My Turn: After meeting with VA secretary, there is reason for optimism

  • Secretary of Veterans Affairs David J. Shulkin takes notes during a visit to the Veterans Administration Medical Center in Manchester on Aug. 4. Shulkin earlier met privately with doctors at the center, who have alleged substandard care at New Hampshire’s only hospital for veterans. AP

For the Monitor
Saturday, August 12, 2017

On Aug. 4, Veterans Affairs Secretary David Shulkin made an unprecedented visit to the Manchester VA. In attendance was the entire New Hampshire congressional delegation, along with Gov. Chris Sununu.

Over the past few weeks, scores of veterans detailed horror stories of poor care they received at the VA. During the secretary’s visit, I and other whistleblowers were able to have a private meeting with Shulkin, which lasted close to an hour. Knowing there would be little likelihood of another meeting anytime soon, we met the night before at our attorney’s office to distill the many complex issues into a clear and concise format. The prep session lasted well into the evening.

We never considered that upon meeting with our group Dr. Shulkin would insist that our lawyer leave. He informed us that if our lawyer didn’t leave, the meeting would be terminated. He claimed that he wasn’t represented by counsel so we shouldn’t be either.

Since Andrea Amedeo-Vickery, our attorney, had been with us throughout this long ordeal, we only reluctantly acceded to Dr. Shulkin’s demand. We knew that asking our attorney to leave was a ploy. Perhaps it was meant to throw us off guard or to ensure that our comments would be more spontaneous and candid. In both regards it succeeded.

What happened next came as an even bigger surprise. Dr. Shulkin wanted to know what we all wanted. His first thought was that we were looking for financial compensation. The battle for improved care had certainly proved a costly one for the whistleblowers. We all had been retaliated against in some way, and some of us had spent a significant sum of money along the way. Yet, without any delay, in unison we made it clear that we had no interest in profiting financially for trying to improve the dangerous conditions our patients had endured. This may have been a turning point. The atmosphere seemed to lighten. A wall seemed to come down between us.

As he said later, none of the problems we brought forth were foreign to him as an experienced health care executive. He had seen these issues in other places. What truly astonished him was the inattention the problems received. We detailed the lack of physician involvement at the medical center. We especially felt marginalized by the nurse executive Carol Williams. We were able to make him understand how she held such a disproportionate amount of sway in the running of the hospital. It was encouraging that after the meeting she was immediately removed.

We explained that the network director, Dr. Michael Mayo-Smith, had also been ignoring our concerns.

We also were able to convince him of the need to take care of Manchester patients in New Hampshire and not transfer them to other New England facilities. We stated with resolve that Manchester should not become a substation of the White River Junction, Vt., VA.

The case was also made that the recent burst pipe, leading to an interruption in services, was just one of the most recent death throes of an obsolete building. Most importantly, by the end of the meeting a dialogue was established that we all felt would continue.

Later that day during a press conference, it was announced that the Manchester VA would receive a total of $30 million. Since this didn’t seem to be on the table before the secretary’s visit, and the visit was instigated by the whistleblowers, it could have been a point of pride for us getting this funding for the medical center. Upon closer examination, $7 million was to repair the flood damage, and $15 million was already earmarked for a new wing for the dilapidated main building. The remainder appeared to be for establishing a program for providing care in the community. This seemed to be to bolster the secretary’s claim that N.H. veterans would be taken care of in state. He did announce a task force led by the network director to study the best means for accomplishing this goal.

This created some unease on our part. Why spend millions of dollars to repair a building when a study may shortly be completed that concludes the best course of action is to tear down the building and build a modern full service hospital? As a group we are opposed to simply admitting N.H. patients to private hospitals in New Hampshire. This was already undertaken in the past few years, and as soon as money became tight the VA went right back to admitting patients out of state. The VA is also uniquely experienced to provide care for veterans.

Even if the task force is run honestly and concludes care in the community is the best option, the building still needs to come down even if only to provide state-of-the-art out-patient care. Building a new wing is a means of avoiding the problems the VA has had with building new structures.

In the execution of new building plans, the VA has been abysmal. The most recent example in Colorado has been plagued by cost overruns that may eventually top one billion dollars. Even the Orlando, Fla., VA that was slated to cost approximately $325 million topped out at over $600 million. As I told Dr. Shulkin, I can understand the VA being gun shy about taking on a new building project but his current boss does have some expertise in this area. The VA must re-establish itself as being able to efficiently replace crumbling infrastructure with new buildings or it will be moving toward complete privatization by default. Many buildings in the system are beyond their useful lives.

As whistleblowers, we are not against forming strategic alliances with local communities when it makes sense. After all, one of our major concerns has been the inability to refer spinal cord injury cases to private sector centers of excellence.

About a week has elapsed since the secretary’s visit. There is now some reason for cautious optimism. Our story did not fade from the public’s consciousness as we might have feared. The continued attention may ensure the integrity of the “top to bottom” investigation. The ineffective local leadership has now been completely removed. The new leadership has made overtures toward engaging the medical staff in key decision-making. Hopefully some of the money promised can be repurposed for a new main building. Shortly we will be meeting with one of New Hampshire’s senators to gain representation on the upcoming “full service medical center” task force.

The Manchester VA has a long way to go, as does the VA nationwide. The discourse now is not centered on whether problems exist but will they be addressed effectively and expeditiously. New Hampshire prides itself on being first in the nation. Perhaps now it can be first in the nation in providing 21st-century quality care for veterans.

(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.)