V.A. Punished Critics on Staff, Doctors Assert
WASHINGTON — Staff members at dozens of Department of Veterans Affairs
hospitals across the country have objected for years to falsified
patient appointment schedules and other improper practices, only to be
rebuffed, disciplined or even fired after speaking up, according to
interviews with current and former staff members and internal documents.
The
growing V.A. scandal over long patient wait times and fake scheduling
books is emboldening hundreds of employees to go to federal watchdogs,
unions, lawmakers and outside whistle-blower groups to report continuing
problems, officials for those various groups said.
In
interviews with The New York Times, a half-dozen current and former
staff members — four doctors, a nurse and an office manager in Delaware,
Pennsylvania and Alaska — said they faced retaliation for reporting
systemic problems. Their accounts, some corroborated by internal
documents, portray a culture of silence and intimidation within the
department and echo experiences detailed by other V.A. personnel in
court filings, government investigations and congressional testimony,
much of it largely unnoticed until now.
The
department has a history of retaliating against whistle-blowers, which
Sloan D. Gibson, the acting V.A. secretary, acknowledged this month at a
news conference in San Antonio. “I understand that we’ve got a cultural
issue there, and we’re going to deal with that cultural issue,” said
Mr. Gibson, who replaced Eric K. Shinseki after Mr. Shinseki resigned
over the scandal last month. Punishing whistle-blowers is “absolutely
unacceptable,” Mr. Gibson said.
The federal Office of Special Counsel,
which investigates whistle-blower complaints, is examining 37 claims of
retaliation by V.A. employees in 19 states, and recently persuaded the
V.A. to drop the disciplining of three staff members who had spoken out.
Together with reports to other watchdog agencies and the Times
interviews, the accounts by V.A. whistle-blowers cover several dozen
hospitals, with complaints dating back seven years or longer.
Dr.
Jacqueline Brecht, a former urologist at the Alaska V.A. Healthcare
System in Anchorage, said in an interview that she had a heated argument
with administrators at a staff meeting in 2008 when she objected to
using phantom appointments to make wait times appear shorter, as they
had instructed her. She said that the practice amounted to medical
fraud, and complained about other patient care problems as well.
Days
later, a top administrator came to Dr. Brecht’s clinic, put her on
administrative leave, and had security officers walk her out of the
building.
“It’s
scary to think that people can try to stand up and do the right thing,
and this is the reaction,” said Dr. Brecht, now in private practice in
Massachusetts.
Her
complaints were corroborated by other Alaska personnel and were the
subject of an email that Dr. Brecht sent to a military doctor at the
time. Dr. Brecht wrote that administrators “schedule fake patient
appointments (i.e. commit FRAUD).” They do so, she wrote, “just so our
numbers look good to DC (and the administrators get their bonuses for
these numbers).”
Kathy
Leatherwood, a nurse and unit manager at the Alaska V.A., said in an
interview that she also objected in 2008 to the use of phantom
appointments. She said administrators directed her to schedule fake
appointments for new patients within 30 days without even notifying the
patients. She was then supposed to mark the patient as a “no show” or a
cancellation and schedule a real appointment for later, she said. That
way, the official record would show the veteran was offered a quick
appointment within the required turnaround period.
Ms. Leatherwood said that she, too, went to V.A. administrators to object.
“It’s
my name that’s going to be on that chart,” she remembered telling one
administrator. The administrator responded that if she was unwilling to
carry out the policy, he would find someone who would, she said. When
she continued objecting, he threatened to call security if she did not
leave his office.
Kathleen
Belmonti, who was a nurse there, said in an interview that she, too,
was aware of staff concerns about scheduling and management practices.
Cynthia
A. Joe, the chief of staff at the Alaska V.A. Healthcare System, said
the facility had never used phantom scheduling and that, while some
staff members had raised questions about scheduling practices, no one
had protested or faced disciplining after raising concerns.
