BY MATTHEW BARAKAT

Associated Press

FAIRFAX

During a family visit to Northern Virginia, Van Putten's chronic back problems flared up and she ended up having spinal surgery at Inova Fairfax Hospital. She came out of surgery a paraplegic. She was held in restraints for weeks. She developed a bedsore so large you could see the titanium implanted in her spine. Medical records show she went nearly a week receiving only clear liquids and dropped 30 pounds. She spent her days moaning "Help me!" to nurses.

An Associated Press examination of her care highlights the dizzying array of federal, state and private agencies charged with regulating hospital care, and the differing standards they use when investigating the most serious cases of possible neglect.

In addition, an investigation report filed by Virginia regulators appears to have been altered to delete parts of the report that substantiated most of the family's complaints. That prompted a former top federal regulator to say the case warrants further investigation.

Van Putten's family contends there was a cascade of errors by the Inova system from when she was first turned away from an emergency room last summer to when she was discharged to an unaffiliated hospital in Florida and died at age 67 last November.

She had long suffered back problems and was treated at hospitals across the country while she and her husband traveled by RV for more than a decade.

They were visiting her daughters in Northern Virginia last summer when her back problems flared up again. In late June 2011, she was turned away from the Inova Fair Oaks emergency room twice in three days, before another hospital sent her to the Inova Fairfax emergency room on July 1. By that time, she could barely walk.

When she finally got surgery, the chances of success had diminished and she came out a paraplegic. She spent three weeks there, was discharged to the National Rehabilitation Hospital in Washington but returned to Inova Fairfax in August and spent another 32 days there in August and September.