This morning, New Times published the second half of its two-part series on a soldier's tragic death inside the Miami Veterans Affairs hospital. Hell On The Home Front follows Nicholas Cutter's journey from heartbroken teenager to battle-hardened soldier to PTSD-suffering veteran to drug addict.
According to extensive interviews and the VA's own internal reports, lax security at the hospital contributed to Cutter's death. Miami VA Director Paul M. Russo, however, insists that the hospital is not to blame.
"I stand by our staff who worked with Mr. Cutter for nearly nine months to help him battle his personal demons," Russo said. Keep reading for his full statement.
On Tuesday, July 22, New Times published Part 1 of the series. That same day, we contacted the Miami VA for comment on Part 2.
A day later, VA spokesman Shane Suzuki responded by saying he took "great issue with the idea that [Cutter] was neglected."
"Our staff worked with him for nearly 9 months, and while it pales compared to the mourning of his family I am sure, our staff is still affected by his passing as they truly made every effort to help him," Suzuki said. "It is also important to note that his case was reviewed medically by outside professionals and they found no issues with the medical care provided to him."
Yesterday, Suzuki sent us a list of Russo's responses to our questions. Here they are, in full:
New Times: In your previous email, you took issue with my use of the word "negligent" to describe the VA's treatment of Nicholas Cutter. However, the OIG report, interviews with VA employees, and other documents make it very clear that Miami VA staff did not properly monitor RRTP patients or inspect them for contraband. In effect, patients were allowed to come and go as they pleased, and could easily time their drug use to avoid failing predictable drug tests. Please describe how this is anything other than negligent care.
Paul M. Russo: The SARRTP is a residential program where patients, under individualized care agreements with their providers, are taught the skills necessary to maintain sobriety after discharge from the program. It is not a locked unit and patients do maintain their ability to apply the lessons they learn in treatment, if they meet the clinical goals they make with their providers. It is important to remember that, as a residential care program, participants can elect to discontinue treatment at any time.
We have addressed the areas that the OIG report listed areas for improvement; however the medical care provided to Mr. Cutter was found to be appropriate after peer review by comparable medical professionals.
Why was Nicholas Cutter's family told that he had choked on a sandwich?
It is uncertain what was exactly stated to the mother by a staff member; however there was a remnant of food in his mouth and the medical resident who responded to the code and pronounced the death also spoke with the mother and documented that there was food in his mouth. However there is no documentation of his exact communication with her. The Veteran's treating psychiatrist spoke with the mother and father on the phone and communicated to them that a half-eaten sandwich was near the Veteran however he recommended ordering an autopsy to determine the cause of death.
The Medical Examiner conducted the autopsy in the following weeks, however it is our understanding they unsuccessfully attempted to contact the family numerous times with the results.
Why was Cutter's body "stripped, tagged, and placed inside a white body bag by medical staffers" before Miami Police detectives could properly investigate the death? (According to a Miami PD report.)
When nursing staff discovered the Veteran, they initiated cardiopulmonary resuscitation (CPR) and the cardiac arrest code team was called and advanced resuscitation ensued. After pronouncement, the body was treated as any death in the medical center and the nursing staff secured his belongings in anticipation of the family members' arrival. Upon notification, Miami VA Police secured the scene, notified local authorities and VA OIG Criminal investigators who took jurisdiction over the case upon their arrival.
The OIG report made four recommendations: repair the surveillance cameras, properly staff the RRTP units, implement "consistent and comprehensive" contraband checks, and aggressively monitor patients for drug abuse. What is the status of these recommendations? Have they all been implemented? If so, when? If not, why?
The 5th floor cameras were functional before the release of the OIG report. Prior to that staff were utilized to monitor the hallways to compensate until these cameras were repaired. The surveillance camera system is continuing to be upgraded and expanded.
All other recommendations were implemented soon after the OIG report was published.
When did the Miami VA learn about the broken security cameras on the fifth floor? VA employees have said they notified the hospital of the broken surveillance system as far back as 2010, but they were never repaired.
A 2010 Miami VA vulnerability report did identify that the hospital surveillance system did need to be upgraded and that a monitor was not working. The report is void on specific non-operating cameras. The Director of the hospital at that time was Mary Berrocal and why not addressed is unknown. The 2013 Vulnerability assessment report completed in March 2013 did identify the need to replace non-operable cameras and need for system upgrade. The Director authorized funds in April 2013 to address the upgrade needs. The Miami VA 5th floor surveillance system is currently online. Currently, we are in the midst of a $380,000 surveillance system upgrade that was approved in April of 2013 by the current Miami VAHS Director.
Given Nicholas Cutter's death, the OIG report's findings, and televised statements made by VA employees regarding rampant drug abuse and sales at the Miami VA, does the hospital admit that it has a serious problem with drugs on campus?
As indicated by the OIG report the Miami VAMC is located in a part of Miami with reported high drug activity. We have investigated recent media stories and have found no evidence of rampant drug abuse/sales to support any of the allegations made. A three year review yielded 4 cases of which 3 were referred to the OIG. The Miami VA Healthcare System works closely with local law enforcement, and if any employees or Veterans have evidence of drug abuse or sales on or near our campus we encourage them to report it to the Office of Inspector General for an investigation.