In
court filings detailing the V.A. response to other problems, Dr. Ram
Chaturvedi, formerly with the Dallas V.A. Medical Center, said that he
began complaining in 2008 about shoddy patient care, including
negligence by nurses who had marked the wrong kidney while preparing a
patient for a procedure. In another instance, Dr. Chaturvedi said
medical personnel had brought the wrong patient to an operating table.
A
supervisor told Dr. Chaturvedi to “let some things slide” because of
staffing problems, but he continued writing up complaints. Officials
considered him disruptive and fired him in 2010.
At
the V.A. Medical Center in Wilmington, Del., Michelle Washington, a
psychologist treating soldiers with post-traumatic stress disorder, also
found her worries unwelcome. She said in an interview that she faced
retaliation when she testified in 2011 to a Senate committee about staffing shortages that she said left veterans waiting dangerously long for psychological help.
A
week before her scheduled appearance, Dr. Washington said she received
an evaluation downgrading her performance at the hospital from
“outstanding” to “unsatisfactory,” citing management complaints she had
never heard before. She was also stripped of some psychological
treatment duties.
“I’m
not sure how I went from outstanding to unsatisfactory in 30 days,” Dr.
Washington said. “The only intervening thing was my testimony.”
In
Pittsburgh, two V.A. doctors specializing in Legionnaires’ disease, Dr.
Janet Stout and Dr. Victor Yu, said they were forced out after
complaining about budget and salary matters in 2006. The V.A. then
closed their lab and destroyed their specimens — decisions the doctors
contend contributed to a 2011 outbreak of Legionnaires’ at the
Pittsburgh hospital that killed six people.
“The V.A. isn’t a place where you speak out,” Dr. Stout said in an interview.
Dr.
Yu called the department’s decision to close his lab “malicious,” and
added in an interview that “I fall into a category that the V.A.
absolutely abhors — whistle-blowers.”
The
number of claims of retaliation by V.A. whistle-blowers are among the
highest of any federal agency, said Carolyn Lerner, who runs the Office
of Special Counsel, and have been documented by Congress going back at
least two decades.
In
1992, a congressional report concluded that the V.A. discouraged
employees from reporting problems by “harassing whistle-blowers or
firing them.” In 1999, a House subcommittee hearing on “Whistleblowing and Retaliation in the Department of Veterans Affairs” found little had changed.
Today V.A. employees and whistle-blower lawyers say the problem has only gotten worse.
In Phoenix, Dr. Sam Foote,
whose complaints triggered the current scandal, said hospital officials
ignored him at first and then harassed him when he complained about
administrators who were “cooking the books.” V.A. administrators
“started coming after me,” he told The Arizona Republic. He decided to
retire early last year as a result.
One
way the V.A. has silenced whistle-blowers, their lawyers maintain, is
by threatening to hold them in violation of patient privacy laws if they
discuss medical cases. That happened in a 2007 case in Chicago, where
Dr. Anil Parikh was fired after reporting “systematic problems” that he
said delayed patient care. In terminating him, the V.A. charged that he
had violated confidentiality laws by reporting his concerns to the
inspector general and to Barack Obama, at the time a senator from
Illinois, and other government officials, court filings show. After four
years, a grievance panel reinstated Dr. Parikh with back pay.
Many employees, still fearing retaliation, are going outside the department to report what they say are systemic problems.
The Project on Government Oversight,
a private group working with whistle-blowers, said it had received
confidential complaints from about 175 current and former V.A. employees
since the latest controversy began. Those complaints are of such
interest to the government that the V.A. inspector general subpoenaed
them last month, demanding all reports related to the Phoenix V.A. The
group is resisting because of concerns about whistle-blower
confidentiality.
“People are coming out of the woodwork,” said J. Ward Morrow, a lawyer for the American Federation of Government Employees, which has received recent reports of problems from more than 100 V.A. employees.
Dr.
Brecht, the Alaska urologist who was put on leave in 2008, said she
thought about calling a whistle-blower’s hotline at the time, but feared
that administrators might take further steps to discredit her and risk
her medical licensing.
“When
I saw all this on the news the last few months, part of me felt this
huge sense of relief,” Dr. Brecht said, “because it was like I wasn’t
crazy after all.”
