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Reports: Dorn VA using less effective colon cancer tests to clear backlog

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A Midlands doctor and government reports claim Dorn VA Medical Center is using a less effective test to clear up its backlog of colonoscopies. The price, he says, is a veteran's health.

Dr. Stephen Lloyd believes veterans should have the right to choose if they want a colonoscop, something that at one point was a VA directive.

As we've reporting in our previous investigations, the backlog of GI cases at Dorn prompted an Office of Inspector General investigation and soon to be Congressional hearings on the matter to determine if anyone was disciplined.

O'Neal Sessions believed the test his VA primary physician recommended to check for colon cancer was enough.

"We did the blood work, then we did the stool test, my indication from them in doing the stool test, was sort of, a way to determine whether or not if I had colon cancer," said Sessions.

The test results and his VA doctor gave Sessions a clean bill of health. It was his wife's visit to the SC Medical Endoscopy Center for her colonoscopy that changed everything.

"They convinced me that I needed a colonoscopy," said Sessions.

According to the National Institute of Health, while colonoscopies have higher upfront risks and higher cost than the fecal occult blood test, the colonoscopy is believed to be the best test to detect colorectal cancer.

In the Office of Inspector General's report, when Dorn's backlog of GI patients grew to over 3,800, they hired additional staff and made a recommendation between Primary Care doctors and GI services, that low-risk patients be given a Fecal Immunochemical Test as the appropriate protocol, not more extensive tests.

Even the OIG report indicates trying to fix the problem caused "chaos."

Our first request to speak with the Dorn Administrative leaders about the issue was in October when they spoke about problems with the surgical suites. A spokesman for the VA said they wouldn't comment on the investigation into GI services.

"If you have a positive test on the fecal occult blood, then you have to have a colonoscopy," said Lloyd. "That's the only way in this Veterans Administration you can get a colonoscopy. Whereas in the rest of the country if you say I want to have a colonoscopy, they put you on the list and you get the test done."

The OIG report in July found the backlog had been addressed, but Lloyd believes the VA has short-changed veterans by offering this less effective FIT screening. While it's an approved screening, neither Lloyd nor Fort Jackson's former commanding general-turned colon advocate think the FIT is as thorough as a colonoscopy.

"You can't find a polyp if you do the FIT test -- the blood in the colon test," said Maj. Gen. Abe Turner. "There's no identification of a polyp on that test. Our veterans and our retirees deserve better."

Our investigation uncovered a nationwide VA directive identifying five different screening methods as acceptable, but that directive also says the veteran has a choice. That directive expired in 2012, but we again asked Dorn officials of the five approved screening methods, over the last two years, how many of each have they preformed? Weeks later, we're still waiting on those results. They did provide us a statement claiming the medical center follows VA policies on standards of care regarding colon screening and testing.

"The veteran is supposed to be educated about the various tests and the veteran is to choose which screening test they would like to have," said Lloyd.

Lloyd wants patients to know there are two groups of screening tests, earlier detection tests that find polyps and cancer using a scope, like a colonoscopy, and those that detect cancer once it's already formed, like the fecal occult blood test and FIT.

"If there's blood in the stool, that means you've got something, a polyp that's already big enough it's starting to disintegrate and it's bleeding or it's already in cancer," he said

Colon cancer doesn't start as cancer, it starts as a polyp and from the time a polyp begins until it turns into cancer it takes 12 to 15 years. If you do a colonoscopy during that time see the polyp, we take it out, destroy it, you can't get colon cancer."

That's exactly what happened to O'Neal Sessions. While his stool test showed no signs of trouble, he says the colonoscopy produced different results.

"When we got the results back, I had four polyps, two of them were pre-cancerous," said Sessions.

"There is some positive stuff with the VA, some very good stuff, it's just that few little things they need to work out, there's little issues with."

Sessions hopes his case encourages the VA to change their practices when it comes to offering veterans a colonoscopy.

"It is very much my life, and I want to be around for my grandchildren," said Session.

In the VA's statement they also tell us there is sufficient capacity to perform necessary procedures in-house and say they're able to accommodate all veterans who require a procedure.

Earlier this month when the congressional delegation, including House Veterans Affairs Chairman Jeff Miller came to Columbia to question Dorn leaders about the GI issues, again we requested to talk with Dorn administrators about the backlog and who was held accountable.

While we spoke to congressional leaders, again Dorn denied the request, but promised to invite us to an open house and discuss the matter. We're still waiting for that invitation and have our questions ready.

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