VA whistleblower: Manchester should be a ‘test case’ for national reform

  • Dr. Ed Kois speaks to the group of veterans and guests at the Sweeney Post 2 in Manchester on Monday, as Dr. Stewart Levenson (left) looks on. GEOFF FORESTER / Monitor staff

  • Dr. Stewart Levenson speaks to the group of veterans and guests at Manchester’s Sweeney Post 2 on Monday July 31, 2017. GEOFF FORESTER—Monitor staff

Monitor staff
Published: 7/31/2017 11:45:01 PM

One of the whistleblowers at the Manchester Veterans Affairs Medical Center said he plans to propose his workplace as a “test case” for national reform of the veterans health care system when he meets with VA Secretary David Shulkin this week.

Dr. Ed Kois, the head of the facility’s spinal cord clinic, said he hopes to peel away restrictive layers of bureaucracy at the state’s only veterans hospital and hold it up as a model for the rest of the country.

The spotlight on the Manchester VA, which came after Kois and 10 other physicians and medical staff reported stories of substandard care, could help accomplish that goal, he said.

“What I’m going to propose is we put our heads together and start on developing a VA system that’s streamlined, that doesn’t have this huge bureaucratic nightmare at the top, and see if we can design a system that not only works for the veterans in Manchester, but nationally, because the national system is broken,” he said.

At the American Legion post in Manchester, Kois sat on a panel Monday with a handful of other whistleblowers, who listened and interacted with veterans at a three-hour town-hall meeting. As veterans recounted instances of unsatisfactory care, he urged them to put their stories in writing so they could be delivered to Shulkin on Friday.

“You guys really deserve a lot of credit,” said John Milne of Hilton Head, S.C., “because it’s got to be sucky to give up your time to come to your patients and ask for help, when the role is really reversed.”

The doctors said that the hospital, especially under ousted director Danielle Ocker and former chief of staff James Schlosser, too frequently emphasized unimportant metrics over the health of its patients. For instance, Mark Sughrue, a nurse practitioner who runs the stress test department, said a needed $1.5 million nuclear camera sat unused because the hospital wouldn’t pay its relatively small share to install it.

Others said their time is wasted on clerical tasks, because they don’t have dedicated assistants, or their work suffers from doing multiple jobs at once.

“We started to have administrators that lost sight of the fact that we’re treating patients that have medical issues and pain issues and psychological issues,” Kois said. “They started to look at it as part of a larger metric system, and if (patient problems) didn’t fit in their metrics, well, that wasn’t an issue for them.”

While the doctors couldn’t get the help or tools they needed, the administrative staff grew rapidly, said Dr. Stewart Levenson, the chief of medicine who retired Friday. Over a three-year period, he said, roughly 125 non-clinical employees were hired while the number of clinicians was relatively flat.

This atmosphere took its toll on the doctors. Dr. Ed Chibaro said he left his job at the Lahey Institute of Urology at Parkland Medical Center in Derry to start a robust outpatient surgery center.

“Two years later, I still don’t have any urological equipment,” he said.

Chibaro described numerous attempts when he tried to improve services for patients or obtain equipment and was “laughed at, basically.”

“That’s how my life has been at the VA. I do very little work. I see patients and have to ship them out to whatever port,” he said, noting that he won’t necessarily see them again or know whether they were taken care of. “I go into the parking lot and I feel rather depressed because I’ve never taken care of patients like that before. I usually finish the job that I started and not leave it up to (the Veterans Choice Program) to know whether these people are receiving the care they’re supposed to receive.”

Similarly, Dr. Kevin Keenan, a physician and retired colonel, said he became so frustrated with his job that it began to affect his home life, so he quit last year after five years at the VA.

“The folks at the top have no skin in the game when it comes to clinical outcomes,” he said. “If you don’t believe that things in Manchester are already perfect, just ask the leadership and they’ll tell you. They’ll show you the metrics.”

Not only was the leadership out of touch, but it refused to hear differing viewpoints, Keenan said.

“When they changed the message of how they communicated things to emphasize the positives, it became unacceptable to mention any of the negatives,” he said. “At Manchester, that was the thing that made it unworkable and unlivable for me.”

Keenan added: “As a veteran of three different wars, I got beat in this one.”

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