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Whistleblower on Manchester VA reforms: 'It's not enough'

New Hampshire Union Leader

September 18. 2017 9:10PM
Dr. Edward Kois, one of the Manchester VA Medical Center whistleblowers, addresses the House Veteran Affairs Oversight and Investigations Subcommittee Monday in Pembroke. To his right are David Kenney, chairman of the New Hampshire State Veterans Advisory Committee and Dr. Michael Mayo-Smith, director of the Veteran Integrated Service Network One in Boston. (MARK HAYWARD / UNION LEADER)

Two months after a newspaper exposé about the Manchester VA Medical Center, whistleblower doctors and medical professionals on Monday raised concerns about continued problems at the facility.

These observations are contained in VA whistleblower statements submitted this month to the House Committee on Veteran Affairs:

• In-house stress tests with a nuclear camera aren’t available, in part because the VA has been slow to hire a technician and install a newer camera, according to cardiology nurse practitioner Mark Sughrue.

• Business-office manager Gary Von George has filed a retaliation complaint, claiming he was moved to an administrative office job after he met with VA investigators about Veterans Choice. “My case is a classic example of how this agency treats employees that try to bring issues to light and they suspect of being a whistleblower,” he wrote.

• An autocratic culture continues to exist in the operating room, according to a urologist and two nurse anesthesiologists. Operating room turnover is high. Money has been spent on office renovations ahead of essential equipment and instruments. A nurse-manager bullies her underlings.

"She has lied, exhibited inferior sterile technique, encouraged the use of contaminated instruments and violated multiple Joint Commission guidelines for unprofessional behaviors," reads a letter written by urologist Edward Chibaro and nurse anesthesiologists John McNemar and Stephen Dubois.

The committee’s Oversight and Investigations Subcommittee met at the New Hampshire Army National Guard’s Regional Training Institute in Pembroke on Monday. The only committee members present were Rep. Annie Kuster, D-N.H., the ranking Democrat on the committee, and the chairman, Rep. Jack Bergman, R-Mich., a retired Marine general.

Over two hours, VA officials lauded the whistleblowers and said the situation at Manchester has improved since July. That’s when a Boston Globe Spotlight article reported about “Third World” outcomes for patients with spinal ailments, a fly infestation in an operating room, unsanitary operating equipment and problems with Veterans Choice.

Critics, including Bergman, pointed to the leadership of the Boston-based VA regional network, which ignored problems when whistleblowers initially raised them.

Bergman said it is clear there was no sense of Veterans Integrated Service Network (VISN) addressing the problems. He directed his comments toward director Dr. Michael Mayo-Smith.

“As a VISN director, your job is to lead proactively, not reactively,” Bergman said.

Earlier in the hearing, Mayo-Smith said “one of the things we’ve learned is whatever system we have now, it’s not good enough.”

VA officials highlighted some positive changes:

• The VA has committed an additional $5 million to hire more staff and is recruiting for eight high-level positions, including director, chief of staff, nurse executive.

• A technician has been hired and will undergo training so nuclear stress tests can begin next month in the cardiology department with the camera currently on site. Construction is necessary before a new SpecCT camera can be installed.

• Veterans Choice will be overseen by a physician-led office that uses six nurse care management teams to speed along referrals to community providers. The referrals, termed consults, are turned over for scheduling in three days, compared to a national standard of seven.

• An outside, peer-review network will review the cases of spinal ailments, termed myelopathy, that the Globe reported on.

Ninety patients suffered paralysis because of inappropriate follow-through, the whistleblower doctors have said.

An investigation into that care is ongoing, but Dr. Carolyn Clancy, a physician and VA deputy undersecretary, said that investigation involves an intensive review of medical records.

Not good enough, said whistleblower Dr. Edward Kois. He said investigators need to speak to patients, who were inappropriately discouraged from having surgery to address back and neck problems.

“For 10 years, medical records were fabricated,” he said. “If you just look at the chart, it’s not enough.”

Also present were U.S. Sens. Jeanne Shaheen and Maggie Hassan, both New Hampshire Democrats.

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