HAMPTON, Va. (WAVY) – A report issued this week by the Office of the Inspector General for the Department of Veterans Affairs says providers at the Hampton VA Medical Center failed to act on test results involving a patient with prostate problems and did not inform him of his health status.

The man is in his 60s and had prostatitis and benign prostatic hyperplasia (BPH).

The 37-page report outlines multi-step failures that began in July 2019 that the OIG says should have been major red flags.

The test results that were listed as mishandled included: An abnormal CT scan that indicated a potentially malignant lesion on the prostate; an abnormal PSA reading, a prime indicator for prostate health; and a failure to act on a recommendation from an outside doctor that the man have a bone scan, to make sure any potential cancer wasn’t spreading.

The net result was a diagnosis of prostate cancer in April 2021, nearly two years after the first negative signs.

Sen. Tim Kaine (D-Va.) issued a joint statement in response, along with Sen. Mark Warner (D-Va.), Rep. Bobby Scott (D-Va. 3rd District) and Rep. Elaine Luria (D-Va. 2nd District):

“We are appalled and disheartened to learn that a series of failures at the Hampton VA Medical Center led to a veteran’s delayed cancer diagnosis. Veterans and their families must be able to trust that they are receiving high-quality, comprehensive, and timely health care whenever they turn to the VA — and it is the VA’s responsibility to provide that level of care to its patients. The findings outlined in the Inspector General report suggest a dangerous series of care coordination and communication failings, both at the individual and systemic level. We commit to engaging directly with the senior leadership at Hampton and pursuing appropriate accountability. We are also committed to conducting close oversight as the Hampton VAMC works to implement the Inspector General’s recommendations, and put in place processes to guard against future failings as happened here.”

“If you misdiagnose someone with cancer and then you catch it two years later, then treatment options are foreclosed and the chance of survival can be dramatically less,” Kaine said in a Wednesday interview.

Because of HIPPA privacy laws, the VA won’t give the patient’s current condition or say whether the cancer has spread beyond the prostate.

“Providers make mistakes sometimes,” Kaine added. “It might have been an individual mistake and not a system problem. We just have to understand what it was and fix it.”

Hampton VA Medical Center Executive Director Taquisa Simmons responded Thursday afternoon with a statement of her own:

“As a healthcare facility, we have a moral and ethical obligation to ensure our Veterans receive quality health care every time they are seen at VA. Since learning of this situation in June 2021 at Hampton VA Medical Center, leadership investigated the allegations, voluntarily launched 120-safety chart audits, enforced stricter safety measures, and worked directly with the Veteran, disclosing the events, and ensuring his care going forward meets all VA health care standards. We will continue to institute stricter safety, quality, and accountability controls to improve care at all levels for the Veterans we serve.”