Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.

VA Neurologist Terminated Following Care Denials

Mary Jo Lanska, MD, has been terminated by the Veterans Administration (VA) after an investigation by KARE 11 in Minneapolis revealed a pattern of misdiagnosis and benefit denials spanning decades, the outlet reported.

Since 2002, Lanska has evaluated more than 1,000 veterans at the Tomah VA in Wisconsin — 600 of whom were denied benefits and are now eligible for re-testing by the VA. An earlier review of a “random selection of Dr. Lanska’s benefits exams found 31% were done incorrectly,” according to KARE 11.

Many of those who had care denied were evaluated for Traumatic Brain Injuries. They will now have their cases reviewed and could be granted backdated benefits.

The House Committee on Veterans Affairs recently called for the Inspector General to investigate a “systemic failure” to provide adequate care for traumatic brain injuries to veterans across the nation. Lanska’s firing comes after a larger pattern of denials was revealed starting in 2015, and led to a national review of mishandled compensation claims for similar reasons.

The Department of Veterans Affairs in 2016 promised “equitable relief” to thousands of veterans, and retested them for traumatic brain injuries. But Lanska continued to conduct inadequate exams, according to KARE 11, often conducting no neuropsychological testing and instead opting for a much shorter and more basic evaluation usually reserved for dementia testing, according to previous reports.

Awakening From Catatonic State Shifts Psychiatric Care

April Burrell had lived in a catatonic state at a psychiatric facility for 20 years after being diagnosed with schizophrenia following a traumatic event at just 19. But after doctors discovered she had lupus that affected her brain, a specialized treatment for the autoimmune disorder brought her back, according to the Washington Post.

Burrell was reunited with her family, finally able to function cognitively like she had prior to the diagnosis, and remembered her life up until that point.

The discovery that her psychiatric condition had been connected to inflammation has opened up new avenues for treatment for some psychiatric disorders. Burrell was treated for “neuropsychiatric lupus” with an intensive immunotherapy regimen of intravenous steroids, cyclophosphamide, and rituximab.

The dramatic turnaround that allowed Burrell to return to a relatively normal life prompted her care team to assess their hospital system for any other patients with the same autoimmune disease markers. The search turned up Devine Cruz, who had also been incapacitated with schizoaffective disorder and lupus, moving in and out of hospitals for a decade with visual and auditory hallucinations and delusions.

In less than a year on similar treatment, Cruz improved dramatically, no longer meeting the diagnosis criteria for schizoaffective disorder or intellectual disability, according to the Post.

Columbia University opened a new center that will develop treatments for genetic and autoimmune cases of psychiatric illness. It has already started treating 40 patients.

Autoimmune conditions such as lupus disproportionally affect women and people of color, and psychiatric conditions are undertreated in underprivileged groups, the Washington Post noted. The center is working with the New York State Office of Mental Health to identify others who could be treated via autoimmune and genetic testing.

Withholding Care From Patients With Medical Debt

At Allina Health System, patients with more than $4,500 in unpaid bills can be cut off from care, the New York Times reported. The non-profit hospital chain even has a detailed policy on cutting off patients who owe money, instructing employees to lock their electronic health records to prevent future appointments.

Doctors and other Allina staff said that some patients who are cut off would qualify for Medicaid — which also means they would be eligible for Allina’s financial assistance, but many are unaware of it.

Beth Gunhus, CNP, an Allina pediatric nurse practitioner, recalled treating a child for scabies. She wanted to follow care standards and treat the whole family, which included two other children, to make sure the disease didn’t spread further — especially since they shared one bed in a single room that they rented. But one child’s account was locked because of unpaid bills, and thus couldn’t be treated.

“There are so many better ways of saving money than what we’re doing,” Gunhus told the New York Times.

Although U.S. law requires hospitals to treat anyone who comes to the emergency room for care, it “is silent on how health systems should treat patients who need other kinds of lifesaving care, like those with aggressive cancers or diabetes,” the article stated.

Allina runs over 100 hospitals and clinics in Minnesota and Wisconsin, and makes $4 billion in revenue per year. The health system told the Times that its policy only applies to its clinics, not its hospitals — but patients disputed this. It also emphasized its patient assistance program, which helps 12,000 patients a year, on average, with medical bills. Allina also said it contacts patients repeatedly with letters about how to apply for this assistance before being cut off.

Allina isn’t alone in its practice. The Times cited a KFF Health News investigation from last year that found 20% of hospitals in the U.S. have debt-collection policies that allow them to cancel patient care.