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National VA problems mirror those in Nevada

"Things need to change. The culture (at the VA) needs to change"
Posted at 5:58 PM, Jun 28, 2019
and last updated 2019-06-28 21:24:59-04

LAS VEGAS (KTNV) — Veterans hospitals are back under fire on the national level. And some of the issues coming to light in hearings in Washington, DC mirror the ones 13 Action News exposed here in Nevada.

The Department of Veterans Affairs clearly knows there's a problem. Just this week, the Office of Inspector General released this report, and the very first sentence highlights the VA's "...chronic healthcare professional shortages since at least 2015."

Congress is now learning more about problems with the VA's work culture as whistleblowers testified on Capitol Hill.

The problems were nearly identical to ones we've exposed here in Las Vegas.

SEE OUR REPORT FROM APRIL 29

"Things need to change. The culture there needs to change," said Dr. Brian Werner.

"Yes absolutely," said Dr. Victoria Smith. "The VA is a numbers company. There's no other way of looking at it."

Our investigation as recently as April detailed claims from more than a dozen current and past VA doctors and employees. People who describe a culture of fear at the Southern Nevada VA.

"Morale was terrible," said Dr. Smith. "People were unsure whether they were going to have a job."

And it isn't an isolated problem. Whistleblower hearings before the house Committee on Veterans Affairs show just how widespread it has become.

After Dr. Katherine Mitchel blew the whistle in 2014 about manipulation of patient wait lists, she received a federal employee of the year award. But she says that didn't mean real change.

"I've been described by the VA as a whistleblower success story and as definitive proof that the VA embraces whistleblowers," Mitchel told lawmakers. "However nothing could be further from the truth. Unfortunately VA administrators today still continue to retaliate."

Here in Las Vegas Dr. Brian Werner left the Southern Nevada VA earlier this year after he says instead of addressing problems he raised, VA leadership turned the tables and investigated him.

"We're supposed to be transparent," Werner said. "You're supposed to have these agencies and whistle-blowers and all these things you can file but the reality... it really doesn't work like that and people are afraid to come forward."

"I've had patients that I've taken care of that were discriminated against because they had somebody who was advocating for them," said Smith. "And it's a sad situation. I hate seeing our veterans be short-shifted like this.

A psychologist from Maryland says she was pressured to reduce wait-list counts by scheduling fake appointments in an imaginary clinic. She was terminated the day before this hearing, where she tried to spotlight staff retaliation.

"After I started voicing my concerns about their improper wait list practices, the agency threatened to remove me as coordinator of the program and transfer me to a different area of the hospital," Minu Aghevli told lawmakers. "I have experienced constant harassment, scrutiny and frivolous investigations. Management has stripped me of authority in ways that have been humiliating. I am exhausted."

The dozens of current and former staffers we've spoken to say it's an ongoing problem here and the primary cause of turnover and staff shortages,which directly impacts patient care.

The Southern Nevada VA is approved for 3160 positions. That includes 400 new positions added in just under two years. The VA says 517 are "in various stages of hiring." 259 of those will start soon or are awaiting final clearance, including about 30 physicians . Which leaves 258 vacancies the VA is actively trying to fill in Las Vegas including more doctors.

In response to this investigation, the Southern Nevada VA provided the following statement:

VA posts all of its vacancy info publicly online

However, the best indicator of adequate staffing levels is not vacancies, but Veteran access to care and health care outcomes. By those standards, VA is doing well.

VA is seeing more patients than ever before, more quickly than ever before, it has more employees than ever before, its budget is bigger than ever before and Veterans are more satisfied with wait times than they have been previously. Consider the facts:

  • VA completed more than 58 million internal appointments in FY 2018, a record and 623,000 more than the same timeframe the year prior.

All VA health care facilities now provide same-day services in primary and mental health for Veterans who need them.

  • A 2018 Rand study found that the VA health care system “generally delivers higher-quality care than other health providers.”
  • A recent study in the Journal of the American Medical Association (JAMA) shows that VA wait times are shorter than those in the private sector in primary care and two of three specialty care areas.

It also found that access to care at VA health centers improved from 2014 to 2017 and patient satisfaction with VA appointment wait times is improving.

VA staffing plans consider normal rates of workforce turnover, retirement, and growth, and the expectation that there will always be vacant positions.

Each year, VA hires more employees than it loses to replace turnover and keep up with the growth in demand for services.

  • As stated in the original response “the best indicator of adequate staffing levels is not vacancies, but Veteran access to care and health care outcomes. By those standards, VA is doing well.” Locally, we served an all-time high of more than 63,400 Veterans in Fiscal 2018 and completed a record 910,600 outpatient appointment – an annual increase of 53,300 appointments from where we were just two years prior. We also provide same-day services in primary and mental health for Veterans who need them and offer a myriad of telehealth options to meet our Veterans needs.

  • As of June 26, 2019, VASNHS had 3,160 approved positions with 517 in various stages of hiring. Of those, we have selected individuals for 259 positions and are either awaiting the new employees’ arrival or are working final clearances for onboarding. The remaining 258 positions are in various stages of recruitment (75 being prepared for advertisement, 80 currently being advertised on usajobs.gov, 42 announcements closed with applications being screened by human resources, and lists of qualified candidates for 61 positions with hiring managers to review and make selections).

  • Of note, many of these positions are new. Since October 2017, the VA Southern Nevada Healthcare System has added nearly 400 new positions locally to meet the needs of the expanding Southern Nevada Veterans population. This includes approximately 70 new positions in behavioral health, 106 new positions in support of a new 20-bed inpatient ward and 20-bed psychosocial residential rehabilitation treatment program ward; and 40 new positions to coordinate Veteran’s care within the community as part of the VA MISSION Act.

  • Recently, the VA Southern Nevada Healthcare System hosted its first-ever nursing career fair. Over two days, the facility interviewed 144 candidates for a myriad of open registered nurse positions and extended job offers to 53. The event was a huge success and VASNHS plans to conduct similar events in the future to attract candidates for other career fields and openings.

  • Nevada ranks 47th for physicians, 48th for nurses and 50th for behavioral health specialists per capita, creating strong competition for health care professionals. Ensuring VASNHS is properly staffed to meet the needs of Southern Nevada’s growing Veterans population is a top priority, however we face many of the same common challenges as the rest of the health care industry locally and nationally. VASNHS is actively addressing these issues and will continue to recruit the best qualified candidates to care for our Veterans.
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