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Fighting for a voice: Whistleblowers want more input on Manchester VA

  • Dr. Ed Kois (left) and Manchester VA acting Director Alfred Montoya meet in the hallway outside the task force meeting Wednesday at the Manchester VA Medical Center. Kois said he likes Montoya and the job he is doing as acting director. GEOFF FORESTER / Monitor staff

  • Acting Manchester VA director Alfred Montoya answers questions during an open house on Tuesday night at the Medical Center on Tuesday, November 28, 2017. GEOFF FORESTER—Monitor staff

  • Doctor Ed Kois at the Manchester VA Medical Center on Tuesday, November 28 during an open house for Veterans. Kois says he hates when administrators and outsiders come to the Manchester VA like they did this week, showing charts and graphs for hours. He says he’s good instincts, an ability to cut through the fog, see the bigger picture. GEOFF FORESTER—Monitor staff

  • Dr. Ed Kois, left, and Manchester VA acting director Alfred Montoya meet in the hallway outside the Task Force meeting on Wednesday, November 29, 2017. Kois says he likes Montoya and the job he is doing as acting director. GEOFF FORESTER—Monitor staff

  • Dr. Ed Chibaro listens at a task force meeting at the Manchester VA on Wednesday. GEOFF FORESTER



Monitor staff
Thursday, November 30, 2017

This week, doctors Ed Kois and Ed Chibaro went to work at the Manchester VA, just like they had for years.

They made rounds, saw patients, gave advice. Then they learned about a two-day meeting between VA officials and a 12-person task force, called to mend the wound opened when a media report this summer revealed substandard care at the state’s lone VA hospital.

Could this be true, the doctors wondered? A meeting down the hall from the VA’s front entrance, within a Tom Brady pass of their offices? A meeting to hammer out a new direction so quality care won’t be sacrificed, to those who sacrificed so much for their country?

Here and now? Without them? Two of the doctors who came forward and exposed this whole mess in the first place?

“I walked in this morning and met Eddie, and he told me the task force was meeting,” Chibaro told me, shortly before taking a seat at the meeting held, in part, because of his dedication to veterans.

“When Ed asked if I would attend, I said of course. They’re talking about the future of surgery at this institution, as well as mental health and everything else. None of the other whistleblowers or other clinicians who have a stake in this situation were invited or even informed.”

There were 11 medical staffers – the whistleblowers – who joined hands to reveal unsanitary conditions, outdated or broken equipment, misdiagnoses, incompetency and, worst of all, decisions that had caused veterans unnecessary pain and suffering for years. Only one, Dr. Erik Funk, was chosen for the task force.

That’s why Kois, in charge of spinal injuries, and Chibaro, a urologist, were dismayed when they were not invited. I met Chibaro on Wednesday, the afternoon after huddling with Kois in his office, along with Funk.

They told me that while there are, indeed, some good things happening at the hospital, conflicts of interest exist, and the people with an inside view of what evolved at the VA have been cast aside during a public relations campaign to rebuild its reputation.

Meanwhile, Kois said he hates when administrators and other outsiders come to the Manchester VA like they did this week, presenting themselves as problem-solvers.

“We’re trying to change this place,” Kois told me. “We finally reached a point where we were not going to take it anymore.”

Kois saw much of it up close and personally. He’s a ponytailed rebel who curses like a high school kid playing pickup basketball. He’s not the type to remain silent about anything he sees as unjust.

After joining the VA staff five years ago, Kois chronicled veterans who suffered from myelopathy, and who found no relief for their back pain after years of check-ups at the VA, eventually leading to wheelchairs and canes and a reduced quality of life.

Imaging might have shown the tumor that had grown on their spine, the one that, if removed years before, would have changed everything, allowing them pain-free mobility.

Kois and other doctors told me they discussed their concerns years ago with top officials, including Dr. Michael Mayo-Smith, the regional director for the New England VA.

Mayo-Smith, who’s based out of Bedford, Mass., didn’t listen, they said. And that was five years ago.

“We talked to him about all these atrocious things that are happening and nothing happened,” Kois said. “The issue is he ignored it and what happened was when the explosion went off, he was standing behind a tree and didn’t get any of the splatter. He got embarrassed.”

And that’s why the 11 whistleblowers were so mad when U.S. Veterans Affairs Secretary Dr. David Shulkin appointed Mayo-Smith as co-chair of the task force.

