I have worked for the VA for close to two decades and am one of the leaders of the Manchester VA Medical Center whistleblowers.
During my tenure, some of which I spent in upper management, I’ve witnessed many problems.
I’ve also witnessed spectacular care delivered by passionate and devoted staff.
On balance, the problems represented only a small portion of the total care delivered. Yet the administration would regularly deflect attention from the problems and extol their successes.
Many issues were brought to light by the recent media attention. Many more require scrutiny.
One of these is the failing of the scheduling system.
With the recent pipe burst resulting in damage to the operating rooms, scores of colonoscopy patients had to be rescheduled. Patients rightfully complained that their procedures were pushed off until the end of the year.
As horrible as this sounds, my first thought was that at least they did not undergo a two-day bowel prep before the procedures were canceled.
This solace did not last long as I quickly learned that several patients did show up for their colonoscopy after having endured the prep, only to find out that they were never notified that their procedures were canceled.
Some (not me) may forgive this because it happened as a result of an extraordinary event, i.e. the closing of the operating rooms due to a pipe burst.
Unfortunately, these types of cancellations have occurred many other times, such as when a physician calls in sick. Even if the procedure doesn’t involve a nasty bowel prep, many of our patients in Manchester drive two or even three hours to get to the medical center.
Other problems abound.
Over the last several years there became an overreliance on the hub and spoke model, with Manchester becoming the mere spoke.
As programs were cut to save money, veterans were shunted to our “Sister VAs” in Vermont and Massachusetts. While some of the disadvantages for New Hampshire’s veterans are obvious, some are more insidious. Travel time and other inconveniences are apparent.
What isn’t as obvious is how N.H. veterans are treated by these “Sisters.” The patients just aren’t given the same priority at these out-of-state VAs.
If a request is made for a consult and the patient can’t be accommodated within the so-called clinically indicated date, or CID, (the VA lives by acronyms) the request for care is denied and sent back to the proffering facility.
To make matters worse, the sister VA has, by policy, seven days to process this request.
Since the local VA also had seven days to process the request, the scheduling delay itself is 14 days.
After this two-week delay, the patient is still no closer to being scheduled to see a doctor, let alone actually see one.
Contrast this to when a program exists locally in Manchester. The nuclear cardiology program is a fine example.
Since the steps done in booking were all on site, the full seven days allowed to book the appointment was rarely needed. In many cases patients actually completed their procedure in less than the seven days permitted just for booking.
Because the nurse practitioner doing the booking actually performed the procedure, he would often overbook the schedule if delays were becoming an issue. There were simply fewer moving parts to add to the delays.
I’m not saying the sister VAs would never do an overbook, but that would often require a phone call making a plea to both the scheduling person as well as one to the person performing the procedure.
There is also another dimension to moving services out of state.
When services are curtailed, the jobs associated with the services are lost.
The Manchester VA provides well-paying jobs. Veterans get preference in hiring for these positions. Patients are therefore not the only ones to come up short. Other veterans are cheated out of well-paying jobs. The state of New Hampshire loses any economic benefit as well.
This is not to say that jobs should be created for their own sake, but this is what was precisely done in the last two years at the Manchester VA.
The top administrators at the Manchester VA hired many non-clinical employees who added very little in the way of value to the patients. The ranks of petty administrators swelled while at the same time clinical programs were stripped to the bone.
Some of these workers were hired to perform myriad senseless administrative tasks that are required in the VA bureaucracy. Others were hired to increase the prestige and rank of the top leaders.
In order for an administrator to reach a higher pay grade, it helps to have a certain number of employees in their org chart.
If you’re already high up enough to control hiring, you just add employees under your own division.
The education division, which a few years back consisted of one employee with shared responsibilities, swelled its numbers to approximately six. To make matters worse, while the name of this department sounds noble all it really does is make sure employees complete their yearly mind-numbing required training.
The required training modules include such topics as telephone etiquette, specimen labeling and everyone’s’ favorite, government rules of behavior. It is estimated that employees are required to perform up to 60 hours a year of nonclinical training that may have nothing to do with your particular job title.
Worse yet, by the time you’ve completed the training, it isn’t long before you have to start all over again as the courses are annual requirements.
It is therefore understandable why a large staff is required to assure compliance.
Many more serious problems of waste and neglect exist, which leads many to consider the VA to be a failed system.
A recent town hall meeting consisted mainly of aggrieved veterans each having their own horror story.
If VA Secretary David Shulkin is sincere about solving the issues facing the VA, fundamental changes are required.
The VA is the largest integrated health care system in the United States. Health care not only for veterans but for all citizens is the most hotly debated issue of our time.
The success of the VA in addressing its problems would likely have significant implications for the nation’s health care as a whole.
(Stewart Levenson is a rheumatologist who advanced to become the chairman of the medicine department at the VA in Manchester. Three years ago, he was named medical director of the New England VA network. He lives in Hopkinton.)