Seven veterans blind and others with "progressive visual loss" as VA admits improper care.

NOTE from Larry Scott, VA Watchdog dot Org ... Use our search engine for more about treatment and programs at the Palo Alto VA and for more about veterans and glaucoma.

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VA says glaucoma patients at Palo Alto facility suffered severe vision loss due to mistreatment

http://www.mercurynews.com/ci_12886990?nclick_check=1

By Jessica Bernstein-Wax

The U.S. Department of Veterans Affairs has confirmed its Palo Alto facility put the chief of optometry on administrative leave and reassigned another optometrist while it investigated the treatment of hundreds of eye patients, some of whom experienced significant vision loss under the department's care.

In February, the VA Palo Alto Health Care System initiated a three-month internal review of 381 charts and determined 23 glaucoma patients experienced "progressive visual loss" while receiving treatment in the hospital's optometry department, the Veterans Affairs office in Washington, D.C., told the Bay Area News Group. The VA informed seven of those patients that improper care might have caused their blindness.

At issue is whether the optometry department failed to follow VA policy requiring it to consult with medical doctors on glaucoma cases — possibly costing the patients their vision.

"The VA Palo Alto Health Care System has a policy that all patients with glaucoma seen in the optometry section should have their cases overseen and reviewed by the ophthalmology section," VA Press Secretary Katie Roberts said in a statement. "Earlier this year, VAPAHCS leadership became aware this had not occurred in some cases. VAPAHCS leadership took immediate action, ordering an exhaustive review of all glaucoma patients and patients at risk for glaucoma who were being actively seen in optometry."

Of the seven blind patients contacted, two have filed lawsuits, the VA said, noting it settled one claim and the other is pending.

During the review, doctors identified 87 other veterans at high risk of losing their sight and placed all of them — except one who was living out of state — under the care of the ophthalmology department, the VA said.

Glaucoma is a group of eye diseases that can cause vision loss and blindness by damaging the optic nerve, according to the National Eye Institute's Web site. Optometrists are doctors of optometry, with a minimum of four years of training, who can treat glaucoma if certified. Ophthalmologists are medical doctors with eight years of training, including medical school, an internship and a residency.

As a result of the probe, the ophthalmology department now handles all glaucoma cases and is supervising the optometry department, the VA said.

The investigation came after doctors discovered a 62-year-old male veteran had "significant visual loss in one eye as a result of poorly controlled glaucoma" during a Jan. 16, 2009, visit to the ophthalmology clinic, the VA said in a second written statement. He had been treated at the hospital's optometry unit since at least June 13, 2005, when a clinic note indicated optometrists suspected he had glaucoma.

"Ophthalmology Service became concerned that optic nerve damage and visual loss might have been avoided if the patient had been referred to ophthalmology sooner," the statement said.

A VA physician involved in the investigation said the patient saw Optometry Chief Curtis Keswick for years but wasn't treated for his glaucoma. The patient went blind in one eye and experienced serious vision loss in the other, said the physician, who asked not to be identified for fear of reprisal.

"They watched the optic nerve get worse, worse, worse, and they documented it," the doctor said. "This particular patient was never even put on eye drops."

Reached by phone Monday, Keswick said he couldn't give his version of what happened because the VA had barred him from speaking about the case.

"As part of the investigation, which is still ongoing, I have been mandated not to talk with anyone about it," Keswick said.

Optometrists and ophthalmologists have been fighting over glaucoma certification requirements for optometrists after state legislation passed last year broadened optometrists' ability to treat the disease and prescribe medication.

Backers of the bill, sponsored by Sen. Lou Correa, D-Santa Ana, argued it would enable more people with glaucoma to receive treatment. Ophthalmologists have expressed concern about the amount of training optometrists receive.

Last week the California State Board of Optometry accepted final education recommendations for the certification and will enact regulations in January of next year, said Mona Maggio, board executive officer.

Keswick has no California glaucoma certification, according to the state board's Web site. However, he is also licensed in Washington state, where additional certification is not required for optometrists to treat glaucoma with topical medications, a spokeswoman for the Washington Department of Health said.

Doctors with certifications from other states can practice at the VA. However, the VA has a stricter policy on what optometrists can do than many private institutions, VA spokesman Roberts said.

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TOPICS: veterans, veterans' benefits, VA, Department of Veterans' Affairs, Palo Alto, glaucoma, improper treatment, optometry, ophthalmology