Friday, May 2, 2014

Trust the government for your healthcare?

Second VA doctor blows whistle on patient-care failures

Late on Sunday night, Dr. Katherine Mitchell said she received a phone call from a fellow employee at the Phoenix VA hospital who needed advice on how to handle a sensitive situation.
Her co-worker explained that records were being destroyed that very moment in the Phoenix VA Health Care System. But he had preserved evidence of what he believed were falsified wait times for medical care. The purported "secret lists," along with accusations that up to 40 Arizona veterans died awaiting care, are the subject of national controversy and investigations by Congress and the VA Inspector General.
Mitchell was a confidante with experience — nearly 16 years at the veterans hospital, first as a nurse who became supervising physician in the emergency room, then as medical director over a transition program for veterans of the Iraq and Afghanistan wars.
She said her colleague explained that the documents were being destroyed that evening. Aware that the House Committee on Veterans' Affairs had issued orders for the VA to preserve documents at the medical center in Phoenix, the two agreed to protect evidence.
Mitchell said she went to the medical center and walked her co-worker to VA police headquarters, where they asked officers to secure the documentation. Police declined, Mitchell said, but suggested they find a safe place to conceal the materials inside the hospital.
Twelve hours later, Mitchell said, her co-worker delivered the evidence and a statement to an investigator from the Office of the Inspector General while Mitchell visited The Arizona Republic, asserting status as a government whistle-blower.
Mitchell struggled with emotions as she described the incident, her career-threatening decision and concerns about the integrity of VA administrators.
"I had no doubts they were capable of destroying evidence, or altering evidence," she said. "So there I am, a 47-year-old doctor with two degrees, trying to figure out where to hide stuff.
"I spent my whole professional life wanting to be a VA nurse, and then a VA physician. ...(But) the insanity in the system right now needs to stop, and whatever I can do to accomplish that, I will."
The Republic this week sought comment from Phoenix VA Health Care System Director Sharon Helman about Mitchell's assertions, and an interview with the director, scheduled Thursday, was canceled at the last minute when Helman was placed on administrative leave by Secretary of Veterans Affairs Eric Shinseki.
Fight for improved care
Mitchell said she fought for improved veterans care within the system, warning that Emergency Department patients were in jeopardy and, more recently, that suicides had escalated amid a shortage of mental-health staffers.She said she was transferred, suspended and reprimanded.
Many of her allegations coincide with complaints lodged by Sam Foote, a VA primary-care physician who retired in December. In letters to the House Committee on Veterans' Affairs and the inspector general, as well as in interviews with The Republic, Foote first made the accusation about patient deaths and fraudulent records.
Both physicians, as well as other VA employees who asked not to be named for fear of retribution, said the Phoenix VA leadership disdains internal criticism and retaliates against those who speak out. In interviews and a written statement, Mitchell told TheRepublic she can no longer remain silent.
"I am violating the VA 'gag' order for ethical reasons," she wrote. "I am cognizant of the consequences. As a VA employee I have seen what happens to employees who speak up for patient safety and welfare within the system. The devastation of professional careers is usually the end result, and likely is the only transparent process that actually exists within the Phoenix VA Medical Center today."
In recent interviews, Helman said employees are encouraged to express concerns, especially about medical care. She and chief of staff Darren Deering said their leadership team has dramatically improved service to veterans, is unaware of any patient deaths linked to delayed care and did not manipulate or falsify wait-time data.
But Mitchell and other VA employees have expressed fears of evidence-shredding before and after inquiries were launched by congressional committees and the Office of Inspector General.
Those concerns were echoed Thursday by Rep. Jeff Miller, R-Fla., who first disclosed the Phoenix VA allegations as chairman of the House Committee on Veterans' Affairs. In a letter to Shinseki, Miller warned against the destruction of evidence and threatened to issue a subpoena.
Helman was placed on leave hours after that letter was sent, and one day after Dr. Robert Petzel, undersecretary for health in the Department of Veterans Affairs, told the Senate Committee on Veterans' Affairs that a VA team sent to Phoenix found no evidence of secret patient lists or related patient fatalities.
Early warnings
Hospital administrators and critics in Phoenix agree that, beginning several years ago, a surge of veterans and an exodus of medical staffers resulted in huge delays in care. Waits for first-time appointments with primary-care doctors exceeded one year, and referrals to specialists often took months.
Because of the logjam, vets began flooding the hospital emergency room, which already was shorthanded. Mitchell, then director of the Emergency Department, said patients waited hours while nurses with inadequate triage training tried to determine which ones needed immediate attention for life-threatening problems.
