The Dallas veterans hospital is so dirty, dangerous and poorly managed, federal investigators have found, that it ranks as the worst such medical center in the country.
An inspector general's report for the Department of Veterans Affairs said the scores for the North Texas Health Care System place it last among all veterans facilities. The report assessed 80 percent of the system's performance indicators below the "fully satisfactory" level.
The flagship of the North Texas system is the Dallas VA Medical Center. Investigators there found that "most patient rooms and bathrooms we inspected were unclean." Also, floors and walls "had buildups of grime," and some stretchers displayed "dried residue suggestive of body fluids."
Those in charge "did not maintain a consistently clean and safe environment," the report said. And investigators found no evidence of a plan for better management.
The deadline for the system's formal written response to the inspector general is Wednesday. Hospital officials said they already have eliminated most of the problems identified in the report, which was released late last year.
"Frankly, that's the job of the I.G.," Dr. Robert Cronin, the system's chief of staff, said of the report. "They don't come and give you a pat on the back and say you're doing a great job.
"We got the message. We're working hard to correct those things. ... We've added a number of people to help us get the job done."
Alan G. Harper, who had been director of the VA's North Texas system for 14 years, left that position several weeks ago. Allen Clark, public affairs officer, said no conclusions should be drawn from the timing of the inspector general's report and Mr. Harper's departure.
"It was time for him to retire," Mr. Clark said.
Mr. Harper could not be reached for comment Monday.
The Dallas hospital complex covers 84 acres near Lancaster Road and Loop 12 in Oak Cliff. It is the center of a system that serves 38 counties in Texas and two in Oklahoma. Last year, the hospital had more than 13,000 admissions and almost 626,000 outpatient visits.
The system also operates an outpatient clinic in Fort Worth and a small hospital in Bonham.
Gary Gingrow, who has undergone spinal surgery, is working to regain his ability to walk at a physical therapy lab at the Dallas veterans hospital.
"It's the worst VA I've been in," said Joe Hillyard of Waxahachie. The 48-year-old Army veteran said he has been treated at five veterans hospitals for post-traumatic stress disorder.
He complained of long waits to see a doctor and delays in the filling of prescriptions at the Dallas medical center. "I was here at eight o'clock yesterday morning," he said. "I didn't get out of here until six o'clock in the evening."
But 80-year-old Jim Neatherlin of Paris, Texas, a patient since 1980, praised the hospital and its staff. "They always treated me real nice," he said.
And cancer patient Louis Powell, a 76-year-old Army veteran from Hurst, said he has high regard for the medical center. "They treat you real good, no problem," he said.
The inspector general's report, however, cited a variety of shortcomings. Among them:
•There were unspecified deficiencies in a number of "high-risk processes," including medication management, restraint use, invasive procedures, resuscitation and mortality review.
•The system administration's quality management program "was not planned, systematic or coordinated." Managers did not "collect, trend or analyze mortality data."
•No one in management analyzed complaints collected by the hospital's patient advocate.
•"Not all patient injuries were recorded, and nurse managers did not receive reports relating to medication errors or falls."
•"Floors and walls had buildups of grime and the rooms had foul odors, suggesting they had not been thoroughly cleaned over a significant period."
•Intravenous pumps were dirty.
•Exposed electrical connections, such as uncovered heater switches, were found in patient bathrooms. Patients' refrigerators needed cleaning.
•In one unit, "the medication refrigerator temperature was consistently below the required range, possibly altering the effectiveness of the medications."
•Several crash carts – portable cabinets containing life-saving equipment to use in case of cardiac arrest – "were in disrepair and required tape to keep the doors closed."
•"An IV pole, soiled linen, a mop pail of dirty water, an oxygen tank and a biohazard can were inappropriately stored in the radiology dressing area. Radiology equipment was covered with thick dust."
•"We concluded there was no evidence of a planned, collaborative effort to improve organizational performance."
Dr. Cronin, the chief of staff, said inspectors "found more than we might have expected" but said improvements are under way.
"Frankly, we didn't pay enough attention to them," he said of the problems. "But we are now."