Congress: Why Did Leaders Get Bonuses at VAMCs with Safety Issues?

by U.S. Medicine

October 7, 2013

By Sandra Basu

PITTSBURGH — In the wake of emotional testimony given by family members seeking accountability for patient fatalities at VAMCs, lawmakers sharply questioned VHA officials about performance bonuses for leaders in the facilities where the deaths occurred.

“I would just ask the panel to put yourselves in the shoes of the family members that are here today who have lost loved ones. … How would you feel if your loved one had died and then you find out that the very person who is supposed to be preventing deaths like that to occur receives a bonus?” House Committee on Veterans’ Affairs Chairman Rep. Jeff Miller (R-FL) asked a panel of VHA leaders.

Miller made his comments at a field hearing held by the House Committee on Veterans’ Affairs in Pittsburgh titled “A Matter of Life and Death: Examining Preventable Deaths, Patient Safety Issues and Bonuses for VA Executives who Oversaw Them.” The hearing came after months of questioning by lawmakers and veterans’ service organizations about why VA executives were receiving bonuses even while serious problems were occurring at their facilities.

“Despite the fact that multiple VA Inspector General reports have linked a number of these instances to widespread mismanagement at VHA facilities, the department has consistently given executives who presided over these events glowing performance reviews and cash bonuses of up to $63,000,” Miller said at the onset of the hearing.

The House Committee on Veterans’ Affairs is behind an “accountability watch” targeting safety incidents at VAMCs around the country.

Patient-Safety Concerns

The hearing centered on accountability questions sparked by patient-safety concerns and deaths at VA facilities in Pittsburgh, Atlanta, Jackson, Buffalo and Dallas.

Among those who testified was Bob Nicklas, whose father, William Nicklas, was one of the victims who died in 2012 as a result of the Legionnaires’ disease (LD) outbreak in the VA Pittsburgh Healthcare System. Nicklas expressed his belief that no administrators have been held accountable for what has happened there.

“No one has said who is responsible. Imagine what my family has been through. … I am asking everyone who is present today to reflect on this one question. What would happen if you had performed your job in the same manner as the administration at the VAPHS? Would you still be employed? Would you still have your benefits? Would you be receiving bonuses? We urge Congress and all veterans to join us to demand answers and accountability,” he testified.

A VA OIG criminal investigation into the VAPHS situation was still underway as of last month.

Lawmakers seemed especially irked that Michael Moreland, the VA’s regional medical director in Pittsburgh, accepted a Presidential Distinguished Rank Award this year. Moreland was chosen as the recipient of the award months before it actually was given out, but the awards ceremony took place three days after a VA IG issued a report critical of conditions at Pittsburgh VAMCs that led to the Legionnaires’ outbreak. The performance award was $63,000.

When Moreland was asked during the hearing whether he should have returned the award, he said he had “significant sympathy and empathy for the families.” He agreed that the timing of the award was very bad, given the disease outbreak, but that the award was meant to recognize his entire career.

“I understand the families that would look at that and make the connection and be upset about that,” he said. “I received the award. I am proud of receiving it.”

Moreland further said that he was focusing his efforts now on “understanding what happened, how it happened, analyzing the information to make changes and to put the changes in place to reduce the risk of anyone else suffering.”

When VHA Undersecretary Robert A. Petzel, MD, was queried whether anyone at VA had asked for the return of bonuses awarded to Pittsburgh administrators, he said he had not done so and didn’t know of anyone else who had.

When asked why not, Petzel said the administrators were awarded for their performance as VA knew it as was occurring then.“As I understand it, we cannot retract or take back those bonuses,” he said.

Petzel, however, said he did agree with lawmakers that it would be appropriate to scrutinize the performance awards system at VA when asked whether there was a need for a “top-to-bottom review.” He explained that, in an internal review,  VA is “continuously and right now intensively” reviewing its practices in terms of bonuses.

Family Testimony

Others testifying blamed VA facilities in Atlanta and Dallas for the deaths of their family members. In addition, VA employees from Buffalo and Jackson talked about what they perceived as a lack of accountability at those VAMCs.

Gerald Rakiecki, a VA police officer and a union representative at the Buffalo, NY, VAMC, testified that whistleblowers there were unfairly punished for reporting that a large number of patient records were damaged and mishandled. Leaders were not disciplined for that reaction, he pointed out.

On his part, Petzel acknowledged that patient-care issues raised during the hearing were “serious” but said they were not “systemic.”

“VA has a long-established record of providing safe healthcare. While no healthcare system can be made entirely free from inherent risks when adverse incidents do occur, VA studies them to fully understand what has happened, how it happened and how the system allowed it to happen and how the system can be changed to prevent it from happening again,” he said.

Petzel also told legislators that acts that are considered “blameworthy” have “clear accountability and consequences.” After the hearing, the VA also released a written statement by Petzel on that topic.

“If employee misconduct or failure to meet performance standards is found to have been a factor, VA will take appropriate action immediately,” he said. “We work hard to incorporate lessons learned so that future incidents can be avoided or mitigated throughout the entire healthcare network, and VA is in industry leader in changing practices and standards that both private and public sector hospitals employ.”

GAO: VA Pay Bonuses Not Linked Enough to Performance

WASHINGTON — The Pittsburgh hearing comes after a GAO report found that VHA’s oversight “is inadequate to ensure that medical centers comply with performance pay and award requirements.”

As part of its review, GAO examined performance pay and award documents for approximately 25 providers from VAMCS medical centers in Atlanta, Dallas, Seattle and Togus, ME. The GAO found that performance pay was awarded to all eligible providers reviewed at the medical centers, including five providers who had actions taken against them related to clinical performance that year.

“The related provider performance issues included failing to read mammograms and other complex images competently, practicing without a current license and leaving residents unsupervised during surgery,” the report stated.

In its review, GAO pointed out that VA’s performance pay policy gives the 152 medical centers and 21 networks discretion in setting the goals providers must achieve to receive this pay but does not specify an overarching purpose that the goals should support.

Therefore, VHA “does not have reasonable assurance that the goals make a clear link between performance pay and providers’ performance,” GAO investigators wrote in the report.

The GAO also stated that VA’s policy “is unclear about how to document certain decisions related to performance pay.”

“For example, the policy does not provide clear guidance on what to document regarding whether a provider’s performance-related action should result in the reduction or denial of the provider’s performance pay. In contrast to the performance pay policy, VA’s performance award policy clearly states the purpose of these awards — specifically, that they are to recognize sustained performance of providers beyond normal job requirements as reflected in the provider’s most recent performance rating.”

In response to the findings, VHA agreed with GAO’s recommendations, including that it should clarify the overarching purpose of performance pay.

“A policy change is being developed (and coordinated with the VHA) that will clearly articulate the purpose of performance pay under VA’s physician and dentist pay system,” VHA wrote in an attached response.

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