Troubles Continue for the Phoenix VA

According to the Joint Commission on the Accreditation of Healthcare Organizations (Joint Commission, JCAHO), an independent organization that reviews hospitals, the Phoenix VA does not comply with U.S. standards for safety, patient care and management (1). The hospital was at the epicenter of the national scandal over the quality of care being afforded to the nation's veterans where the now notorious practice of double-booking patient appointments was first exposed. The hospital's indifferent management provoked congressional investigations that uncovered still more system-wide abuses leading to the removal of the hospital director and the resignation of then VA secretary, Eric Shinseki. The hospital maintains its accreditation but with a follow-up survey in 1-6 months where it must show that it has successfully addressed the 13 identified problems (1). Inspectors who conducted the review in July found that VA employees were unable to report concerns "without retaliatory action from the hospital." Other alarming deficiencies were that Phoenix administrators did not maintain a "safe, functional environment" or "a culture of safety and quality." They concluded that the hospital does not have adequate policies and procedures to "guide and support patient care, treatment and services."

Elizabeth Eaken Zhani, a media relations manager at the JCAHO, stressed that noncompliance findings do not typically lead to a loss of accreditation (2). Of more than 4,000 medical facilities evaluated each year, she said, less than 1 percent are denied accreditation. The Phoenix VA has a right to appeal and an opportunity to correct failings so the hospital meets national standards. In a written statement October 20, VA officials said plans have been developed with an expectation that compliance issues will be resolved within 120 days. "We are also working diligently to address the cultural issues identified by The Joint Commission and have implemented a number of items to enable employees to raise concerns about safety or quality without fear of retaliation...".

In 2010, the Phoenix VA was among 20 VA medical centers to earn The JCAHO's "Top Performer" honor. The most recent audit, in 2011, showed Phoenix at or above target values established by the commission for every major category of health care and administration. It is unclear if care quickly deteriorated at the VA over three short years or previous JCAHO evaluations were inadequate. JCAHO inspections usually are conducted by a retired hospital administrator, physician and nurse. They usually review policies and procedures and rarely meet with physicians, nurses, technicians or clerks directly involved in patient care.

In an editorial entitled "After ALL THAT, Phoenix VA still fails review?!" the Arizona Republic (3) stated the "Phoenix VA is the hospital the VA would want to get right. The one at which the troubled agency would throw all its resources to assure that, despite all evidence to the contrary, VA leaders really did know what they were doing. And, yet, the Phoenix VA flunked its review". The editorial goes on to say that, "Perhaps the most fundamental flaw in the VA system is the forbidding culture of the organization, which regularly and ruthlessly punished whistle-blowers. You would think that, above all else, the VA's new administrators would strive to assure that that malignant practice was banished. Didn't happen. Failure to assure that a VA worker could 'report concerns about safety or the quality of care to (the reviewing agency) without retaliatory action from the hospital' was at the top of the Joint Commission's list of findings". The Republic goes on to say that "The Joint Commission's audit provides still more evidence of the intransigence [pigheaded] and resistance to change that the VA presents to even the most determined reformers".

Richard A. Robbins, MD

Editor

Southwest Journal of Pulmonary and Critical Care

References

1. The Joint Commission. Phoenix VA Health Care System: Summary of accreditation quality information. Available at: http://www.qualitycheck.org/qualityreport.aspx?hcoid=2508# (accessed 10/23/14).
2. Wagner D. Phoenix VA hospital fails outside compliance review. Arizona Republic. October 21, 2014. Available at: http://www.azcentral.com/story/news/arizona/investigations/2014/10/21/phoenix-va-hospital-fails-outside-compliance-review/17649623/ (accessed 10/23/14).
3. Editorial board. After ALL THAT, Phoenix VA still fails review?! Arizona Republic. October 22, 2014. Available at: http://www.azcentral.com/story/opinion/editorial/2014/10/22/phoenix-va-downsize/17748023/ (accessed 10/23/14).  

Reference as: Robbins RA. Troubles continue for the Phoenix VA. Southwest J Pulm Crit Care. 2014;9(4):240-1. doi: http://dx.doi.org/10.13175/swjpcc140-14 PDF

Helman Defends Decision to Pull VA Sponsorship of Veterans Day Parade

Sharon Helman, Phoenix VA Director, defended her decision to cancel VA sponsorship of the annual Phoenix Veterans Day Parade in a 4/10/13 email to VA employees. Helman said that VA sponsorship was cancelled because of “…priorities in the organization (specifically access), and heightened awareness over liability concerns which VA Legal Counsel brought forward”. She concluded her letter by warning “… that all media inquiries should be forwarded to Paul Coupaud, Acting Public Affairs Officer”.

VA officials initially said fear of litigation prompted the review of VA support. Last year, a float carrying wounded Veterans in a Midland, Texas, parade collided with a freight train, killing four and injuring 17. Crash victims and their families filed lawsuits in Texas against Union Pacific Railroad and the float owner. The VA was not a defendant, and the VA has not issued any national directives on liability as a result of the tragedy.

In past years, the VA did not contribute cash for the parade. Instead, it served as lead sponsor by providing staging areas at its medical center and allowing Paula Pedene, the former Director of Public Relations at the Phoenix VA, to serve as coordinator. It also provided other support and hosted award events, an essay contest and banquets. Pedene was demoted in the wake of her testimony to the VA Office of Inspector General against former VA administrators. Pedene testified that the Phoenix VA suffered from leadership run amok. She said that agency bosses intimidated employees and created a hostile workplace.

Phoenix VA employees had provided volunteer support on their own time for the Phoenix Veterans Day Parade. No mention has been made of clinical VA employees who participated in parade activities during regular working hours instead of providing care. It is difficult to understand how cancelling sponsorship of the Phoenix Veterans Day Parade will provide increased access to healthcare for Veterans. However, wasting clinical staff time with lengthy and extraneous emails such as the one sent out 4/10/13 or Ms. Helman’s equally lengthy and extraneous weekly e-mails to employees will compromise access. As Helman said in her letter the VA must focus on “bringing additional staff on board” to care for the 81,000 Veterans enrolled at the Phoenix VA. If true, the alleged pattern of abuse, discrimination and retaliation at the Phoenix VA will jeopardize the hiring and retention of the necessary clinical staff to provide Phoenix Veterans access to quality healthcare.

Richard A. Robbins, MD*

*Dr. Robbins was the chief of pulmonary and critical care at the Phoenix VA from 2003-11.

Reference as: Robbins RA. Helman defends decision to pull VA sponsorship of Veterans day parade. Southwest J Pulm Crit Care. 2013;6(4):180. PDF