- The Washington Times - Wednesday, March 7, 2018

Veterans Affairs Secretary David J. Shulkin announced a sweeping overhaul of senior leadership at about 20 troubled VA hospitals Wednesday on the heels of a watchdog report blaming top agency officials — including Mr. Shulkin — for failing to fix dangerous problems at the Washington D.C. VA Medical Center.

The restructuring was announced hours after the VA’s inspector general issued a report that found Mr. Shulkin, while serving as the VA’s undersecretary of health in the Obama administration, took no action to fix chronic problems of dirty syringes and equipment shortages at the medical center. The report found “failed leadership” and a “climate of complacency” at the agency.

Inspector General Michael Missal also found that Brian Hawkins, whom Mr. Shulkin removed last year as director of the medical center, didn’t take adequate action to correct problems and had a management style described as “exclusionary, nonresponsive, resistant and/or intimidating.”

Mr. Shulkin called the report’s findings “a failure of every level” and said the problems at the D.C. medical center “are happening at VAs across the country.” He made clear that the failures have not led to any known patient harm.

Announcing the start of a restructuring of VA affairs, Mr. Shulkin said he is replacing leaders of VA facilities from Phoenix to New Hampshire, including in Maryland and Virginia.

“It is time for this organization to do business differently,” Mr. Shulkin said at the D.C. medical center. “These are urgent issues, and many of these issues are unacceptable.”

The changes include removing three regional VA directors responsible for 23 hospitals that treat about 3 million veterans. Michael Mayo-Smith, who oversaw VA medical centers in New England, and Marie Wheldon, who was in charge of VA hospitals in Arizona, New Mexico and Southern California, chose retirement.

The third official, Joseph Williams Jr., who led VA facilities in Washington, Virginia, West Virginia, Maryland and Kentucky, was reassigned.

Mr. Shulkin also ordered a reorganization of the VA’s headquarters in Washington by May 1.

But the inspector general’s report amounted to a second strike against Mr. Shulkin, who was heavily criticized by an internal report last month for wasting taxpayer dollars on a trip with his wife to Europe last summer. He also is expected to face another inspector general’s report documenting misuse of his security detail.

The White House said Wednesday that President Trump still has confidence in Mr. Shulkin, the lone holdover from the Obama administration in his Cabinet.

Mr. Shulkin was tapped to lead an agency reeling from scandals in the Obama years of falsified patient wait times and overprescribing of medication.

“Secretary Shulkin has done a great job,” said White House press secretary Sarah Huckabee Sanders. “We’re proud of the work we’ve done.”

She said the president “has directed [Mr.] Shulkin to take an aggressive approach, and he’s done that since becoming secretary.”

But Concerned Veterans for America said the problems outlined in the inspector general’s report illustrate the need for more drastic changes. Executive Director Dan Caldwell called the report “yet another disgraceful instance of a VA medical center not only failing to provide safe, reliable care to patients, but also failing to address it for months and years on end.”

“VA officials received reports of these lapses and did nothing for years,” he said. “This case is exactly why our grass-roots army is working every day to pass legislation to expand health care choices for veterans.”

The left-leaning group VoteVets.org this week filed a Freedom of Information Act request for records detailing whether senior VA officials coordinated with the White House and outside groups such as Concerned Veterans for America to use Mr. Shulkin’s travel scandal as an excuse to replace him, because he opposes privatizing the VA health care system.

“If the controversy surrounding the travel of Secretary Shulkin is being promoted by people within the administration, to force the secretary out because he refuses to privatize the VA, then veterans have a right to know,” said Will Fischer, an Iraq War veteran and director of government relations for VoteVets. org. “If chaos is being promoted, to the detriment of veterans, as a means to oust a secretary simply because he won’t pawn veterans off to the for-profit health care system, veterans have a right to know. Veterans deserve to have someone get to the bottom of this, and that’s what we’re doing.”

On the report about the Washington D.C. VA Medical Center’s chronic troubles, Mr. Shulkin said he didn’t know about the mismanagement “until Mr. Missal picked up the phone, and I am very much appreciative of that. We took action on the very same day with leadership.”

Mr. Shulkin told investigators that he expected the problems outlined in the report to be raised through the usual communication channels, from the local level to the regional office to VA headquarters. The report did not address whether subordinates warned Mr. Shulkin about the problems, but it found an “unwillingness or inability of leaders to take responsibility for the effectiveness of their programs and operations.”

Secretary Shulkin told interviewers he does not recall senior leaders bringing to his attention issues relating to supplies, instruments and equipment while he was undersecretary from March 2015 to February 2017.

Among the problems uncovered were more than 10,000 open and pending prosthetic and sensory aid consults as of March 31, 2017. Some patients had to wait months for these items.

The report found that poor accounting procedures resulted in taxpayer waste of at least $92 million in overpriced medical supplies.

While no patients died as a result the safety issues at the Washington medical center, the report found, shortages of equipment resulted in lengthy hospitalizations, “prolonged or unnecessary anesthesia” and cancellations of medical procedures.

The report said a dedicated staff of doctors and other personnel prevented the problems from resulting in patient deaths.

“In a number of situations, doctors and other health professionals borrowed supplies from a nearby hospital, conducted their own inventories, and took other steps in efforts to provide patients with quality and timely care,” the report said. “However, these stopgap measures are not accordant with an effectively managed healthcare facility. Moreover, patients were put at risk, such as when the lack of supplies or instruments caused surgical procedures to be canceled or delayed.”

The report said that since Mr. Shulkin replaced Mr. Hawkins, the medical center “has made progress in reducing the number of open and pending prosthetic consults, updating standard operating procedures and competencies in sterile processing of instruments, and the overall cleanliness of storage areas, among other improvements.”

House Veterans’ Affairs Committee Chairman David P. Roe, Tennessee Republican, said the findings are unacceptable.

“There are still several significant issues that have not been resolved at the [medical center], so I am grateful to Secretary Shulkin for being proactive in addressing the problems at the D.C. facility and across the department,” he said.

The medical center, which consists of a hospital and four outpatient clinics, served 72,265 patients in fiscal year 2016 and performed more than 3,000 surgical procedures from April 2016 through March 2017.

Of the 124 patient cases reviewed, the report documented problems with supplies, instruments or equipment that affected 74 patients from Jan. 1, 2014, through September 2017.

One patient was admitted in 2015 for a right hip replacement and received a local anesthetic, or nerve block. The appropriate surgical instruments were not available, so the surgeon canceled the procedure.

“The patient, who could not walk immediately after the procedure, had to be admitted overnight until the effects from the anesthetic resolved,” subjecting the patient to the risks of an unnecessary nerve block and hospitalization, the report said.

The patient was readmitted three days later for a successful hip replacement.

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