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Senators seek answers to “alarming” reports of excessive arterial procedures on veterans

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Just hours after ProPublica, in cooperation with The Wichita Eagle, disclosed serious allegations of illegal kickbacks and alleged harm to patients at a veterans’ hospital in Kansas, state US senators have urged the Department of Veterans Affairs to contact patients involved and say whether the doctors involved and medical device company was held responsible. Congressman from Wichita is also demanding answers.

In a letter sent Thursday, “regarding alarming reports of patient safety lapses and misuse of taxpayer dollars,” Republican senators Jerry Moran and Dr. Roger Marshall asked the VA for a “comprehensive chronicle and accounting” of the the agency’s knowledge of and response to the allegations, and to contact all veterans who received care at the cath lab at the Robert J. Dole Veterans Affairs Medical Center in Wichita between 2011 and 2018. During this time, according to an informant Lawsuit filed in 2017, representatives of Medtronic, the world’s largest medical device maker, treated healthcare workers to dinners at a steakhouse, Apple electronics and NASCAR tickets, and in turn, the company secured a lucrative contract with the Veterans Hospital.

Medtronic representatives also allegedly “trained and trained” hospital doctors, who then distributed the company’s devices, even in cases where it wasn’t medically necessary. The doctors in question were contract workers, paid by the hour by the facility, according to the lawsuit, and therefore incentivized to do longer and more complex surgeries, which would increase their pay.

In many of the procedures, doctors used more than 15 devices at a time, deviating from best practices, according to an internal investigation. One used 33.

“I mean the term ‘egregious’ was used,” former facility director Rick Ament testified last December in a whistleblower lawsuit deposition.

These procedures were done to treat blockages in the legs, a common medical condition also known as peripheral artery disease, which affects more than 6.5 million Americans over the age of 40. Any time a doctor inserts a foreign device into a patient during one of these surgeries, they carry a risk of complications, which can include clots or even require amputation.

An internal investigation at the Wichita hospital uncovered a number of clinical failures, including overly aggressive procedures and a disregard for best practices. It also found, according to an internal email, that amputations had increased sixfold during the time period in question. A VA spokesperson didn’t say whether these findings were related to excessive use of the devices and said the agency’s review had yet to find any “quality of care” issues. The review is expected to last several months. (Read the VA’s full statement in response to the ProPublica story.)

In 2018, the director of the Wichita facility halted interventional radiology procedures at the hospital and shared the findings of his internal investigation with the VA’s office of the inspector general. The following year, according to an investigation note found in the whistleblower’s lawsuit, the OIG found that hospital employees “may have received improper tips, in the form of lunches, dinners, etc., from sales representatives of Medtronic. “

Although the VA has known about the allegations of kickbacks and device overuse for about five years, the agency did not publicly acknowledge these findings outside of the lawsuit until reaching out to ProPublica. It is unclear whether the VA contacted patients undergoing these procedures during the time period in question. ProPublica contacted more than half a dozen veterans community groups in the Wichita area, and none were aware of the allegations or the internal investigation.

Following the publication of the ProPublica story, U.S. Representative Ron Estes, a Republican from Wichita, expressed concern and pushed for accountability within the VA. “The VA has to come [the] these serious allegations,” he said in an email. “Veterans in our community should contact my office here in Wichita with any issues they face.”

Kansas senators urged the agency to notify affected patients of the “steps the VA has taken to evaluate the quality of care they received there and provide them with contact information for the appropriate officials who can answer any questions or concerns they might have.”

Moran, the ranking member of the Senate Veterans Affairs Committee, and Marshall, a physician who served seven years in the Army Reserve, also ask for answers to the following questions:

  • What steps has the VA taken to “remove the affected contract employees from patient care duties, report them to appropriate authorities, hold them accountable for their wrongful conduct, and prevent them from practicing not only at the Dole VAMC but also at any other facility VA or through VA community care networks”? (A VA spokesperson told ProPublica that neither it nor the hospital had taken formal action against the medical providers.)

  • What steps has the VA taken to “hold the contractor, Medtronic, accountable for its role in this incident”? (The VA found evidence that the facility had purchased a large number of devices from Medtronic, which resulted in increased costs. The VA did not respond to ProPublica’s questions about the reasons for the over-purchase of devices, citing ongoing whistleblower case and OIG investigation The agency said the Wichita facility is no longer purchasing Medtronic equipment and supplies for complex lower extremity vascular procedures, but is continuing to purchase other types of the company’s products. Medtronic declined to answer ProPublica’s questions, citing ongoing litigation.”These allegations are false and Medtronic is defending these claims in court,” said Boua Xiong, a company spokeswoman.Medtronic did not respond to a request for comment. by ProPublica in response to the letter from the Kansas senators.)

In addition to more details about the agency’s investigation, the senators also asked the VA to assure patients at Wichita Veterans Hospital that “their safety is the VA’s primary concern” and to “inform those who are understandably wondering whether it is safe for them to continue seeking care there of their right to seek care in the community.”

Gary Kunich, a VA spokesman, said the agency received the letter and was “working on a quick and comprehensive response to Senator Moran and Senator Marshall.”

Do you know more about the procedures at Dole VA? Were you or was someone you know a patient who underwent one of these procedures? Contact reporter Annie Waldman at 347-549-0332 or [email protected].

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