Miami-Dade County

June 6, 2014

Chief at Miami VA surrendered N.Y. medical license

The chief of staff for the Miami VA Healthcare System was disciplined by Florida and New York medical boards in a case where a patient died under his care.

One year before he was appointed senior executive physician for the Miami VA Healthcare System in 2010, Vincent A. DeGennaro surrendered his medical license in New York, stemming from a disciplinary finding in a Florida case of a patient who died under his care at a Fort Lauderdale hospital.

According to the complaint filed with the Florida Board of Medicine, DeGennaro botched a number of his responsibilities while treating a patient for severe abdominal pain at Holy Cross Hospital in January 2003 — including failing to follow up and misinterpreting X-rays of the patient, failing to respond to the patient’s symptoms and complaints, failing to act on the urgent need for surgery and failing to recognize that the patient had a torn large intestine.

DeGennaro, who remains licensed to practice medicine in Florida, could not be reached at his home in Pompano Beach, where a recorded greeting says messages will not be returned. He also could not be reached through the Miami VA’s public affairs office, which issued a statement in response to interview requests.

“The Professional Standards Board (PSB) here at the Miami VA Healthcare System … found that this action had no bearing on his practice at the Miami VAHS,” Shane Suzuki, public affairs officer for the Miami VA, wrote in the statement. “In addition, the PSB also found that no further action was warranted.’’

DeGennaro’s role is to “oversee clinical operations of the Miami VA Healthcare System,’’ Suzuki said, which includes the hospital in Miami and several community clinics in Miami-Dade and Broward counties. He also sees patients and performs surgeries.

Nationally, the Department of Veterans Affairs has been under intense scrutiny for long patient waits for care and falsified records covering up delays that, in some cases, may have resulted in deaths. Miami VA’s public affairs office has not responded to the Herald’s inquiries about whether the healthcare system keeps secret waiting lists for patient appointments.

Florida’s complaint against DeGennaro details the events in 2003 that led to his discipline. The patient, described in the document by the initials R.B., died four days after showing up at Holy Cross complaining of acute abdominal pain and constipation, and reporting a 20-year-history of Crohn’s disease.

According to the complaint, DeGennaro elected to “hydrate the patient for 48 hours prior to scheduled surgery,’’ and later prescribed Demerol, a narcotic pain killer, and Vistaril, a sedative, when the patient reported moderate to severe pain.

DeGennaro interpreted an X-ray of the patient as showing “air in the colon but not dilated,” but the radiologist noted “abnormal distension,” according to the complaint.

After two days in the hospital, another physician found the patient “writhing in pain without relief from medication,’’ according to the complaint. He received a second abdominal X-ray, but the results were not screened until the following day.

On his third day in the hospital, the complaint states, patient R.B. again was seen by DeGennaro, who noted that the patient was in pain, short of breath, and needed to go “to OR now.’’ The patient’s heart stopped beating on the way to the operating room, but he was resuscitated.

DeGennaro’s pre-surgical diagnosis of the patient had been a perforated organ, but the operation revealed a torn large intestine and a distended colon.

The day after surgery, R.B. died in the intensive care unit.

DeGennaro, a colon and rectal surgeon by training, could have had his medical license permanently revoked or suspended.

Instead, after DeGennaro agreed to a settlement in June 2008, the Board of Medicine censured him with a letter of concern, fined him $5,000, imposed $2,744 in legal costs, required him to complete 50 hours of community service and five hours of continuing medical education, and ordered him to deliver a one hour lecture on abdominal emergency surgeries.

The state of New York — where DeGennaro had been licensed to practice since August 1973 — also charged him with professional misconduct as a result of the findings in Florida. But rather than settle the charge in New York by accepting censure and a $5,000 fine, DeGennaro surrendered his New York medical license in May 2009 and agreed never to reapply for a physician’s license or practice medicine in that state again.

DeGennaro, 68, now is responsible for overseeing dozens of physicians at the sprawling Miami VA Healthcare System, and ensuring they deliver the best care possible to veteran patients. According to his résumé supplied by the public affairs office, he was hired by the Miami VA as assistant chief of surgery in 2004, one year after patient R.B. died under his care.

Despite his leadership position, DeGennaro has remained behind the scenes, declining interview requests from the Miami Herald and other media after the April revelation that a combat veteran died of an overdose while enrolled in a residential drug abuse rehabilitation program at the Miami VA, followed by accusations from a VA employee that administrators routinely ignore reports of crimes and other wrongdoing.

DeGennaro’s selection as permanent chief of staff in 2011 was approved at the national VA office in Washington, according to Suzuki’s statement.

In addition to the Florida and New York disciplinary actions, DeGennaro’s online physician’s profile with the Florida Department of Health notes that he has been sanctioned by the Medicaid program.

Shelisha Coleman, a spokeswoman for the Agency for Health Care Administration, which administers the Medicaid program in Florida, said the office could not locate any record of a sanction because the action may have been imposed “years ago’’ and the records destroyed.

Coleman said any Medicaid sanction would have been separate from the administrative complaint filed by the Board of Medicine in the case of patient R.B.

Suzuki’s statement said the state of New York had issued a Medicaid sanction against DeGennaro, but he added that it was “an administrative mistake on their behalf and should have been removed.’’

A past president of the Florida Medical Association, the state’s largest and most influential physicians advocacy group, and an affiliate associate professor of surgery at the University of Miami Miller School of Medicine, DeGennaro holds a number of awards for charitable work in South Florida and abroad.

He volunteers his medical services in Haiti, including a surgery program in partnership with the nonprofit Project Medishare, and he has made numerous trips to the island to perform cleft palate surgeries, according to a profile of DeGennaro written by the Florida Medical Association in 2012, when he was incoming president.

Despite the national focus on the VA in recent weeks for excessive wait times for appointments and secret lists at some facilities of the VA’s 150-hospital medical system, many veterans are satisfied with the healthcare they receive at the government-run medical centers, said U.S. Rep. Joe Garcia, a South Florida Democrat.

Garcia said he would “reserve judgment” on DeGennaro’s role as the Miami VA’s chief of staff, but added that he’s not yet satisfied with the system’s administration.

“I’ve got a concern with the VA and the healthcare that is being given across the board,’’ said Garcia, who spent Memorial Day weekend touring VA clinics and meeting with veterans and administrators. “I want to be clear here: The overwhelming majority of people I’ve spoken to, those that receive care, were happy that they were getting it at the VA. … They just want it to work.’’

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