Tomah VA Medical Center

The VA Medical Center in Tomah

TOMAH — The Veterans Administration is asking nearly 600 patients of its Tomah hospital to get screenings for hepatitis and HIV after discovering that a dentist wasn’t using sterilized equipment.

The dentist, who was hired in October 2015, was reusing drill bits without properly sterilizing them. The VA requires its dentists to dispose of bits after one use.

The VA announced the lapse Tuesday, the same day it began contacting 592 patients seen by the dentist over the past year.

Acting director Victoria Brahm said only 54 of those patients received crowns or bridges, but the VA wants to test every patient he treated.

“We’re trying to be transparent,” Brahm said. “We’re taking extreme measures.”

The dentist, one of four who practiced at the facility in the past year, has not been identified because of federal employee protections.

VA spokesman Matthew Gowan said the screenings are precautionary.

“There is no indication of a transmission of an infection,” Gowan said. “Out of an abundance of caution it’s still the proper thing to do.”

If any veterans are found to be infected, the VA says it “will provide the necessary care and treatment without charge.”

Gowan said the dentist was removed from patient care on Oct. 21, immediately after senior staff learned of the violation. The VA’s Clinical Episode Response Team launched an investigation that concluded Oct. 31.

Brahm said the VA spent the past four weeks reviewing patient medical records and organizing a hotline and clinic for testing and follow-up care if needed.

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“We needed to know exactly what we were dealing with first,” Gowan said. “Folks have not been sitting on their hands.”

A review board is scheduled to meet Dec. 5 to recommend disciplinary action against the dentist, who is currently on administrative duties.

Brahm said the VA also has contacted the dental licensing board in Texas, where the dentist was licensed, as well as state and federal prosecutors who are reviewing the case for possible criminal charges.

“This was a purposeful act by a dentist who knew better,” Brahm said.

The violation was initially reported by a dental assistant who was filling in for the dentist’s regular assistant, who Brahm said is also being investigated.

Brahm praised the assistant for coming forward and said she hopes that organizational changes made since she took over the troubled organization last year has made it more comfortable for employees to speak out.

“We’ve been working really hard to change the culture,” Brahm said.

Brahm also said dental assistants now rotate regularly so they are not always working with the same dentist.

The Tomah medical center was at the center of an 18-month Congressional investigation that culminated in May with a top VA official acknowledging a “clear and inexcusable lack of leadership” was to blame for the deaths of at least to veterans who were treated there.

The investigation began after 2015 media reports detailed high levels of opioid prescription and a pervasive culture of intimidation and retaliation against employees who spoke out. Two top officials from Tomah — Director Mario DeSanctis and medical Chief of Staff Dr. David Houlihan — were removed in the wake of that report, as were at least two other care providers.

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(7) comments


My dogs get better treatment that these vets.


Because of the government bureaucracy this guy still has his job, he can't be fired, things need to change!


Where is Ron Johnson's fix on this??? Hasn't he ridden in on his white horse to play hero yet? I suppose he will blame this on Russ Feingold.


bay, a substitute assistant turned him in. The assistant is being investigated too. Let the investigation run its course, he may get arrested/sued yet.


Wouldn't this be a criminal case?
Wasn't this dentist arrested?
How was it discovered that this dentist was not sterilizing their instruments?

Is there any writers at the Tribune actually doing investigative reporting on this story? This should be a huge front page story.


This is a criminal case if there ever was one. He willfully did not follow procedures to ensure the safety of our veterans. In fact he used his own dental equipment making him absolutely 100% culpable.


when wil, his name be released? ever?

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