Michael Mayo-Smith: Reports debunk claims of VA whistleblowers – and now it’s time to move on

For the Monitor
Published: 12/21/2018 9:26:11 AM

In July 2017, disaffected medical staff at the Manchester VA Medical Center gained wide publicity for concerns alleging poor patient care and leadership mismanagement.

Then-VA Secretary David Shulkin immediately removed leadership at Manchester, promised transparency and chartered two investigations. In an earlier Monitorop-ed, I called upon the VA to follow through with its promise of transparency and release reports of these investigations. Recently, although never released publicly by VA, copies were obtained. The facts uncovered in them reveal a dramatically different story than initially reported in the press.

The first report addressing each quality of care allegation in detail consistently found them unfounded. Rust and blood on surgical instruments: Never happened. Delays in surgical care due to fly infestation: Not a single case. Nuclear medicine tests stopped because a purchased camera was too big for the room: Not true.

One doctor identified more than 100 cases where he claimed care of spinal cord patients was substandard. Carefully following Office of Special Counsel guidance, the VA contracted with an outside company that sent them for review to non-VA, board-certified specialists. The large majority, over 90 percent, were found to have received good care. It did find some cases where care fell short. This is unfortunate for we would all like to see every veteran get outstanding care.

However, the outside specialists failed to find the widespread, systematic breakdown that was alleged.

The second report was done by the Office of Accountability and Whistleblower Protection, a new office set up under President Donald Trump’s tough VA Accountability Act. It addressed allegations that leadership neglected its duties or failed to provide appropriate oversight. Its findings were even more stunning.

Over and over investigators found the assertions “were speculative and not supported by credible evidence.” They spoke positively of Manchester leadership: “Although the whistleblower letter characterized the leadership style of the Manchester VAMC Quadrad as ‘insular and not focused on patient care,’ we disagree.”

They noted a clear rift between a segment of the clinical staff and leadership, but accurately described several factors, including increased accountability and “staff disagreeing with operational decisions made by the leadership team . . . decisions that we found to be sound, defensible and within their discretion to make.”

They did find the medical center was overwhelmed by the volume of Community Care consults and didn’t follow proper protocol in tracking consults. However, care was being arranged and no harm found. Otherwise, one by one, every allegation of mismanagement was “not substantiated.”

Furthermore, the investigators “did not find evidence” that any of the whistleblowers, contrary to their assertions, tried to contact or request assistance from me, as director of the New England Network, regarding these issues.

These reports are an important part of this story. Far from a cover-up or whitewash, they tried to objectively establish what actually happened, using standards of evidence universally accepted in health care.

Nationally other trends contributed to this story gaining traction. In an analysis of media coverage of the VA, the Veterans Healthcare Policy Institute found a marked lack of balance. Despite congressionally mandated independent studies showing that quality of care at the VA is as good or better than private sector, media have heavily emphasized negative stories about the VA.

The group of disaffected staff, making up only about 2 percent of the medical center employees, were largely clinicians who recently joined the VA after careers in the private sector. There’s no doubt the many rules and regulations that guide government agencies, the slow pace of change and realities of fixed budgets were frustrating. They are frustrating to those of us who spend our careers in the VA. The consistent theme of resentment that nurses had too big a say – including the RN director – suggested another source of cultural discomfort. However, there were many ways these concerns could have been addressed in a more constructive and less vindictive manner.

Since these allegations were reported, the rate of new patients coming to Manchester has fallen. Fewer veterans are taking advantage of valuable VA services for problems such as suicide, PTSD and homelessness. Employee morale dropped and recruitment is not easy. The abrupt removal of Manchester leadership was completely unjustified. It is no wonder the VA struggles to find candidates for senior leadership positions. Public scrutiny of the VA is needed, but it is important that the VA receive balanced and fair treatment for the overall excellent care it delivers to our nation’s veterans.

Despite these consequences, it is now time to move on. There are new faces, from service chiefs in Manchester to VA secretary. There is a clear vision for VA services in New Hampshire and innovative efforts in such areas as employee engagement and high-tech artificial limbs. The staff are working hard to ensure the medical center delivers exceptional services that improve the lives of veterans.

We should all wish them success, for the veterans deserve nothing less.

(Dr. Michael Mayo-Smith of Franklin is a former network director of the VA New England Health Care System.)

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