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Watchdog: Accountability

Delays, denials by Department of Veterans Affairs deliver 'death sentence' to cancer victim

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Photo - Michael Keslosky knows he will die soon -- the victim, he says, of years of failure by Department of Veterans Affairs doctors to diagnose his fatal illness and get him the treatment that could have saved his life. (Photo by Chris Adval)
Michael Keslosky knows he will die soon -- the victim, he says, of years of failure by Department of Veterans Affairs doctors to diagnose his fatal illness and get him the treatment that could have saved his life. (Photo by Chris Adval)
Watchdog,Mark Flatten,Veterans Affairs,Health Care,Accountability,Minusextra,Pennsylvania,Veterans

Michael Keslosky knows he will die soon — the victim, he says, of years of failure by Department of Veterans Affairs doctors to diagnose his fatal illness and get him the treatment that could have saved his life.

Keslosky has advanced prostate cancer. It’s in his bones now, inoperable and terminal.

Faces of Delay

A five-part series by the Washington Examiner on some of the individual veterans who have suffered from poor care and long delays by the Department of Veterans Affairs.

Today: Delays, denials by VA deliver 'death sentence' to cancer victim

Part Two: A fatal level of trust in VA care

Part Three: Korean War veteran dies after VA hospital ignored his medical history, daughter says

Part Four: Treatment at a VA hospital nearly killed an agency whistleblower

Part Five: Missed leukemia diagnosis by VA leaves vet who put his trust in doctors living 'day to day'

Click here to see a summary of the series and find more resources

For years, his doctors at the VA claimed he didn’t have cancer, only a lingering prostate infection.

For years after the disease was confirmed, they refused to authorize the surgical procedure to remove his prostate, despite having the needed state-of-the art equipment available at one of its own hospitals a few hundred miles away.

Now it’s too late for the police officer who spent much of his adult life in military service, first in the Coast Guard and later the Army Reserve and Pennsylvania National Guard.

“The VA handed me a death sentence,” said Keslosky, who lives near Scranton, Pa. “I’m being practical. I’m mad as hell, but I can’t let the bitterness overtake my life.

"Maybe it’s my military training. Maybe it’s my police training. I know I’m looking at the short end of life. But I have to stand on my faith. Only by the grace of God am I still here.”

Keslosky enlisted in the Coast Guard shortly after graduating from high school, then served long stints in both the Guard and Reserve while working as a police officer in Old Forge Borough, Pa.

He volunteered for deployment to Iraq when his Guard unit was called up in 2003. But because of an injury he suffered at Fort Dix, N.J., Keslosky returned home to resume police work. He soon found himself out of a job.

A new police chief and captain were promoted, drawing protests from Keslosky that he should have gotten the top job because of his veterans’ preference, recognized by both federal and Pennsylvania state law.

Keslosky was suspended without pay or medical benefits in 2005, supposedly because he missed required police training while serving in the Guard.

Both the police chief and the captain later were sentenced to prison on charges involving the sexual abuse of an underage girl. Despite the turmoil, Keslosky was not reinstated. He wound up homeless, living in his car, and suffering from pneumonia.

When the local hospital refused to treat him because he could not pay, Keslosky sought treatment at the VA hospital in Wilkes-Barre, Pa.

To clear his lungs, VA doctors gave Keslosky massive doses of prednisone, a powerful steroid. The heavy doses triggered a condition called steroid-induced diabetes.

When he was discharged from the hospital, Keslosky entered a work program run by the VA, first doing housekeeping and later working in a warehouse.

I know I'm looking at the short end of life. But I have to stand on my faith. Only by the grace of God am I still here.
 

Despite the excess doses of prednisone, Keslosky had no alternative but to continue receiving health care from VA, he said.

“I had nowhere else to go for my treatment, and I had nowhere else to go for a job,” he said. “I was annoyed with what they had done to me, but I was in basically a no-win situation except using the VA to survive.”

The first signs of cancer surfaced in 2006, when Keslosky was sent to a private clinic by VA for a colonoscopy. Blood work for that procedure showed elevated levels of PSA, a protein produced by the prostate gland.

High PSA levels are an early warning sign of prostate cancer. Keslosky’s primary care doctor at VA referred him to an in-house urologist, who concluded he did not have cancer, only a prostate infection and enlarged prostate.

Because he was getting different answers from different doctors, Keslosky requested a biopsy to determine whether his prostate was cancerous.

The request was denied.

What happened over the next several years is in dispute.

Michael Keslosky stands by the entrance to the Veterans Affairs
Medical Center at Wilkes-Barre, Pa. (Photo by Chris Adval)

Keslosky says specialists at VA refused to approve a biopsy because they continued to believe he had prostatitis and an enlarged prostate.

A biopsy was finally scheduled for August 2009, but then canceled by VA. From then on, the agency stalled, at times scheduling Keslosky for the biopsy but refusing to authorize the pre-operative medicines he needed to prepare for it, or canceling the procedure at the last minute.

VA’s version, laid out in a July 2013 letter to members of Congress, blames Keslosky for delays in diagnosis and treatment, saying he repeatedly missed appointments.

