Another Phoenix VA Director Leaves

The Arizona Republic reports that the director at the Phoenix VA Medical Center, Deborah Amdur, will retire after only 9 months for health reasons (1).  Amdur will be replaced by Barbara Fallen, director of the VA Loma Linda Healthcare System. Fallen will be interim director until a permanent replacement for Amdur can be found. This is the fifth hospital director since former Director Sharon Helman was removed in mid-2014 amid the nationwide veterans health-care scandal that was first exposed at the Phoenix VA.

The Veterans Integrated Service Network (VISN) in Gilbert, which oversees the VA Medical Center in Arizona, New Mexico and West Texas has also been through a series of 4 directors since Susan Bowers retired under pressure in the wake of the VA scandal. Marie Weldon, current acting regional director, also oversees the Los Angeles-based VA Desert Pacific Healthcare System. Weldon described Fallen as “an experienced leader who will continue the tremendous effort being made to improve access to high quality health care for veterans in the Phoenix area.”

Amdur's retirement comes just one day after 12 News KPNX in Phoenix reported a taped conversation between a patient and employees at the Southeast VA Clinic in Gilbert (2). During the visit a nurse called the patient phone scheduling system “a nightmare", and a doctor employed by the VA for 3 months said he was “not a fan of the VA” and complained that assigning him 500 patients on May 23rd did not allow him sufficient time with patients. According to the tape the doctor expresses his desire to help but simply states, “It’s just I’m so lost in what to do.” Regarding the audio recording, Director Amdur said before her resignation that "the agency is looking into the matter" and threatened "actions with the providers involved”.

Congressman Matt Salmon, who represents Arizona's 5th District which includes the Southeast VA Clinic, told 12 News he was “disappointed” by what the audio recording revealed and does not consider it an anomaly. Salmon said while there are pressing matters facing the agency, he is optimistic new leadership can help turn it around. "I have nothing but praise for Director Amdur who is running the (Phoenix) VA. I think she is a breath of fresh air," Salmon said. "But the problem is so many people who still work there are the people that were there when the problem was created and getting rid of people that don’t do the job the way they are supposed to is almost impossible in the VA." Salmon said the VA's HR system needs to be revamped in order to recruit higher-quality employees. "It needs to be streamlined so that when they find good doctors they are able to hire them quickly," Salmon said.

Amdur's threats and Salmon's comments are in line with the last 2 and a half years of VA excuses for poor care by blaming bad employees rather than mismanagement and lack of oversight. Both the nurse and the doctor are new to the VA and will likely shortly be gone for telling the truth further worsening the shortage of providers. As predicted 2 and half years ago, no fundamental changes have been made at the VA and it is not surprising that problems with patient scheduling persist (3). The last 20 years demonstrate that if the VA wants to provide the best of care, it is time to stop putting VA bureaucrats in charge and replace them with professionals who know something about it, doctors and nurses. Those doctors and nurses need to be overseen by a local committee of professionals to ensure that Veterans get the best of care. Otherwise no real change occurs and VA bureaucrats and politicians will continue to blame bad employees rather than a bad system. If no fundamental change is made, it may be time to scrap the VA system and send patients to outside providers as suggested by both the patient who made the recording and implied by Salmon.

Richard A. Robbins, MD*

Editor, SWJPCC

References

1. Wagner D. Phoenix VA hospital getting yet another boss. Arizona Republic. August 26, 2016. Available at: http://www.azcentral.com/story/news/local/phoenix/2016/08/26/phoenix-va-hospital-getting-yet-another-boss/89412700/ (accessed 8/27/16).
2. Dana J. VA cancer patient secretly records doctor visit. 12 News KPNX. August 25, 2016. Available at: http://www.12news.com/news/local/valley/va-cancer-patient-secretly-records-doctor-visit/307185216 (accessed 8/27/16).
3. Robbins RA. VA administrators breathe a sigh of relief. Southwest J Pulm Crit Care. 2014;8(6):336-9. doi: http://dx.doi.org/10.13175/swjpcc077-14.

*The views expressed are those of the author and do not necessarily reflect the views of the Arizona, New Mexico, Colorado, or California Thoracic Societies or the Mayo Clinic. Dr. Robbins does see VA patients under the Veterans Choice Act.

Cite as: Robbins RA. Another Phoenix VA director leaves. Southwest J Pulm Crit Care. 2016;13(2):95-6. doi: http://dx.doi.org/10.13175/swjpcc084-16 PDF

VA Office of Inspector General Releases Scathing Report of Phoenix VA

The long-awaited Office of Inspector General’s (OIG) report on the Phoenix VA Health Care System (PVAHCS) was released on August 27, 2014 (1). The report was scathing in its evaluation of VA practices and leadership. Five questions were investigated:

1. Were there clinically significant delays in care?
2. Did PVAHCS omit the names of veterans waiting for care from its Electronic Wait List (EWL)?
3. Were PVAHCS personnel not following established scheduling procedures?
4. Did the PVAHCS culture emphasize goals at the expense of patient care?
5. Are scheduling deficiencies systemic throughout the VA?

In each case, the OIG found that the allegations were true. Despite initial denials, the OIG report showed that former PVAHCS director Sharon Helman, associate director Lance Robinson, hospital administration director Brad Curry, chief of staff Darren Deering and other senior executives were aware of delays in care and unofficial wait lists.

Perhaps most disturbing is the OIG finding that scheduling deficiencies are systemic throughout the VA. The OIG is currently investigating 90 VA facilities. The findings prompted Rep. Jeff Miller, House Veterans’ Affairs Committee chairman to comment “We have seen no evidence that the corrupt bureaucrats who created the VA scandal will be purged from the department’s payroll anytime soon. Until that happens, VA will never be fixed,” (2).

Though whistleblowers alleged veterans died while awaiting care in Phoenix, acting Inspector General Richard Griffin did not draw any conclusions about criminal culpability and declared that he was “unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans.” Phoenix whistleblowers Drs. Sam Foote and Katherine Mitchell, said the OIG standard made no sense because 45 examples described in the OIG report showed that delayed care likely resulted in premature deaths or harm to patients’ quality of life. It is the later standard that is usually applied to physicians.

The day prior to the release of the report the Deputy VA Secretary Sloan Gibson was interviewed noting that more veterans are being sent to private doctors for care reducing waiting times (3). "The fundamental point here is, we are taking bold and decisive action to fix these problems because it's unacceptable," said Gibson. It is unclear whether these reports of improved waiting times are any more reliable than the initial denials of prolonged patient waiting times from both the Phoenix VA and VA Central Office.

Richard A. Robbins, MD

Editor

Southwest Journal of Pulmonary and Critical Care

References

1. Office of VA Inspector General. Review of alleged patient deaths, patient wait times, and scheduling practices at the Phoenix VA health care system. Available at: http://www.va.gov/oig/pubs/VAOIG-14-02603-267.pdf (accessed 8/26/14).
2. Wagner D, Lee M. Scathing VA report stirs outcry for accountability. Arizona Republic. Available at: http://www.azcentral.com/story/news/arizona/investigations/2014/08/26/scathing-va-report-stirs-outcry-accountability/14665455/ (accessed 8/27/14).
3. Associated Press. Watchdog report details ‘systemic’ problems at VA facilities. Available at: http://www.foxnews.com/politics/2014/08/26/no-proof-delays-in-care-caused-vets-to-die-va-says/ (accessed 8/25/14). 

Reference as: Robbins RA. VA office of inspector general releases scathing report of Phoenix VA. Southwest J Pulm Crit Care. 2014;9(2):140-1. doi: http://dx.doi.org/10.13175/swjpcc112-14 PDF