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Coronavirus heightens problems at veterans’ Decatur hospital, clinics

Nurses assist visitors coming for COVID-19 tests at a drive-thru testing center at the Atlanta VA Medical Center in Decatur on Thursday, July 2, 2020. Staff have raised health concerns for patients and other staff, fearing exposure to the virus through lax protective procedures. (REBECCA WRIGHT FOR THE AJC)
Nurses assist visitors coming for COVID-19 tests at a drive-thru testing center at the Atlanta VA Medical Center in Decatur on Thursday, July 2, 2020. Staff have raised health concerns for patients and other staff, fearing exposure to the virus through lax protective procedures. (REBECCA WRIGHT FOR THE AJC)

The Veterans Affairs hospital in Decatur is struggling to limit COVID-19 exposure, and the shutdown of most other health care services during the pandemic has kept many veterans from getting needed help, say staff and patients.

Staff are concerned about lax screening of people entering the hospital, the mixing of veterans being tested for the coronavirus with surgery patients and inadequate cleaning of exam rooms after positive tests, among other problems, according to internal emails from doctors and nurses reviewed by The Atlanta Journal-Constitution.

Forty-one staffers at the largest hospital for veterans in Georgia have tested positive for COVID-19, four in the last two weeks, according to a doctor who spoke on condition of anonymity. The screening process to prevent potentially infected people from entering the hospital “has been an epic fail,” the doctor added.

The virus-related problems have slowed the attempted comeback of the VA regional healthcare system from years of notable failures including some of the lowest hospital scores in the nation.

In a written response to questions, the VA said it has heard some virus-related complaints, but has been taking steps since the beginning of the outbreak to protect patients and staff.

“The Atlanta VA Health Care System’s number one priority is the health, safety, and protection of all our veterans and staff,” it said. “We are equipped with an amount of essential items and supplies and are prepared to safely handle COVID-19 cases.”

Nurses assist visitors with Covid-19 tests at a drive-thru testing center at the Atlanta VA Medical Center in Decatur, Georgia, on Thursday, July 2, 2020. (REBECCA WRIGHT FOR THE AJC)
Nurses assist visitors with Covid-19 tests at a drive-thru testing center at the Atlanta VA Medical Center in Decatur, Georgia, on Thursday, July 2, 2020. (REBECCA WRIGHT FOR THE AJC)

Slow climb back from a shutdown

The Decatur hospital, the largest in the Southeast, and its community clinics serve about 120,000 Georgia military veterans.

It was working its way out of problems that culminated last fall, when concerns about unsanitary conditions caused a months-long shutdown of the surgery center. Earlier last year, a fire ant infestation that went unaddressed by staff left one veteran covered in bites. The regional director resigned amid a broader shakeup.

COVID-19 has slowed progress and made some things worse.

Like medical practices everywhere, the pandemic cut deeply into VA doctor visits, surgeries, and other procedures as businesses adjusted to shutdowns. The agency kept its Decatur hospital emergency room and critical services open, but closed its satellite clinics to in-person visits and began telehealth appointments.

The pivot has slowed service, which is also hampered because the VA is switching management companies for its community care program that sends veterans to non-VA doctors. The AJC spoke with five area veterans who said getting appointments through the already problematic program has gotten slower and more confusing.

Samuel Little of Newnan said he had an appointment in the spring at a VA clinic, but they would not let him in because of the pandemic shutdown. Two weeks later, the VA sent him a letter, saying he had missed his appointment.

That was nothing compared with the problem he now faces. A colonoscopy by a non-VA doctor on June 18 showed a cancerous-looking nodule. The next day, Little said he went to the Newnan VA clinic to talk to his doctor, but was turned away again. The 58-year-old Army veteran, who said he had gotten good care before the pandemic, doesn’t have a computer to do a telehealth meeting.

“Because of the pandemic, they are not seeing anyone face to face,” Little said.

Little talked to a security guard at the clinic, and a nurse came out to take his colonoscopy documentation. She promised to give it to his doctor.

Little said he received a call Thursday from the VA, telling him it would set him up for a CT scan to review the problematic area in September.

“That’s their idea of a rush job,” he said.

James Yarbrough, who lives about 40 miles north of Atlanta, said he has had constant trouble getting appointments or treatments through the community care program and that it has gotten only worse.

He called the VA the first week of June to try to see a gastrointestinal doctor because he had been having stomach pains and occasionally spitting up small amounts of blood. He said the VA didn’t have a doctor available and directed him to community care. The VA gastrointestinal department is functioning at 25% capacity.

Veterans in Georgia have long complained the community care system is too often slow, bureaucratic and bungled. Yarbrough has experienced that, which caused him to buy expensive, high-deductible health insurance as a backup.

“It’s a nightmare just to get an appointment,” he said.

A call-back from the old community care management company on Tuesday told him the new company would have to take care of it. On Wednesday, the new company called to say it would be maybe another two weeks before someone would contact him for an appointment.

The south entrance to the Atlanta VA Medical Center, located on Clairmont Road in Decatur. File photo. Bob Andres / bandres@ajc.com
The south entrance to the Atlanta VA Medical Center, located on Clairmont Road in Decatur. File photo. Bob Andres / bandres@ajc.com

Staff concerns

Meanwhile, there are problems at the main VA hospital in Decatur, according to staff.

As of June 17, the operating rooms, which had nearly reached full capacity after the September shutdown, were back down to only 50% capacity, according to the VA. Other departments are working at 25% capacity or still closed.

The recent increase of COVID-19 cases in Georgia and among veterans will mean putting plans to reopen departments on hold, according to an internal note to staff in late June.

The Atlanta complex has treated 388 cases of COVID-19, 66 of them active, according to a VA website. Twenty-three veterans treated have died from the disease. No Atlanta VA employees have died from it, though 39 have nationwide.

Internal emails shared by doctors and nurses with the AJC complain that veterans coming in for outpatient surgery mingle in a waiting room with those who have been let in for COVID-19 tests. That is despite the VA having set up a drive-through testing area at the hospital.

The emails complain that some patients wanting COVID-19 tests come to outpatient surgery waiting room, then wait 60 to 90 minutes for results. When tests come back positive, some of the exam rooms the test seekers were seen in were not properly cleaned, and staff who cleaned them were not wearing the proper personal protective equipment, emails allege.

Staff say potentially infected people can be found wandering through the hospital. Doors that are supposed to remain locked, aren’t. Some unscreened visitors have entered through the emergency department, then walk into the hospital looking for their doctor or for appointments.

The drive-through test area has been shut down some days without explanation and doctors are told to see patients who refuse to wear masks, according to one doctor.

Two employees said the hospital briefly ran out of swabs for rapid tests in late June.

The VA, in written responses, denied that patients waiting for COVID-19 testing comingle with patients waiting for surgery or that it ran out of testing swabs. It said it has addressed the cleaning problem.

It said the VA protects staff and patients by screening all who enter the complex. It added that it requires staff, visitors and contractors to wear masks, bars visitors and implemented social distancing and other steps such as installing plexiglass shields.

The doctor who spoke to the AJC said the programs such as screening stations are in place, but some staff are not doing their jobs.

“It’s all very haphazard,” the doctor said.