Three associate chiefs of staff at the Roseburg Veterans Affairs Medical Center have been removed from supervisory responsibilities in response to an investigation by the federal Office of the Medical Inspector.
New Interim VA Director Dave Whitmer sent an email to staff and to the News-Review Friday that outlines an array of changes that have taken place or soon will in the wake of the investigation.
A two-page report summary on the investigation was received Thursday by The News-Review. It confirmed reports that senior VA leadership created an environment of intimidation, and also raised a host of other problems, most notably with radiology, cardiology and mental health care. Former Director Doug Paxton stepped down about a month ago, after investigators conducted interviews with 131 current and former employees late last year.
Friday’s email fleshes out some of the detail that was left out of the summary report, which had presented a broadly-worded list of seven investigative topics and 22 changes the facility would be required to make.
The Office of the Medical Inspector mandated that three associate chiefs of staff be removed as supervisors, but didn’t name them in the report summary. Although names aren’t given in the staff email either, the job titles are.
It appears that former Chief of Surgery Dinesh Ranjan, cardiologist and Associate Chief of Staff of Medical Education William Stellar and Associate Chief of Staff for Mental Health Paul Beiring are the three supervisors. According to the staff email, all three have been removed from supervisory responsibility.
However, rather than be terminated, the three have been reassigned. Ranjan, who stepped down Jan. 21 following complaints of bullying and whistle-blower retaliation, has been reassigned to the regional network to help develop a surgical telehealth program. Stellar was relieved of all cardiology duties Feb. 26, according to the email.
According to the email, Beiring was given a new job Jan. 10 as coordinator for the SAIL program, which measures the VA on performance metrics that influence its official star rating. However, Beiring, who is a social worker rather than a doctor, may have been monitoring metrics for longer than that. He was cited in a Jan. 1 New York Times story as having been assigned to improve the hospital’s metrics in 2014. Beiring was quoted in the story saying the hospital was just “a death or two” away from a two-star rating. The hospital currently has a one-star rating.
Some current and former employees have expressed dissatisfaction that the three supervisors have been reassigned or transferred rather than being fired. According to some reports, all three, including Ranjan, are continuing to work on the Roseburg VA campus even if they’re not supervising anyone.
The OMI called for a fourth person, the chief of mental health nursing, to be removed from supervisory duties, according to the memo. According to Friday’s email, she has transferred to a different facility.
VA doctor Steven Blum said the OMI report vindicated whistle-blowers and shone a spotlight on the “failure of VA management at all levels.”
He said it proves management knew patients were being harmed and staff retaliated against for reporting it. And he said it’s not enough to reassign the supervisors mentioned in the report.
“The next rational step would be to dismiss the managers referred to in this report, rather than simply transfer them to another department or another VA,” he told the News-Review Thursday evening, before the staff email was sent out.
Whitmer included a copy of the OMI report summary in his email to staff members, and spoke about a new openness in dealing with the VA’s past issues.
“A major aspect of our cultural transformation is to share information in an open and transparent way, seek input from you and other stakeholders, and communicate so all are aware of the changes we must undertake together for the long term success of our healthcare system,” he wrote.
He emphasized the Roseburg VA is “under new leadership and on a new path,” and said the report represents the past and the actions that need to be taken, but said the focus is moving forward together.
“Thank you in advance for the work you do each day supporting our mission. Our Veterans are counting on us to deliver the best healthcare that they have earned,” he said.
One of the most puzzling findings in the OMI report involved a demand that a root cause analysis study be performed to find out why a veteran diagnosed with frostbite died. Multiple sources close to the VA said they had never heard about such a case, and in the email, even the VA’s top brass appears puzzled. Under its notes on actions taken for this item, the email said, “Awaiting clarification from OMI on identity of patient.”
On other measures, the VA appears to already be making changes. A problem with nursing supplies to the Eugene clinic has already been fixed, according to the email. Executives’ travel expenses are being audited.
A radiology case involving a patient with a kidney problem was flagged for review, and has already been reviewed by a committee of doctors, while a case involving an involuntary blood draw and forced medication will be reviewed by another committee of doctors.
A vague mention of operating room utilization in the report comes clearer in the staff email, where it appears that contract doctors were not using the Eugene clinic’s operating room for urology cases. The VA’s still working on that item.
There’s more work to be done. A list of mandates regarding the radiology department has been only partially addressed. Other tasks ahead include ensuring adequate cardiology coverage and improving access to primary care due to vacancies at the Eugene clinic.