Another VA scandal has erupted, this time for chronic and systemic failures to provide care, this time in Cincinnati. Scripps-Howard and WCPO report on a months-long investigation driven by almost three dozen whistleblowers who claim they have been ignored by VA officials and members of Congress in their attempt to rectify the issues within their hospital. At the same time, workers complain that acting chief of staff Barbara Temeck gets paid for two positions, while only performing one of them:

Here are some of the Scripps-WCPO findings, all based on interviews and documents:

• Services to veterans have been reduced, including spine and orthopedic surgeries, along with customized prosthetic services for artificial limbs.
• Dr. Temeck prescribed controlled substances, including hydrocodone and a generic form of Valium, to Mrs. Hetrick, the wife of her regional boss, Jack Hetrick. State and federal authorities confirm Dr. Temeck does not have a valid controlled substances license that would allow her to write prescriptions privately for Mrs. Hetrick.
• Dr. Temeck cut around-the-clock staffing by emergency airway specialists to save money, resulting in at least one close call involving a patient who could not breathe.
• Dr. Temeck told operating-room staff they were being “too picky” when they reported surgical instruments delivered to operating rooms with blood and bone chips from previous surgeries.
• Dr. Temeck is paid separately as a VA administrator and cardiothoracic surgeon. But whistleblowers say she has never served as the operating surgeon since coming to Cincinnati.

The nearly three dozen whistleblowers have been voicing their concerns for the better part of a year, including meeting in person with regional director Hetrick and reaching out to members of Congress and Secretary McDonald. They say little has been done to remedy the problems.

The most disturbing allegation concerns the cleanliness of the instruments. Data bear out the whistleblower complains, as MRSA infections have risen significantly since Temeck’s arrival even as they have declined slightly across all VA facilities:

When doctors began demanding clean instruments, Temeck began requiring that she be consulted — even if the patient was already on the table and under anesthesia:

Brooks and other operating-room staff said one of the most disturbing problems involved contaminated surgical instruments. “I’ve seen surgical instruments that once we open the sterile pack, they will have pieces of debris, possibly bone or other debris from previous surgeries still on the instrumentation,” Brooks said.

Instead of committing to better training or spending to hire more certified technicians, Brooks said Dr. Temeck told operating-room staff to stop complaining.

She also required them to notify her when they spotted problems so she could inspect the tools before they could be replaced with clean ones. Brooks said surgeries were halted, sometimes with patients cut open, waiting for Dr. Temeck to arrive for an inspection.

“She felt that these were all fabrications, that we were making up stories about the instruments not being clean, so she wanted to see for herself,” he said. “If she was in another meeting, it could be 20 minutes, half an hour, with the patient under anesthesia.”

When the 34 whistleblowers tried working within the system, the Office of Special Counsel declined to investigate. OSC told them that they “were unable to provide our office with detailed information regarding the gravity and frequency of the problem,” and dismissed the multiple complaints last May. Now that the VA, Congress, the OSC, and Secretary McDonald have all passed on opportunities to correct the situation, the whistleblowers are turning to the media. And all of a sudden, Congress and McDonald have taken a keen interest in the Cincinnati VA. Whodathunk?

The chairman of the House Committee on Veterans Affairs, Florida Republican Jeff Miller, said his staff has been talking to Cincinnati whistleblowers, but he wanted to give McDonald some time to address the issues they raised. “If in fact this is true, I would hope the secretary will take it seriously because if he doesn’t, we’ll examine it from the committee standpoint,” Miller said.

How long will Miller give McDonald? How long will Temeck draw double pay while doctors are told to operate with non-sterile instruments? It’s worth pointing out that if these conditions existed in a private or non-profit hospital unaffiliated with the government, regulators would have crashed down on them long ago with much fewer complains such as seen for the Cincy VA.

This is why reformers want to move to an open VA system in which the experts on service-related injuries and illnesses can focus on their core competencies, but our veterans can seek care for routine issues with the providers of their choice under the VA’s health-insurance umbrella. Our veterans should not be forced into failing systems that lack accountability all the way from Cincinnati to Washington DC.