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Dr. Michael Mayo-Smith: The elusive transparency of the Manchester VA investigation

  • On Aug. 4, Secretary of Veterans Affairs David J. Shulkin (left) addresses reporters during a visit to the Veterans Administration Medical Center in Manchester. Shulkin had earlier met privately with doctors at the center, who alleged substandard care at New Hampshire’s only hospital for veterans. From left are Shulkin, Sen. Maggie Hassan, Sen. Jeanne Shaheen, Rep. Carol Shea-Porter, Gov. Chris Sununu and Rep. Annie Kuster. AP file



For the Monitor
Thursday, April 05, 2018

I recently retired as network director of the Veterans Administration New England Health Care System after a 30-year career with national and regional leadership positions. I am now able to speak freely and offer a side of the story about the Manchester VA Medical Center that has been missing.

When former Veterans Affairs Secretary Dr. David Shulkin visited New Hampshire, he promised a detailed review of all allegations and complete transparency. Investigations by the VA Office of Accountability and Whistleblower Protection (OAWP) and the Office of Medical Inspector (OMI) were initiated. However, nine months later, reports from both offices remain unreleased. As a result, unsubstantiated allegations have come to be accepted as fact. Careers and reputations have been damaged. Veterans have hesitated in seeking VA services. Individuals have used the allegations for personal and political gain.

While I have not seen the final reports, I do know from documents recently released that in reviewing the lengthy letter from the whistleblowers’ lawyer, the Office of Special Counsel identified only three items that met their criteria as being worthy of further investigation. No systematic breakdowns in patient care were actually found. Based on reports to me as regional director, I know OAWP found leadership to be engaged and responsive to problems: They have recommended no disciplinary action.

Also reviewed was the often-repeated allegation that some whistleblowers repeatedly informed me of their concerns without any response. Investigations found no evidence of this – no requests for meetings, no letters, no telephone conferences between myself and the whistleblowers. The issues were not raised by them at network briefings or meetings as documented by presentations, minutes and testimony of those present. One whistleblower alleged he had emailed me several times. Outside services identified all email between us. This is what they found:

– An email with the subject “Chief of Staff Issue” where he complained about being passed over for promotion,

– A second email complaining about his pay,

– A final email also raising personnel issues, which I am not allowed to disclose.

While there were complaints about relations with local leadership, not one of the communications concerned the patient care issues raised in the letter or media stories.

Furthermore, the letter detailing the whistleblower complaints was never shared with VA leadership until a copy was provided by a veteran advocate a week after the Boston Globe published a series of Spotlight Team articles. It is difficult to respond to allegations one has never seen.

Review of patient care at Manchester – and across New England – shows continued high performance. VA New England leads the VA nationwide in access, veteran satisfaction, mental health services, employee satisfaction and research. Recently Dr. Carolyn Clancy, head of quality for the VA and an international expert in health care, sent a letter to Manchester complimenting the major advances in quality at the medical center in the year preceding the media coverage. Recent outside accreditation teams have left with glowing remarks about the care that has been provided at Manchester VA, comparing it to the best in the country. Actual evidence that care has been allowed to deteriorate is remarkably hard to find.

How did it come to pass that public discourse wandered so far from actual facts on the ground?

A perfect storm of events contributed. The VA adopted a philosophy of no-response, hoping public interest would fade. At public hearings the guidance was to not challenge whistleblower allegations. Third-party investigations were slow moving and delayed. VA leadership in Washington became absorbed with its own major controversies, leading to the recent removal of Secretary Shulkin.

And, not incidentally, the entire situation was further sensationalized and politicized when one whistleblower used the issues to run for public office.

Are there problems in the system that cares for our veterans? Absolutely. And we should be thankful for the whistleblowers bringing forward their concerns. We share the common goal of ensuring veterans get the very best care. However, the VA’s promise of transparency should be kept. Veterans and whistleblowers should join New Hampshire congressional representatives in demanding that VA’s new leadership immediately release the reports of the investigations. It’s crucial that a balanced and fair understanding of the allegations be a matter of public record.

(Dr. Michael Mayo-Smith is the former network director of the Veterans Administration New England Health Care System. He lives in Franklin.)