St. Louis VA Medical Center Problems Identified More Than A Year Ago

A former sterility processing employee says that supervisors at a St. Louis VA medical center ignored warnings that they were practicing improper sterility procedures a year before the facility was forced to warn more than 1,800 veterans that they may have been exposed to blood borne diseases while undergoing dental procedures at the facility. 

Earlene Johnson testified before the U.S. House of Representatives Veterans’ Affairs committee last week, telling lawmakers that her efforts to warn about inadequate sterility procedures fell on deaf ears at the John Cochran Veterans Administration Hospital in St. Louis, and her persistence led to her being fired while on disability leave. The VA hearing was called in response to 1,812 warning letters the hospital sent out to veterans in late June telling them they needed to be tested for HIV and Hepatitis C.

The letters were sent after hospital officials determined that dental technicians took it upon themselves to wash dental tools using soap and water, instead of sending them to be cleaned properly by the hospital department charged with sanitizing and sterilizing medical instruments. While the instruments were still sent on later to be cleaned, the breach in proper protocol could have still led to veterans being put at risk, hospital officials said. The improper cleaning procedures went on from February 2009 until March 2010, when inspectors discovered the error.

“I warned management that they needed to go to every auxiliary department to ensure no one was sterilizing any instrument or anything that pertains to Sterile Processing,” Johnson said in her written testimony, in which she says she was rebuffed when she tried to take her concerns to higher levels. “Afterwards, I started being harassed and intimidated because of my warning.” Johnson said she was eventually fired while on medical leave and is suing to get her job back.

Committee Chairman Bob Filner said in his testimony that lawmakers also appeared to have been stonewalled and did not receive the information they needed in a timely manner. He also chastised hospital officials for trying to dismiss the hearing as a political ploy in the media.

The VA hospital system has faced substantial criticism over the quality of medical treatment provided at other medical clinics in multiple states throughout the course of 2009. Investigators from the Nuclear Regulatory Commission reported in June that a cancer unit at the Philadelphia VA Medical Center mishandled nearly 100 cases involving radiation treatment and suggested that staff involved had altered records to cover mistakes. The VA is also still dealing with the fallout from colonoscopy problems at VA centers in Tennessee, Georgia and Florida, where contaminated equipment exposed thousands of veterans to hepatitis, HIV and other blood borne diseases. Lawmakers blasted the VA in a hearing last July for the repeated lapses in veteran care.

“My biggest concern is that we’ve been here before,” said Rep. Hilner, referring to the sterility problems with colonoscopy equipment. “Clearly, VA has had issues with ensuring the sterility of reusable medical equipment in the past and clearly thy have yet to resolve these problems.”