Roughly six months after Paul Russo left the West Palm Beach VA, federal officials launched an investigation into widespread drug dealing at the hospital. On August 18, 2011, feds arrested 18 West Palm Beach VA employees or patients, including several nursing assistants, a pharmaceutical technician and a respiratory therapist. They were charged with stealing thousands of prescription pills and then selling them, along with marijuana.
Given the close similarity between the situation in West Palm Beach and the current allegations of lax supervision and rampant drug dealing at the Miami VA, is the VA concerned about Director Russo's leadership abilities?
As we said previously, there is no objective evidence of rampant drug dealing at the Miami VA and these situations are not similar. We have no communications from the Network Director or VA relative to concerns about Mr. Russo's leadership.
According to VA employees, Dr. Vincent DeGennaro - at Russo's direction - reassigned or removed the Miami VA's controlled substance coordinator in 2012. As a result, reports of missing drugs plummeted.
Is this true? If so, why did DeGennaro reassign or remove the controlled substance coordinator? If this is not true, please provide the names and dates of service of the Miami's controlled substance coordinators since 2010.
I have been told that the reports dropped from roughly 500 in a quarter (3-month period) to only 12 over the next year. Please confirm that these numbers are accurate. If inaccurate, please provide the correct numbers of reports from the beginning of 2012 until today's date.
The previous controlled substance coordinator was a pharmacist, although there is not a requirement for the CSC to be a pharmacist. The Miami VA Pharmacy Service had staffing vacancies and the Pharmacist was reassigned to the service to assist in patient care needs. The Pharmacy Service reports directly to the Chief of Staff. The Medical Center Director reported for duty in May of 2012 and was not involved with the decision to change controlled substance inspector.
The number of reported discrepancies by quarter are listed below. A decrease in the number of discrepancies being reported after April 2012 can be attributed to a change in practice implemented by the previous CSC. There were discrepancies being reported for expired medications found during inspections and for counting errors that were immediately corrected. These items were not actual discrepancies and the changes implemented were as follows:
a. Expired products would not be considered discrepancies but would be reported to the Inpatient Pharmacy Supervisor for staff education, performance evaluation accreditation, quality assurance.
b. Any miscounts through an automated dispensing cabinet that were immediately corrected would not be considered discrepancies.
As you can see, the figures have remained relatively steady since 2011. This is out of a total of 512,035 pharmacy transactions for controlled substances. Resulting in a very low 0.008% discrepancy rate.
(Note: Thomas Fiore says the VA's statistics are bogus. "I can assure you these numbers are not correct," he says. "In fact if someone were to get a copy of all the police reports pertaining to controlled substance discrepancies for the past 3 years, you will be able to get a true and accurate number. If these numbers were accurate, where are the 500 I did? It appears the VA, once again does not want the public to know what's really happening!")
Why was VA police detective Thomas Fiore reassigned on February 5? Who replaced him? When?
Due to privacy laws and respect for his personal information, all I can say is he has been reassigned to a different department and has not been working as a detective since February 5, 2014. 10. His position has not been filled and his duties have been fulfilled by other officers in the Miami VAHS Police Service.
In late April, Director Russo wrote a letter to Mary Zielinski to apologize for the "inconsiderate and inadequate... communication" about her son's death. However, the director did not apologize for the quality of treatment that Nicholas Cutter received. Does Director Russo believe that Nicholas Cutter received proper care at the Miami VA?
Our thoughts continue to go out to the family of Mr. Cutter and I feel it is our responsibility and duty to live up to the highest standards when it comes to the care and treatment of our Veterans. Mr. Cutter's death was a tragedy that will be felt by all who knew him for the rest of their lives. There were environment of care process gaps however medical peer review of the clinical care did not substantiate poor quality care. I stand by our staff who worked with Mr. Cutter for nearly nine months to help him battle his personal demons, however we can always learn and improve and I am dedicated to ensuring that our staff provides the care our Veterans deserve.
CBS recently reported that at least 769 new veterans had waited more than 90 days for an appointment at South Florida VA centers. How many of these veterans were waiting for an appointment at the Miami VA?
As of July 17, 146 patients did not have a scheduled appointment within 90 days. We continue to work to bring these patients in sooner by working with both VA and non-VA care providers depending on the individual needs of each patient.
Does Director Russo consider this waiting period acceptable? If not, what is the Miami VA doing to reduce these delays?
It is our goal to always provide care in a timely manner. When demand for a specific service extends past 90 days, we continue to authorize non-VA care where needed relative to private sector availability. Most non-VA care is centered in Audiology, Dermatology, Chiropractic, Optometry and Home Health programs.
In addition, we are improving access through expanding the number of available clinic appointments, expanding capacity in clinics of high demand, optimizing clinical scheduling grids in primary care and continue our expanded and weekend hours availability at many of our locations.
Who decides when RRTP patients will be ejected from the program for drug use? How is that decision made?
Internal policy guidance exists to evaluate situations that may require patients be discontinued from the program. Substance abuse is a very difficult and very individual issue and the clinical decisions made in regards to each patient are personalized to each Veteran. As a residential care program, participants can elect to discontinue treatment at any time.
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