By Sandra Basu
WASHINGTON – Retaliation against physicians and other employees who voice complaints is unacceptable and will not be tolerated in the agency, a senior VA official emphasized to lawmakers at a House hearing last month.
“I apologize to every one of our employees who feels that their voice has been silenced and their passion has been stifled, because that is not acceptable,” said James Tuchschmidt, MD, VA acting principal deputy under secretary for health. “Quite frankly, I am past being upset and mad and angry about this. I am very disillusioned and sickened by all of this.”
Tuchschmidt made his comments at a House Veterans Affairs hearing following testimony by VA physician whistleblowers who recounted how retaliation against those who speak up about problems at VA is “alive and well.”
“The harm it causes the family members of federal workers who are being retaliated against cannot be measured,” said Christian Head, MD, Greater Los Angeles VA Health Care System associate director and chief of staff of legal and quality assurance. Head added that some VA employees perpetuate the idea that “we should be silent, that we shouldn’t stand up and do the right thing.”
Katherine Mitchell, MD, Phoenix VA Health Care System Iraq and Afghanistan Post-Deployment Center medical director, testified that she faced years of retaliation for reporting patient health and safety concerns. She alleged that VA physicians who speak up about problems can be at risk for retaliation in the form of sham peer reviews to sabotage their credibility.
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“In the medical community, peer reviews are only done if there are huge red flags. That is the reason that, if you are ever the subject of a peer review, you have to report it on a license or on a job application,” she explained.
Also testifying about retaliation was Jose Mathews, MD, former chief of psychiatry in the St. Louis VA Health Care System. He contended that he found problems such as outpatient psychiatrists in his department who spent only about 3.5 hours a day on direct patient care, even though veterans were complaining of poor access to care there. His discovery of the problem and efforts to correct it eventually resulted in his transfer to a different position, he said.
“There is a sense of mission that is lacking and I am really hoping that this committee with its powers will take aggressive actions to really make sure this retaliation stops,” Mathews said.
Carolyn Lerner, who heads the Office of Special Counsel (OSC), told lawmakers that her office currently had 67 active investigations into retaliation complaints from employees who reported health and safety concerns. Those complaints came from 45 different VA facilities.
“The number increases daily. Since June 1, we have received 25 new retaliation complaints,” Lerner pointed out.
The VA has taken several steps to resolve these complaints, however, including reallocating staff and resources to investigate reprisal cases and having a priority intake process, she said.
When asked about sham peer reviews, Eric Bachman, OSC deputy special counsel for litigation and legal affairs, told lawmakers that his office is “taking a very close look” at those types of allegations when they come up.
“These types of investigations can be difficult to prove as pretext for retaliation sometimes, but we are seeing that as an emerging trend,” Bachman explained. “It is something that we are focusing on and making sure that we are gathering all the evidence we can to see exactly why the peer review was undertaken.”
Meanwhile, Lerner said there are recent encouraging signs that VA leadership has a “new willingness” to “listen to concerns raised by whistleblowers, act on them appropriately and ensure that employees are protected for speaking out.”
Hours before Lerner testified, VA announced that it would restructure the VHA Office of Medical Inspector in response to a recent OSC letter to President Barack Obama that was critical of the OMI’s handling of investigations. VA announced that the person who served as the OMI stepped down at the end of June, and Gerald M. Cox, MD would serve as interim director of the OMI.
VA also said it would suspend OMI’s hotline and refer all hotline calls to the Office of Inspector General. The personnel change was only one of several changes that have come in recent weeks. Among the other major departures was the resignation of General Counsel for the Department of Veterans Affairs Will A. Gunn, JD.
Tuchschmidt told lawmakers that he was shocked and appalled by the testimony of the physicians.
“We need to do a better job of making sure that people can communicate their concerns,” he emphasized. “There are a lot of avenues. They have the OSC process, they have the OIG, they can come to you all. But my dismay is that they don’t feel like they can come to us within the organization.”
Tuchschmidt also sought to reassure lawmakers that VA Acting Secretary Sloan Gibson is committed to addressing whistleblower retaliation issues and pointed out that a letter was sent from Gibson to VA employees about that very issue.
“The message has clearly gone out to everyone in that June 13 letter that there are consequences for retaliation,” he said.
During the hearing, lawmakers lauded whistleblowers for what they have revealed at VA medical facilities. House Committee on Veterans’ Affairs Chairman Rep. Jeff Miller (R-FL) pointed out that the national scandal involving data manipulation of appointment scheduling “did not spring forward out of thin air at the Department of Veterans Affairs.”
“Whistleblowers serve the essential function of providing a reality check on what is actually going on at the department. At great risk to themselves and their families, whistleblowers dare to speak truth to power,” he said.
Miller said that he has asked his staff to develop legislation to improve whistleblower protections for VA employees.
Legislation that would streamline VA’s community care programs into one program and expand VA’s caregiver program to veterans of all eras was signed into law earlier this month..
The good news from a recent consultant study is that, overall, the VA healthcare system is generally equal or better than others when inpatient and outpatient quality is measured.