Truth & Lies at the VA, Part Two

Central Alabama VA

courtesy of VA Administration

Truth & Lies At the VA, Part Two
| published July 27, 2014 |

By Earl Perkins
Thursday Review features editor

A steady stream of allegations continue dogging the Central Alabama Veterans Health Care System (CAVHCS), but lack of staff to assist sick veterans is a major issue that's only recently been emphasized, according to the Montgomery Advertiser and Yellowhammer.

Accusations of negligence, mismanagement and cover-ups have brought ire from far and wide, but a steady stream of deficiencies has caused federal investigators to take a nationwide interest. Administrators ordered staffers to falsify records to cover up long wait times, with CAVHCS Director James Talton misspeaking concerning the firing of supervisors responsible for those actions—instead, whistleblowers who brought the issues to light were shown the door.

More than 1,200 patient records were manipulated by a VA pulmonologist, and even after repeating the offense, he received a "satisfactory performance" review and continues to work for CAVHCS. Top administrators also covered up the fact that more than 900 unread patient x-rays were lost. The files were miraculously re-discovered after investigators began a deep probe.

E-mail records show Talton knew about patient scheduling discrepancies more than eight months before taking action, and CAVHCS has shown an inability to pay bills in a timely fashion, damaging its ability to perform needed outsourcing to area hospitals. Rep. Martha Roby (R-AL), and her office have been researching allegations of problems concerning the local VA, and she sees the potential for a protracted crisis.

“This isn’t over,” she said. “Expect more to come to light moving forward. It is important for misconduct within the VA to be exposed. Only then can there be true accountability.

"I applaud those who have come forward with information to shed light on disturbing practices at the Central Alabama VA. There are many good, courageous people who truly respect our veterans and want to do the right thing.”

Roby has reached out to concerned citizens, hoping those with "special knowledge" concerning VA shortcomings will contact her confidentially on her Congressional website.

Her staff is also studying why there is a massive shortage of doctors and other key staffers, which means sick veterans have nowhere to go for needed medical care. When you're sick or dying, you need a professional opinion in a timely manner and you need to be referred to the appropriate specialist as soon as possible.

The local facility is facing a critical shortage, with 441 open positions, leading to a figure of approximately 78 percent staffed, according to a June 27 report from the CAVHCS human resources department.

Concerning the available positions, 157 are considered "active recruitments (authorized for hire). two are pending recruits, while 282 opening are not being actively recruited, agency records show. There are just 38 jobs posted on the website, including 14 in Montgomery, 20 in Tuskegee, one in Fort Rucker and three in Columbus, Georgia.

There are 15 openings for doctors, which includes primary care physicians, a nursing home doctor, a neurologist, a urologist, a cardiologist, an ophthalmologist and a psychiatrist. The local agency needs eight registered nurses and several pharmacy staffers, along with medical, mental health and substance abuse support staff.

A key shortage concerns primary care providers, according to several employees who wish to remain anonymous because they fear reprisals. A fully staffed team has the ability to serve 1,100 to 1,200 patients, but that includes a doctor or nurse practitioner, a registered nurse, a licensed practical nurse a medical support assistant.

Not including geriatric primary care, CAVHCS' five locations are short 10 doctors, seven registered nurses, five licensed practical nurses and 13 medical support assistants. When fully staffed, 36 teams have the ability to deal with 43,600 patients. There are presently 42,511 patients on the local rolls.

Monroeville has two primary care teams, which means it's the only area facility that's fully staffed. Montgomery has seven full-staffed teams, meaning they are five teams short. It presently needs four physicians, one registered nurse, one licensed practical nurse and three medical support assistants.

Tuskegee is the most understaffed, with less than half the teams fully staffed. Right now the facility needs 4.5 doctors, three registered nurses, two licensed practical nurses and five medical support assistants. Thousands of Tuskegee patients need primary care appointments, having recently been placed onto "recall reminder"—an electronic holding area for patients needing appointments.

The primary care teams are short-staffed, so patients are not receiving appointments and are not being reassigned to other doctors. When openings become available, new patients and established patients who call new appointments receive priority, according to one concerned employee.

"Patients don't know they're just sitting there waiting for a provider," the employee said.

Talton has not responded to recent interview requests, but the last time he spoke on the record, he told reporters his agency has had trouble recruiting and retaining doctors.

"If you don't have the physicians, you don't have the capacity to see new patients," he said. "That's the primary reason that the waiting list is so long. There's a national shortage of providers."

Talton said a recruiter is constantly searching for physicians, and he's been "aggressively" recruiting since he came to CAVHCS in 2011. Supposedly constant hiring numbers are being outstripped by physicians who are retiring, transferring and leaving for better opportunities.

"Birmingham can hire at the drop of the hat," he said. "Not so much for places like us here in Montgomery. Other reasons for that could be physicians often look for research and academic affiliations."

Budget concerns are not an issue, but a lack of adequate space and salary ceilings are primary concerns in luring doctors to Montgomery. The salary range for the CAVHCS general surgeon job posting is $98,967 to $295,000 per year. The national average for a general surgeon is $216,810. Montgomery is offering between $98,967 and $195,000 for a primary care doctor, with the national average at $147,890. For a registered nurse case manager, the salary is $63,547 to $99,721, and the national average is $70,590.

Talton could not cite his area's turnover rate, but noted a lack of adequate space for physicians is a constant battle, especially in Montgomery. A 112,000-square-foot facility is being built on Chantilly Parkway to address space needs, but it has "minimum" new hires, he said.

Related Thursday Review articles

A Look Inside the VA's Culture of Neglect; Earl Perkins; Thursday Review; July 1, 2014.

The VA's Problems Won't Go Away Quickly; Earl Perkins; Thursday Review; July 24, 2014.