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Careless Care 

Veterans decry the treatment they receive at the St. Louis VA Medical Center's John Cochran Division.

On June 10, 2006, Phillip Baldwin was shot in the back and foot while trying to help a wounded comrade during his second deployment in Afghanistan. He spent three weeks at Walter Reed Army Medical Center, where, he recalls, his treatment was good.

The 35-year-old army staff sergeant from Roxana, Illinois, says his wife and three kids were permitted to pass the days in his room. His doctors were attentive, the facilities clean and modern. But Baldwin never had to spend time in the rodent-infested outpatient Building 18, which the Washington Post exposed earlier this year, sparking national outrage.

Baldwin, who was then unable to walk, met a fellow St. Louisan with a similar injury who arrived for surgery at Walter Reed. He remembers dismissing the veteran's cautionary tale about the John Cochran Division of the St. Louis Veterans Affairs Medical Center.

"I thought, well, maybe he was a problem patient," says Baldwin.

Vets with spinal-cord injuries like Baldwin's receive rehabilitation, psychiatric and long-term care at the VA's Jefferson Barracks Division in south county. The specialized ward is a peaceful, roomy place with ample parking for visitors, not to mention a squad of career nurses who get to know many intimate details of their patients' lives.

For anything else, like acute medical attention, lab work and specialized procedures, vets must go to Cochran, a full-service hospital on North Grand Boulevard.

"If you've got a spinal-cord injury and you can get into Jefferson Barracks, that's the place to go," says Dr. John McGarry, the ward's former director. "It's better than anything I've seen in the private sector. But the John Cochran center seems to be quite busy and quite frightening for these folks."

Back at home nine months later, Phillip Baldwin agrees. Paralyzed in one leg and forced to walk with a cane, Baldwin was first admitted to Cochran late last summer with a urinary tract infection and high fever.

"It was as if I had disappeared," he recalls. "I went long periods of time without seeing a nurse. My IVs would run dry, and there would be nobody there to swap them out, and nobody to empty my catheter bags. The facilities were dirty, and at that particular time the air conditioning wasn't working — and it was incredibly hot."

Baldwin says his wife and child were not allowed in his room to deliver medication that nurses had promised him but hadn't supplied. After a hemorrhoid surgery, the hospital, he says, forgot to call the pharmacy with his pain prescription.

At other times the VA sent Baldwin appointment-reminder cards, and he took off time from work as a train dispatcher for the Terminal Railroad Association of St. Louis, only to arrive at Cochran and find that his visits weren't on the hospital's calendar.

After nearly a dozen trips to Cochran, Baldwin is ready to issue his own warning to fellow service members: "Veterans, if you're coming back from war and you're supposed to be treated there — if you have any other options, don't go to John Cochran hospital. Find another solution."

Veterans' hospitals have long been regarded in the medical community to be better than private institutions — especially for spinal-cord care. But Cochran, even with its many Washington University and Saint Louis University physicians, earned a different distinction entirely.

Four years ago it became only the second veterans' hospital in the nation to be placed on probation by a Chicago-based hospital accreditation group, for noncompliance in 14 of 45 performance areas.

A military veterans' medical center since 1954, Cochran regained full accreditation eleven months later and maintained it in a 2004 followup. It faces its next unannounced inspection later this year.

In its own quarterly patient surveys from 2006, Cochran consistently ranked lower than the other six medical centers in the VA's Midwestern network, and "significantly worse than the national average" in eight of the nine categories polled.

"These numbers are an agenda item at every meeting," says Dr. Florian Thomas, director of the VA's spinal-cord service and a neurology professor at SLU. "We're very worried about them. And we have newly created positions — task forces and workgroups — that are looking at the data to see how we can improve."

It's a common notion among paralyzed veterans that they leave Cochran sicker than when they arrived.

"I left with a sore on my butt, and now I've been here at Jefferson Barracks almost five months trying to heal it," says Bernard Carr, a paraplegic.

A number of paraplegics and quadriplegics interviewed by Riverfront Times complained of being abandoned for hours without a nurse available to change their catheters and help perform bowel-management programs. Others offered stories about the lack of nurses available to feed them or turn them over to prevent the gaping pressure sores that result from prolonged immobility. Some say they were left in their own feces and urine for hours on end.

"This last time I came back from Cochran was the worst ever," says Jerry Ray, an amputee. "My catheter was leaking urine, so I was laying in urine for a long time, and they weren't changing my dressings or my bedding. My skin broke down, and then my sores were leaking a lot of fluid. I ended up with another sore on my scrotum and all the rest of the skin on my buttocks was damaged."

Stan Brown, president of the Gateway chapter of the Paralyzed Veterans of America (PVA), says he's fielded such complaints for five years running. "I never go to Cochran when I'm sick," says Brown. "I do everything I can to stay out of there."

Past and present VA physicians acknowledge the problems and attribute them to the peculiarity of the St. Louis VA structure. The St. Louis spinal-cord center is the only one of 23 in the country that's located on a separate campus, some 20 miles away from the medical center's full-service hospital.

"A lot of times the nursing staff at Cochran has never seen a spinal-cord patient until they get one, so they don't know the techniques to get them out of a wheelchair, the turning schedules that they need, the proper bladder care and whatnot," explains the retired Dr. Robert Woolsey, for whom Jefferson Barracks' spinal-cord center is named.

At Woolsey's direction some years ago, Cochran stepped up training for its nurses and tried to isolate all of the paralyzed patients in one wing of the hospital.

"We'd bring the whole nursing staff down to J.B. and train them over three days," explains Woolsey. "And within six months those people had all been dispersed: They'd quit or they transferred to a different service. We went through that over and over.

"It's the same thing with training the doctors, many of whom are residents and interns. They rotate in there from SLU or Wash. U., we have a training program for them, and in three months they're gone. It is a problem. No doubt about that."

But, adds Woolsey, "there's a lot more horror stories than real horror."

Florian Thomas, the spinal-cord service's present director, agrees.

Jefferson Barracks becomes a second home for most patients, to which no other building or staff compares, says Thomas. "If your perception is you just left that beautiful farm where you look on fields where cows graze, and now you're in the city with smokestacks and smog, and you don't know anybody — that clouds your perception. The wait time for a cup of water will seem longer than it really is."

The problems could be solved if the spinal-cord-injury service relocated to Cochran — a proposition much discussed but long discouraged by the local PVA, Thomas adds.

"I don't believe it can be cleaned up in-house," maintains Stan Brown. He wants an outside agency to monitor the hospital. To that end, both before and after the Walter Reed scandal broke in February, Brown appealed to Missouri lawmakers for congressional oversight.

The Department of Veterans Affairs has since launched a 30-day investigation into Brown's complaints at the request of U.S. Senator Christopher "Kit" Bond.

Brown was also party to visits to Cochran and Jefferson Barracks by Bond and Missouri's other congressional leaders. The visits turned into PR bonanzas, he says, with patients too afraid to raise concerns to lawmakers in the presence of many VA staffers.

Missouri Veterans Commission ombudsman Pat Rowe-Kerr says it's a valid complaint. "I think the congressional visits can do a little bit of a disservice. They want to hear from vets, but the vets don't want to speak out when the VA is sitting right there. There are some issues of security, like, 'If I talk about this, am I gonna have a problem later?'"

Rowe-Kerr says she's in the process of organizing private visits between Missouri veterans and lawmakers so that health-care concerns can be aired freely.

"I think it's going to be a work in progress forever," concludes John McGarry, the spinal-cord ward's former director. "They need to have more people take care of these guys."

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