Veterans Administration Docs: If We Speak Up, We Become A Target

By Lauretta Brown | June 12, 2014 | 1:15pm EDT

Rep. Dan Benishek (R-Mich.)

( - The primary complaint of health care providers employed by the Department of Veterans Affairs (VA) is retaliation by management - including “sham peer reviews” and even dismissal - for speaking up about serious deficiencies in the VA’s medical system, several VA doctors said during a two-day meeting in Washington on how to improve veterans’ health care.

Dr. Rafael Montecino, a surgeon with the VA in eastern Kansas, complained that “when you try to make things more efficient, the system is working against you. They say that you are creating a hostile environment.”

And “when you complain, or you say like ‘You know, this is not the right thing,’ then you become a target and they gang together to get you out of there,” Dr. Montecino added.

Other complaints raised by VA physicians included inefficient scheduling systems, a lack of appropriate post-surgical care, lazy VA employees, and having their input ignored by VA management.

The discussion was hosted by the Foundation for Veterans Health Care (FHVC) and the National Association of Veterans Affairs Physicians and Dentists (NAVAPD) at the National Press Club prior to Thursday’s House and Senate hearings.

“I mean, you know, I got fired from the VA many times,” Rep. Dan Benishek (R-MI), chairman of the House Committee on Veterans’ Affairs’ Subcommittee on Health who is also a doctor, commiserated with the physicians, dentists, and others talking about retaliation for complaining about substandard conditions in VA medical facilities,

“You have to be willing to put your career on the line, frankly,” Benishek told them, recounting that he had been fired by the VA himself for voicing his concerns, but that he was eventually re-hired because of the scarcity of surgeons in his rural area.

The majority of the doctors who testified complained of “sham peer reviews” - a name given to the abuse of a medical peer review process to attack a doctor for personal or other non-medical reasons.

“Sham peer reviews are something that we need to look into because they’re destroying the doctors,” Dr. James Martin, a national representative for the American Federation of Government Employees (AFGE) and physician on its National VA Council, told Benishek.

”They’re afraid to come forward because they see what happened to their colleagues. So if there’s some way we could look into these peer reviews that are not being done ethically, that would help us a lot,” Dr. Martin told Benishek.

The congressman replied that that would be a good topic for a congressional hearing, noting that “we need to just fix that at the top.”

Montecino said that  talking to other doctors across the country has convinced him that the retaliation problem is widespread.

At his hospital, he said, “you have the people who are in the leadership over there telling you: 'Don’t work that hard [because] you’re going to make other people look bad. We need to provide the most basic care for homeless kind of patients.' That’s what we’re told.”

(AP file photo)

Dr. Katherine Mitchell, medical director of the Phoenix VA’s post-deployment clinic and a former whistleblower, asked Rep. Benishek for protection against retaliation for VA physicians who dare to speak up.

“Currently the avenues for investigating retaliation against physicians for reporting patient care concerns can take up to two years,” she explained.

"During that time, your professional life is made a living hell - your proficiencies are dropped, your hours are made horrendous. In my case, I was told I had to work unlimited hours for two years while they figured out when to hire.”

“No one should have to lose their job or fear for job security for doing the right thing. It is our ethical duty as a physician," Dr. Mitchell said. "The administration has created all sorts of things to permanently destroy a physician’s reputation: sham peer reviews are one, where they’re conducted with pre-determined results,” she added.

“All I can tell you is that I’m here, I’m working hard to make these changes happen,” Benishek responded, adding, “I can’t promise you that I’ll fix it and make it all perfect, but that’s my goal.”

The VA’s real problem, Benishek said, “is the people that actually are taking care of the patients have little input as to what’s going on.”

A retired VA cardiac surgeon related that “there was no, absolutely zero, ancillary support to help us move patients around the hospital” when he was head of the heart surgery program at a VA facility in Portland, Oregon. "But there’s people all over the hospital...I couldn’t tell what they were doing, but they weren’t doing anything that had anything to do with taking care of my patients,” he added.

“At my facility there is an incentive to reward supervisors and administrators at the expense of the folks taking care of patients and there is absolutely no accountability and there is inevitably retribution,” a VA radiologist from Connecticut testified.

Benishek encouraged the VA physicians to continue to complain despite the career risks involved. “These are the stories that need to be told,” he said, adding that “you got to be persistent, stand up for your values and make yourself heard.”

Benishek was a general surgeon in private practice in Michigan and worked part-time at the Oscar G. Johnson VA Medical Center for two decades.

“We know all these things have been going on for decades, but getting the American people to demand action, this happened now... So I would appreciate your help in bringing the issues to at least my committee where we can air them out,” he urged the physicians.

When one of the doctors in attendance pointed out that the VA administration does not allow them to talk to either the press or Congress, Benishek said that while that may be true, it did not prevent him from having “a consultation about one of your patients,”

“Give me a call,” he urged. “I’ll tell you what I can do for you.” He encouraged the other doctors to “also consult” with him, joking that “it seems like there might be a lot of consultation needed."

Following the event, asked Rep. Benishek: “What are some of the most important things you feel you need to bring to the attention of Congress…[that] you think you can practically get done?”

“Well, you know, our goal is to actually have a management team within the VA that listens to physicians," he replied.

“Frankly there’s better communication channels between the nursing staff and the management than there is with the physicians and I think that’s the primary goal that we’re working on, and just simply to hold these people accountable for failure."

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