Ken Hare In Depth: VA officials keep digging a deeper hole

MONTGOMERY, AL (WSFA) - The late, great Will Rogers once said, "If you find yourselfin a hole, stop digging." That's advice that officials of the VeteranAffairs Department just can't seem to take to heart.

By now most readers know the gist of the horror stories about longwaits for care and falsified waiting lists designed to hide those long waitsand seriously ill patients who may have died while waiting.

But it just keeps getting worse. For instance, national news mediaare reporting that one whistleblower claims that in the past few weeks,Phoenix, Ariz., VA officials may have changed computer listings to hide thefact that patients are deceased in order to make it appear that fewer veteransdied while awaiting care.

Meanwhile, here in Montgomery, a report has surfaced that apulmonologist with the Central Alabama Veterans Health Care System copied oldnotes onto new charts for more than 1,200 patients at the Montgomery facility.

A letter from the U.S. Office of Special Counsel sent to PresidentObama outlined several problems -- including the Montgomery situation -- thatshow a "troubling pattern of deficient patient care" at VAfacilities.

According to the letter, an investigation substantiated awhistleblower's claim that the pulmonologist copied prior provider notes intocurrent patient records and that his action likely caused inaccurate patienthealth information to be recorded.

But here's the rub: Central Alabama facilities director JamesTalton told the Associated Press that the doctor is still employed by the VAbecause there is no indication the action endangered any patients.

What? Say that again? Falsifying patient records does not endangerpatients?

That claim is absurd, of course. But it is that kind of runaroundthat is causing VA officials to dig the hole they created for themselves evendeeper.

It is not just the Central Alabama VA facility where such claimsare being made. Carolyn Lerner, who leads the U.S. Office of Special Counsel,wrote that the VA and the VA Office of Medical Inspector "has consistentlyused a 'harmless error' defense where the department acknowledges problems butclaims patient care is unaffected."

News reports indicate such claims of patient care not beingaffected were made in cases where medical instruments were improperly cleanedor psychiatric patients went for years without being evaluated.

For instance, among problems reported by whistleblowers at the VAfacility in Jackson, Miss., were "improper credentialing of providers,inadequate review of radiology images, unlawful prescriptions for narcotics,noncompliant pharmacy equipment used to compound chemotherapy drugs, andunsterile medical equipment."

But apparently the VA did not feel these were issues thataffected patient care. The special counsel's office is reviewing 50 suchcomplaints from facilities around the nation.

Again, such claims are absurd on their face. But they apparentlyhave been enough to keep anyone -- including the Montgomery pulmonologist --from being fired.

It seems that it is almost impossible to be fired in the VA system-- unless, of course, you're a whistleblower who risks his or her job to reportthese abuses.

Meanwhile, CNN reports that 78 percent of 470 top senior managersqualified for bonuses last year by receiving ratings of "outstanding"or "exceeds fully successful." All 470 of them got ratings of "fullysuccessful" or better.

Again, that is absurd. It is the Lake Wobegon Effect, where allchildren are above average.

Congress has suspended bonuses in the VA for a time span untilinvestigations can be completed. But the VA should be asking every top managerwhose rating was based in any way on falsified data to repay those pastbonuses.

I wrote in a column recently that fixing what ails the VA shouldstart with firings -- "lots of them." After learning about theselatest disclosures, I am even more convinced that nothing will change withoutpeople being fired.

So let me repeat several of the recommendations I made in thatearlier column:

-- Congressional watchdogs need to ensure that not just thoseschedulers who falsified records are fired. Any administrator who encouragedthem to do so should be fired as well.

-- Any scheduler or supervisor who instigated or condonedfalsifying records that resulted in their receiving bonuses should be the focusof a criminal probe. To falsify records may be a crime in and of itself, but todo so to receive a bonus sounds a lot like fraud, and should be treated assuch.

--  Firings should not be limited to those who activelyfalsified or encouraged falsification of records. Those administrators whofailed at their responsibilities to prevent such abuses should be fired or atleast demoted, depending upon how culpable they are. And that includes topdirectors as well as those down the line.

-- The entire bonus system in the VA (and probably other federalagencies as well) needs to be reassessed and overhauled, and maybe even ended.

Again, this is what should happen. But the more about the VA thatbecomes public, the less it appears that anyone will be held accountable.


Ken Hare was a longtime Alabama newspaper editorial writer andeditorial page editor who now writes a regular column for WSFA's web site.Email him at

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