Conflict of interest? You bet, Kois and others insisted. Under pressure, Shulkin removed Mayo-Smith in October, but concern remains that he’s still part of the process, still pulling strings, still writing the book on what went wrong when; doctors say he was part of the problem.

“He could be here for the task force meeting,” Dr. Funk told me in Kois’s office, the day before the marathon session began. “Put him on the spot. Ask him what he’s doing here.”

So I did, sitting next to Mayo-Smith during a break in the eight-hour seminar. Polite and polished, I asked him why his input was needed after his dismissal from the task force.

He asked me to turn off my recorder so he could collect his thoughts, then stressed that Shulkin had appointed him in the first place.

“I’m here to offer advice and expert knowledge when they ask for it,” Mayo-Smith told me.

Had Kois and Funk and others spoken to him about problems at the VA years ago?

“That’s not true,” he said. “Things have been done. We developed a contract with Concord Hospital and we increased our outpatient services here.”

Mayo-Smith added that the creation of a task force had been in the works prior to media reports exposing the VA’s shortcomings. “It’s a very positive thing, and now it has accelerated with tremendous energy behind it and political attention, so this is great,” he said.

Kois, who prides himself on having a bloodhound-like sense of smell when it comes to baloney, calls this fluff. The steps the VA is taking on the surface sound good, but contain no real teeth, he said.

He and Funk and Chibaro saw a task force devoid of whistleblowing voices, with Funk being the lone representative. And they saw a presentation made to the task force by officials under the New England VA health care system.

In other words, they saw the VA searching for solutions by, essentially, investigating itself.

“It’s very exciting to see these very qualified people from the community and the VA working together and addressing this issue,” Mayo-Smith noted.

Still, Shulkin emerged from his Washington, D.C., office and cleaned house when the news broke last summer. He replaced three top officials, including Director Danielle Ocker and Chief of Staff Jim Schlosser.

Here again, however, the whistleblowers saw a problem, because while Schlosser was ousted by Shulkin, he was later moved to the VA Community Based Outpatient Clinic in Tilton, despite an ongoing investigation by two VA-connected boards.

Unfairly or not, that led to comparisons with the church sex abuse scandal 15 years ago, when priests were shuffled around to different churches after sexually assaulting young boys.

“The only thing that is comparable on the entire planet is the Catholic Church,” Chibaro told me. “They are bulletproof. You can bring all the accusations against how they managed things and it doesn’t really matter. They move them around.”

John Irish agreed. The Army veteran who was discharged 40 years ago said he was bleeding to death in 2013 from a botched heart surgery when the Manchester VA refused to send an ambulance to his home. He said he was treated like a first-grader, told, “Mr. Irish, you’re just a little bit anxious because you’re not used to seeing a little bit of blood.”

That’s why his eyes blazed with intensity when he talked to me outside the meeting room’s double doors.

“How can anyone in their right mind justify taking a medical provider who was relieved of duty because of incompetence and transferring them to another facility?” Irish said, referring to Schlosser. “He’s endangered the lives of veterans here.”

So I went to Alfred Montoya, the interim director of the Manchester VA, and asked for his input on Schlosser. A slender, soft-spoken man with a disarming nature, Montoya said Schlosser kept working because of a doctor shortage.

“I have a provider who is sitting there who at the end of the day is still a provider who provides primary care,” Montoya told me. “Regardless of an investigation that is still going on, that’s still what he does.”

To build trust among veterans, Montoya announced his cellphone number during an open house at the VA this week. Then he attended Wednesday’s presentation to the task force, which offered solutions and suggestions on how to create a smoother, more efficient operation in Manchester.

The task force will take the data they receive and make recommendations to Shulkin and his people, with a final report scheduled for the end of March, not late January as had previously been stated.

More than anything, Kois, Chibaro and Funk want the VA to become a full-service hospital, saying that’s what veterans deserve, and that’s what veterans throughout the rest of the country get.

They also want the staffers who rolled up their sleeves and told the truth about the VA to have more input in the weeks ahead. In fact, several whistleblowers were scheduled to meet Friday afternoon with Sen. Jeanne Shaheen, moving outside the task force to get things done.

Kois will be there, of course. The man with Civil War-era sideburns knows a good fight when he sees one.

“I’ve had no one from the new (VA) administration blow back against me,” Kois said, smiling from a sense of power. “I think they know I’m like a piece of s---. When you step on it, you can’t get rid of it.”