FORT HARRISON -- A doctor at the VA Medical Center accused of improperly conducting patient exams and fudging medical records to reflect care that was never provided was fired by the hospital based upon the findings of an investigation that started back in 2008.

The VA Medical Center at Fort Harrison declined to confirm the doctor's name to the Independent Record, but a spokesperson with the hospital said veterans once under the doctor's care were notified of the findings and assigned to another practitioner.

The doctor was terminated in March.

"If veterans are concerned about their individual care, and they would like to talk to someone, they can speak to our patient representative," said Teresa Bell, the hospital's spokeswoman. "We've been very proactive in this. We pride ourselves in giving the highest care to our veterans."

A report released Wednesday by the VA's Inspector General's Office said the allegations first appeared in a letter dated April 13, 2008.

In that letter, a complainant accused the doctor of providing poor care to veterans and engaging in irregularities when documenting treatment in their medical records.

The complainant accused the physician of practicing in an "incompetent manner" and of not performing the proper physical examinations on the patients he saw. This falsely documented treatment, the complainant added, led to misdiagnoses, which led to delays in treatment and prolonged suffering by patients.

"At best, I believe that you will find gross incompetence on the part of the (subject physician)," the complainant wrote. "At worst, some cases will lead you to believe that sham examinations are performed and therefore fraud is taking place."

The complainant, who also is not identified in the report, provided the VA's Inspector General's Office excerpts from the medical records of 28 hospital patients.

Bell said the physician's patients were notified that their doctor had come under investigation.

"Any allegations the VA gets we take very seriously," Bell said. "This report we take very seriously. We address all concerns."

On April 17, 2008, after receiving the complainant's letter, two senior physicians from the Office of Healthcare Inspections reviewed the allegations and brought them to the attention of the VA Central Office in Washington, D.C.

A panel known as the Administrative Board of Investigation, or ABI, was created to review the allegations while the physician was placed on administrative leave.

"Through our internal ongoing review process, we discovered the potential that one of our providers may not have met standards of care," Bell said. "The provider was removed from patient care and an action plan was put in place."

The review by the ABI "did raise patient care concerns," the report notes. It adds, however, that the evidence reviewed by the panel "largely did not substantiate the allegations."

Of the 38 cases reviewed, the ABI found evidence supporting the allegations in just three of the cases. In those three cases, the panel wrote, "all appear to be missed diagnoses by (the subject physician)."

But as the ABI completed its review, additional allegations surfaced against the doctor. The report said the ABI's own investigation had failed to sufficiently address the complainant's allegations.

The hospital hired an external doctor practicing in the same field to re-examine one of three cases. It was this external doctor and not the ABI who "identified serious quality of care deficiencies by the subject physician."

Bell could not say how many patients the doctor was seeing at the Helena-based hospital. Nor could she release the physician's name, saying instead that the VA's Inspector General's Office did not include the doctor's name in its report and, therefore, the hospital was only following the Inspector General's lead.

Sen. Jon Tester, D-Mont., who is a member of the Senate Committee on Veterans Affairs, expressed disappointment in the hospital's internal review process and the time it took to reach a conclusion.

"This should have been taken care of earlier," Tester said. "The internal investigation was absolutely flawed. If they need to do a better job of peer review, we will encourage them to do that."

Tester also said the VA is a large organization that, overall, has seen improvements in recent years.

By and large, Tester added, veterans across Montana speak positively about the VA and the quality of care they received at the hospital. In 2005, the hospital was ranked as the top VA medical facility in the country.

The Inspector General reached several conclusions in Wednesday's report, saying the hospital's managers complied with current policies in pursuing its actions.

It also noted that the ABI impeded the task by failing to fully address the complainant's allegations.

Also, the report suggested that the undersecretary of health create a panel of specialists and administrators to review the care in the specialty once filled by the terminated doctor.

Bell would not confirm the doctor's specialty, saying again that such information was not included in the Inspector General's report.

The Independent Record will continue to press for the confirmation of the doctor's name.

Veterans concerned about their individual care at the Montana VA should call patient representative Susanne Corbette at 447-9770, or toll free at 1-877-468-8387.

Click here to read the VA's Office of Inspector General's report on the allegations.

Martin Kidston: 447-4086 or mkidston@helenair.com