Mitchell said she wrote memos to hospital administrators, including Deering, describing "near misses," to raise a red flag. The Republic has obtained substantiating e-mails.
Mitchell said her warnings were dismissed at first, and patients were further endangered as some nurses, resentful of perceived criticism, became uncooperative. Then, in early 2012, Helman took over leadership at the hospital and paid a visit to the Emergency Department, which was overwhelmed with patients.
"When she asked me how things were going, I pulled her into the back and answered her honestly and without the usual political correctness," Mitchell said. "Without adequate staffing, ancillary services and sufficient triage training, I told her the ER was so dangerous that it should be shut down immediately. ... The only thing worse than losing my career was failing to prevent another vet from dying. I hoped a new leader would understand the critical nature of the situation and divert needed resources. I was wrong."
Mitchell alleges that, within days, she was told by senior administrators that the only problem in the Emergency Department stemmed from her deficient communication skills. After other ER doctors met with administrators to express similar concerns, Mitchell said, hospital managers began making improvements.
But they also transferredMitchell out of the ER to a position as medical director of transition services for vets who served in Iraq and Afghanistan.
In that role, Mitchell said, she became concerned that suicides among Phoenix veterans had spiked in recent years amid a shortage of mental-health staffers. Once again, she said, vets appeared to be suffering from delayed care and triage failures. She sounded another alert without immediate results.
Mitchell said she decided in September to file a confidential complaint with the Office of Inspector General, channeled through Arizona Sen. John McCain's office because she believed that would be more effective. She said the Phoenix VA was so dysfunctional that she included a multitude of other safety and patient-care issues in hopes of bringing "the greatest change possible."
Records show Mitchell's list of concerns went to Tom McCanna, McCain's staffer for veterans affairs. An aide to the senator said that more than 2,000 complaints about the VA have been received in the past 18 months but declined to discuss individual constituent complaints or to allow The Republic to interview McCanna.
Mitchell said she learned that only part of her correspondence was forwarded to the VA. Records show her list of concerns wasnot submitted to the inspector general, who investigates systemic problems and wrongdoing, but to the Office of Congressional and Legislative Affairs — a political liaison department in Washington.
A Feb. 27 letter to McCain's office from Michael Huff, congressional-relations officer for the VA, contains responses to Mitchell's complaint. It describes suicide-prevention processes, but does not address assertions that suicides increased amid growing delays in care. With regard to medical care, Huff's letter confirms a new Electronic Wait List was implemented, an inspector general probe was under way and new procedures and staff training were initiated. It does not address whether wait-time data had been falsified.
The VA Office of Congressional and Legislative Affairs did not respond to Republicinquiries.
Complaints filed
Mitchell said that within days after she made the complaint via McCain's office, she was placed on administrative leave pending an investigation for unspecified wrongdoing. She said her confidentiality had been breached, and in January, Mitchell received written counseling that alleged she "may have" violated patient privacy in filing her complaint.
Mitchell said VA leaders refused to explain what she'd done wrong or provide documentation.
"I was devastated to learn I would not be given access to the investigative file because it was shredded 'for my own protection,' " she wrote recently in an open letter describing her experiences. "I was told that HR (human resources) determined it did not need to inform me of which specific policy I had violated because a written counseling did not rise to the level of a disciplinary action employees were allowed to challenge."
Jean Schaefer, a Phoenix VA spokeswoman, said agency officials are unable to comment on investigations or disciplinary actions regarding Mitchell because she declined to sign a privacy waiver.
Mitchell said she sent a second complaint, with extensive backup materials, to the senior liaison for the Senate Committee on Veterans' Affairs. She said she was advised those documents would be shared with the Office of Inspector General, but that to date she has been unable to verify that her accusations are part of the ongoing investigation.
A spokeswoman for the inspector general said the office does not comment on specific complainants or their allegations.
Mitchell said she decided to go public as a last resort, risking a career she loves.
"It's not like I'm going to get any fame or fortune out of this," she said.
In her letter, she wrote: "The pending investigation has the potential to help address and resolve the issues which have held a stranglehold on our facility, ourveterans and our employees for decades. ... Although I welcomed news of an official Senate Committee inquiry last week, I have no faith at this point that the VA Medical Center is capable of providing an accurate accounting of its deficiencies, or that an investigative team will accurately document what it finds."
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