Whistleblower: Mismanagement Continues at Manchester VA

Aug 30, 2017

As the Manchester VA Medical Center continues to recover from catastrophic flooding, allegations of dangerous delays in veterans’ care, and unsanitary conditions, VA officials and a dozen whistleblowers are trying to chart the future of veterans’ healthcare in New Hampshire. It’s not clear what that will look like.

Doctor Stewart Levenson is one of those dozen whistleblowers who went public last month with accusations of dangerous mismanagement at the Manchester VA. And he writes in today’s Concord Monitor that conditions at there have actually gotten worse since July, and not just because of the flooding. He spoke to NHPR's Peter Biello, who also spoke with Manchester VA interim director Al Montoya (see end of interview).

  

How, in your view, have conditions gotten worse at the Manchester VA since July?

I think the leadership void—none of the major departments has stable leadership at this point. Decisions are being made on the fly and then reversed, such as the decision to use the radiology suite for endoscopic procedures and then at the last minute cancelling those procedures. It really strikes of not only mismanagement but inexperienced leadership.

Last month the director of the hospital and chief of staff were removed pending an investigation and interim directors have been put in those positions, but, as you say, that’s unstable leadership.

Well, it takes a while to get up to speed, and even if you grant that, they’re still on staff at White River Junction, Vermont, so they’re traveling between the two centers. If you’re willing to give them the benefit of the doubt that they’re capable, hard-working leaders, still, they’re not in Manchester enough to make things run smoothly, as evidenced by recent issues.

You worked at the VA for a long time but you just recently left, so how did you come upon this knowledge of how things are at the Manchester VA?

I still have quite a few interactions with the employees and department heads. I have about as much interaction with the people who are still in place there, such as the other whistleblowers (and) some others that confide in me. So there really is no change in my interactions. We’re still this group. I don’t work there on a day-to-day basis, but I’m kept well-informed of what’s going on there.

In your view, are the whistleblowers and officials at the Manchester VA and in the VA system working towards the same goals?

I would hope so. I can’t read their minds. It’s sometimes difficult to tell because the VA is such a large bureaucracy and they don’t always seem to be moving in a linear direction towards those goals, but one would hope. I have no reason to doubt that our goals are any different.

I spoke with Dr. Mayo-Smith—

Dr. Michael Mayo-Smith, the network director for the New England VA system.

Yes, he’s the network director, and while we have a lot of differences, we’ve worked together for close to twenty years, and there is some common ground. I’m in a unique position in that we respect each other so we at least have a dialogue open, which I’m not sure would be possible with other people who have gone up against the VA, so to speak. We talked about our goals and there wasn’t a lot of daylight between what we both want for the VA.

The whistleblowers, for the most part, want a full-service hospital, correct?

Yes, some iteration of that. That’s what Dr. (David) Shulkin (Secretary of the Department of the Veterans Affairs) promised when he came down to Manchester, saying that New Hampshire veterans should be cared for in the state of New Hampshire. That’s a firm goal.

What’s the likelihood that New Hampshire will get what’s called a “full service” hospital—with in patient and other comprehensive services offered at other VA hospitals, like the one in White River Junction, Vermont?

I think it’s difficult to say. One possibility is where the VA contracts with local medical centers and calls themselves “VA at X Medical Center.” But we would prefer that the old building that is currently experiencing the repair for the flood damage be torn down and a new building be put in its place, even if the VA in Manchester doesn’t become a full-service inpatient medical center, that building is a white elephant that can’t support any further utility.

You and the other whistleblowers have targeted the gigantic bureaucracy as one of the sources of the VA’s troubles. In your view, is that being addressed?

They make attempts to address it. At one of the town hall meetings, Al Montoya (acting director of the Manchester VA) started talking about a list of things that needed to be removed for being overly bureaucratic. But I’ve seen this before. It’s very hard for bureaucracies to self-police.

So when Sec. Shulkin came to Manchester earlier this month, he asked the network director to set up a task force to look at the future of the Manchester VA. There was some discussion of having one of the whistleblowers on the task force. Many hoped it would be you. It turned out not to be you. It’s going to be Dr. Erik Funk. Is that appropriate, in your view?

Dr. Funk is a gifted physician. I couldn’t say a single ill thing about him. He’s a great colleague and he deserves to be on the task force, but it’s turning out to be a rather large task force and I am not sure one voice in the wilderness, so to speak, will be sufficient. I think another member of our group should be placed on the task force and that Dr. Funk, by himself, may have difficulty getting his points across.

Do you feel like the task force is going to do an honest look at what needs to happen at the Manchester VA, or has the conclusion already been decided?

I think both are true. I think they’ll take an honest look, but there is some pre-determination involved. Because there’s a moratorium on building new buildings, so if you include that one factor in the charter of the task force or in their work product, the task force is already limited its eventual outcomes. So it depends on how it’s set up and how it’s being steered.

Let’s turn now to Al Montoya, interim director of the Manchester VA. In your view, have conditions worsened since July?

No, absolutely not. I think we’re moving in the right direction. Some of the things that we’ve identified over the last six weeks—we’re rebuilding the leadership team, going out and doing searches, recruitment for key vacancies. One of the “Way Forward” categories is improved care, essentially enhancing open access at the Manchester VA.

In making sure that we’re adding additional cardiology staff, making sure that we’re recruiting two new primary care-aligned teams. There are a number of things that we’re doing to really improve the care at the Manchester VA.

Next month is suicide prevention month. One of (the things we’re doing) is growing the suicide prevention program at the Manchester VA. I’m happy to report that we have two full-time suicide prevention coordinators at the Manchester VA who will be addressing suicide prevention.

Similarly, I would say that one of the things that we have been very successful at, Peter, is being able to leverage our community partnerships that we have. A very good example of that is the relationship we’ve created with Catholic Medical Center (CMC) in Manchester. We’re doing a very similar relationship with other community partners to be able to have our providers in Manchester provide the services and the level of services that they have and that they aren’t able to provide because of the flood and the damage that created in community space, and so that is certainly one way that we’re improving the level of care.

Dr. Levenson mentioned that leadership now is sort of divided. You’re speaking to us from White River Junction, Vermont, but you’re interim director in Manchester. Is splitting your time between these two centers harming your ability to manage things on the ground in Manchester?

That’s one I appreciate being able to correct. I’m not splitting my time between Manchester and White River Junction VA. I’m calling you from White River Junction because we had a valuable training that I wanted the Manchester VA team to be able to participate in. So that notion that I’m splitting my time is inaccurate.

I will tell you in White River Junction we have acting medical center director Matt Mulcahy, who is here fulltime. And that’s how we’re moving things forward, but I don’t agree with that statement of the time-splitting.