogens as a result of their care.  Those who enabled this to happen must be held accountable.  We must also identify the source of this problem and ensure that a similar working environment has not taken root at any other VA Medical facility.  We must do all we can to prevent this situation from ever happening again.
I ask that you create a dedicated task force with appropriate staff and resources to review all of VISN 10’s facilities, activities, and services.  Doing so will allow VA to identify how lapses in the past allowed this situation to happen, and what measures can be taken to prevent similar lapses in the future.  Such a task force should include health care professionals, VA medical professionals and employees, veterans, and leaders in the veteran community.  If given the ability to perform a collaborative, tough, and fair look at VISN 10, this task force can provide invaluable insight to the VA and policy makers.   The results can then be used to improve VISN 10’s services and services at all VA facilities.
Finally, taking this bold step will reassure our veterans that the VA remains dedicated to their care and patient safety.  It will also give veterans and those who care for them a seat at the table and the opportunity to participate in the improvement the VA system.
I appreciate your consideration of my request and I thank you for your service to our nation and its veterans.  I look forward to your response.
Sincerely,
Sherrod Brown      
United States Senator
Michael Turner
United States Congressman
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Full text of the letter is below. 

April 7, 2011

The Honorable Eric K. Shinseki
Secretary
Department of Veterans Affairs
Washington, DC 20501

Dear Mr. Secretary:

As we have previously discussed, the egregious violations of medical standards of practice at the Dayton VA Medical Center’s Dental Clinic are unacceptable, as is the time it took for the Department of Veterans Affairs (VA) to be informed of the violations and begin to correct them.  As the VA and the Senate Committee on Veterans Affairs continue to investigate this situation, I call on you to take additional steps in accordance with your authority as Secretary.  

We must determine how, for more than 18 years, the VA allowed patient care to erode to the point where hundreds of patients at Dayton had to be tested for Hepatitis B, Hepatitis C, and HIV because they were exposed to blood borne pathogens as a result of their care.  Those who enabled this to happen must be held accountable.  We must also identify the source of this problem and ensure that a similar working environment has not taken root at any other VA Medical facility.  We must do all we can to prevent this situation from ever happening again.

I ask that you create a dedicated task force with appropriate staff and resources to review all of VISN 10’s facilities, activities, and services.  Doing so will allow VA to identify how lapses in the past allowed this situation to happen, and what measures can be taken to prevent similar lapses in the future.  Such a task force should include health care professionals, VA medical professionals and employees, veterans, and leaders in the veteran community.  If given the ability to perform a collaborative, tough, and fair look at VISN 10, this task force can provide invaluable insight to the VA and policy makers.   The results can then be used to improve VISN 10’s services and services at all VA facilities.

Finally, taking this bold step will reassure our veterans that the VA remains dedicated to their care and patient safety.  It will also give veterans and those who care for them a seat at the table and the opportunity to participate in the improvement the VA system.

I appreciate your consideration of my request and I thank you for your service to our nation and its veterans.  I look forward to your response.

Sincerely,

Sherrod Brown
United States Senator

Michael Turner
United States Congressman

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