Manchester VA Interim Director: 'This Is A Personal Mission To Make Sure We're Doing This Right'

Jul 20, 2017

The Manchester VA Medical Center is under federal investigation after a report by the Boston Globe's Spotlight team  revealed allegations of seriously substandard care at the facility. Among the conditions described in the report: an operating room infested with flies, veterans with crippling spinal damage that might have been prevented, and obsolete surgical instruments.   

After top officials there were removed, Alfred Montoya was named interim director. Montoya is also director of the White River Junction VA. We talked with him four days after he landed in Manchester and a day after a pipe failure flooded five floors of the hospital. 

Below interview excerpts have been edited for clarity. 

What is your reaction to the Boston Globe report?

I would direct you to Secretary Shulkin’s statement, which  he released on Sunday; certainly he ordered a top-to-bottom review of the Manchester VA Medical Center, which is currently underway.  On Monday, we had two groups come to the facility --  the Office of the Medical Inspector, as well as the Office of Accountability and Whistleblower Protection. Those are just two of the groups coming in. There are certainly more to come in the near future, as well as after that.

What we’re doing right now, starting today, is making sure we're undertaking a thorough review to assure that the VA is a place of high quality. Our patient satisfaction data, which is asking veterans themselves -- those who go and get their care there -- it’s extremely high, much higher than in other parts of the country. And so I don’t want to prematurely tell people that they shouldn’t have confidence, but I can assure you we’re going to get to the bottom of it very soon. -- Dr. David Shulkin,  U.S. Secretary of Veterans Affairs, speaking on WGIR with Jack Heath. 

What has been your interaction with the investigators?

I don’t have much involvement with them, as their investigation is certainly separate than what we’re doing here at the Medical Center. I came in here on Monday and my job is to make sure that I’m out listening to veterans and employees and hearing their concerns and really being transparent and sharing that open-door policy, which I’ve had up in White River Junction.

My biggest priority moving forward right now certainly over the next weeks and months is to really look at our operations as a whole in Manchester and how we can complement those with other providers in the region, as well as other VAs in the region. 

What are you hearing from staff?

I hear all sorts of things --  the positive, the negative. I hear ways we can make improvements.  My job as acting medical center director is to really listen to the feedback from our veterans.  I am a veteran. I was in the Air Force for 10 and a half years; I was medically separated. And I get 100 percent of my healthcare within the VA, so, for me, this is a personal mission to make sure we’re doing this right and listening to the feedback of our veterans.

A new report on WMUR says the whistleblower doctors were asked to sign a form promising not to speak about the investigation. One doctor felt it was a “gag order.”  Are you aware of that request?

I certainly can’t speak to that.  I’m not aware of anything like that, as yesterday, I was immersed in water, in some cases up to my  knees. I don’t  think people understand how big a crisis (the flood) was and what we actually were faced with yesterday.

I know there was a statement the Secretary’s office put out yesterday regarding that and so we can certainly point that in your direction…I think the Secretary statement yesterday really stated that this is normal, this is in place to protect our veterans and their privacy. 

Producer's note: We received the following statement from the Manchester VA regarding the request:  

The document is simply a reminder of the legal protections and requirements that apply in the investigation process.

It tells witnesses that they have a right to have a union representative present during interviews, that they will be protected from retaliation for cooperating with the investigation, and that they need to comply with the investigators’ instructions to safeguard Veterans’ medical information or other information – the disclosure of which might violate Veterans’ rights or compromise the investigation process.

For example, no VA employee has the right to disclose a Veteran’s sensitive HIPAA or Privacy Act-protected information publicly without the Veteran’s consent.

What’s your feeling about this request?

I’ve had many feelings since Sunday. I was notified Sunday evening that I was to report to Manchester on Monday morning. So my feelings have gone all the way across the spectrum -- certainly not thinking there was going to be a major flood on Wednesday that we were going to be faced with.

I will tell you that my main priority here is to be very transparent and open and to listen. I told our employees yesterday during a town hall with the Principal Under Secretary for Health that we will be having town halls with our staff and our stakeholders --  to really listen to what they have to say and what their concerns are and really use that to formulate the way forward for this organization.

It does seem that there were concerns circulating for a long time -- to members of Congress, lawyer letters, complaints to various agencies. Why do you think it finally took a Boston Globe report to finally bust this open?

My first day was on Sunday night, Monday morning, so I can’t speak to that.  I can tell you that I have been very transparent with all of our Congressionals. The White River Junction  Medical center shares the same Congressional stakeholders as the Manchester catchment area. So we are continuing the process of listening to our veterans, our stakeholders, our staff, and this is what we’re going to be doing going forward.

What’s the policy to make sure doctors and others won’t pay a price for speaking up for their patients?

The Department does have a policy on that and it was very clear in Secretary Shulkin’s statement, as well as his sending out the Office of Accountability and Whistleblower Protection. That is a new office that was stood up because of recent legislation. So this is something the Secretary certainly takes seriously as you can see in the statements he put out.

Do you see the Veterans Choice program as part of the problem? There have been many complaints about it.

If you look at the Secretary’s top priorities for the agency – redesigning Choice into Choice 2.0 is certainly among his top priorities. We’re going to be taking different measures to be able to make sure that we help our veterans navigate through that Choice process.... Whether they get care in the VA or outside the VA using Choice, making that as easy as possible is certainly my priority.

How hopeful are you that you’ll have the budgetary authority to get the necessary funds to help veterans get care outside the VA if necessary?

I’m very hopeful that I’m going to be out there listening to our veterans and our staff and stakeholders. Right now we’re trying to get a veteran town hall scheduled. I’m certainly hopeful that we can take this opportunity and learn from it as an organization. Looking at processes here at the Manchester VA Medical Center, much like we have in White River Junction, is going to give us opportunities for improvement. That coupled with veteran feedback and stake holder feedback is certainly going to improve any system, regardless of where you’re at.

How much information do you get about these investigations?

We’re here to facilitate those investigations moving forward. The Secretary ordered a top-to-bottom review. I’m focused on operations in the facility, continuing that, making sure our veterans get access to care. So I would say we’re here in a facilitation mode to give them space and also give them the latitude to do their jobs as is appropriate.

Some problems are systemic in the VA but some are quite local, like an infestation of flies in an operating room. Not just a one time thing but for years. How hard is it to get rid of flies?

That depends. I can’t speak to the specifics on this because I was not here. I can speak to everything as of Monday morning going forward.  I have walked this facility more in the last four days than I think I’ve ever walked any other facility and that’s due to the flood and all of that… I think we have an opportunity to hear from our staff, whether it’s through my open door policy, which I had in White River Junction, which has been quite popular, to monthly sessions with our veterans service officers. All the different avenues of communication.

More often than not, I do give out my cell phone number in public forums to be able to have them call me to raise those concerns.  That level of availability and transparency is exactly why I wanted to be on your show today.

What is your next concrete step?

We’re still looking at flood response.. Afterwards, we’re looking at opportunities for veterans to voice their concerns, their feedback, and then really take that and develop where we want to go as an organization.

Listen here for the entire program with VA Director Alfred Montoya, David Kenney, chairman of the N.H. State Veterans Advisory Committee, Howie Howe, Veterans Service Officer and liaison between the Manchester VA and the N.H. State Veterans Advisory Committee, and Peter Biello, NHPR's host of All Things Considered.