“A complete review of the record reveals that any perceived delay in diagnosis of prostate cancer occurred due to Mr. Keslosky failing to show and his canceling of scheduled diagnostic tests and biopsy,” Michael Moreland, then the regional director of the health network that includes Wilkes-Barre, said in letters to members of the Pennsylvania delegation to whom Keslosky turned for help.

Though Moreland says his letter was based on medical records, recent investigations have revealed widespread falsification of information in patient medical files to hide delays and improper treatment at veterans’ hospitals.

The agency’s inspector general confirmed the “systemic” use of bogus appointment logs, and continues investigating such allegations in at least 92 VA sites nationwide. The IG would not disclose whether Wilkes-Barre is part of that investigation.

Among the tricks that have been identified, even in the VA’s own internal documents, is scheduling and then canceling medical appointments, and claiming the patient failed to show up. This was often done without the patient’s knowledge.

The U.S. Office of Special Counsel released a report in June 2014 criticizing VA health officials for downplaying or dismissing legitimate complaints of inadequate care.

Moreland came under fire last year when he collected a $63,000 performance bonus a few days after the inspector general blamed mismanagement at the VA hospital in Pittsburgh for an outbreak of Legionnaires' disease that killed a half-dozen patients in 2011 and 2012. Moreland retired last October.

In the fall of 2010, heart problems drove Keslosky to seek emergency treatment at a private hospital, Geisinger Wyoming Valley Medical Center. Blood work done at Geisinger showed high levels of PSA, and doctors recommended a biopsy.

VA still refused to authorize the procedure.

Michael Keslosky sits in front of some of his paperwork from the Department of Veterans Affairs. (Photo by Chris Adval)

The Geisinger staff found a workaround and were able to secure approval for one day of Medicaid coverage so Keslosky could undergo a biopsy.

The biopsy in January 2011 confirmed he had aggressive prostate cancer.

Doctors at Geisinger recommended a radical prostatectomy — removal of the prostate — plus hormone therapy and implantation of radioactive “seeds.”

At that point, VA stopped stalling on the diagnosis and started stalling on the treatment, Keslosky said.

Implantation of the radioactive seeds into his prostate was not an option because the VA’s facility in Philadelphia, which normally would have performed the procedure, suspended operations after an investigation by the Nuclear Regulatory Commission identified a pattern of botched surgeries and other safety problems.

VA doctors initially concurred that a radical prostatectomy was needed. The surgery was scheduled for May 2011, but then canceled at the last minute.

Keslosky said he was initially told he did not qualify for the surgery because it was not connected to his military service, and later because of concerns the cancer had spread to his lymph nodes, which even today are clear of the disease.

Keslosky was put on hormone therapy and radiation, the only treatment for his cancer he received from VA.

He was sent to hospitals in Manhattan and Brooklyn to see VA specialists. His doctors in New York and Pennsylvania could not agree whether he was an appropriate candidate for surgery.

The only good news he got in that time was periodic tests showing the cancer had not spread.

Eventually, Keslosky came to see his last hope for the delicate surgery in a robotic device called the da Vinci Surgical System, which made the intricate operation possible.

But VA doctors said they did not have a da Vinci device anywhere in the VA system and would not authorize a private provider to perform the procedure, Keslosky said.

During an office visit in 2012, Keslosky was thumbing through an agency-published magazine and came across a photograph of then-VA Secretary Eric Shinseki standing next to a da Vinci device.

It had been operating in the Pittsburgh VA hospital since 2005.

Click through the image to read an article from a Veterans Affairs-published magazine about the da Vinci Surgical System.

“Here I am, a veteran in Pennsylvania being sent to Manhattan and Brooklyn, and the lifesaving device for me is sitting in Pittsburgh since 2005,” Keslosky said.

With doctors still debating whether Keslosky was a candidate for prostate removal, he asked for a new bone scan to determine whether his cancer had spread.

The test was performed in November 2013, seven years after elevated PSA levels indicated prostate cancer and almost three years after the presence of cancer was confirmed. The cancer was now in Keslosky’s bones, making it inoperable and terminal.

There was more bad news to come.

Frustrated by the runaround he was getting, Keslosky sought help from members of the Pennsylvania congressional delegation.

In his response to the congressional inquiries, Moreland included a case summary that said Keslosky was first diagnosed with Stage 4 cancer in January 2011, which means the cancer at that time had already spread to other organs.

Keslosky said he first learned VA officials were claiming he had Stage 4 cancer as early as 2011 when he was told by his lawyer this year.

If that diagnosis was correct, Keslosky said his life now may be measured in months rather than years.

“I’m not angry or violent toward the VA,” he said. “What benefit does that do me now? I can’t stress on my cancer because all that does is hurt me.”

Keslosky is suing the Old Forge Police Department in federal court, and in May he filed a $4 million medical malpractice lawsuit against the VA.

His goal, he says, is to spare other veterans from the kinds of delays that turned his cancer from treatable to inoperable.

Until the end comes, he works at a local nonprofit organization advocating for veterans, especially those who are homeless or need medical care.

“I’m living every day like it’s my last,” Keslosky said. “But I’m still helping other veterans. I’m helping veterans who are falling through the cracks.”

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Author:

Mark Flatten

Senior Watchdog Reporter
The Washington Examiner

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