In my more naive days as a patient safety and engagement advocate, I believed our wounded veterans might fix health care. Or at least, as we justly built new devices, systems and housing to heal and restore their torn bodies and scarred psyches, new levels of transparency, efficiency and function might carry over to our fractured health care system. After all, these men and women are American heroes. We can and should do anything and everything to try to make them whole. If we don’t step up for them, what hope is there for the rest of us?
Which is why recent headlines about our vets, and their treatment in health care, leave me angry and disheartened. And now, I’ve just read about big bonuses top VA administrators are getting, in a system that seems all but broken (details in a moment). Coupled with what happened at the Cleveland Clinic last month, it all leaves me very sad.
In a nutshell, former VA secretary Eric Shinseki resigned last month after coming under criticism for weeks about the VA’s inability to meet the health needs of veterans and alleged efforts by employees to cover up the problems. Victor Lipman writes in Forbes today: “I’ve followed with grim interest the current VA hospital scandal and it seems to me a failure of many things. Underlying the preventable deaths for patients awaiting care, the endless waiting times for appointments, and the army of veterans (40,000+) who requested appointments and never got them, are multiple failures. There are failures of government, failures of bureaucracy, failures of communication and failures to care for our veterans – who of course deserve far better.”
The White House, anxious to move quickly on the VA scandal, had been looking to replace former VA secretary Shineski with Delos “Toby” Cosgrove, CEO of the prestigious Cleveland Clinic. Cosgrove is a heart surgeon who served in the Air Force in Da Nang, Vietnam. He’s decorated with a Bronze Star and the Republic of Vietnam Commendation Medal– seemingly an ideal candidate. But in a statement released Saturday, June 7, Cosgrove said “I have decided to withdraw from consideration from this position and remain at the Cleveland Clinic, due to the commitment I have made to the organization, our patients and the work that still needs to be done here.”
Photo Courtesy Modern Healthcare
The real reason? The White House had no comment. But Cosgrove’s announcement came just hours after Modern Healthcare published a three-month investigation showing stonewalling of patient complaints at the Cleveland Clinic, which raised questions about the nation’s patient-safety regulatory system. On the front page of Modern Healthcare’s report was a heartbreaking photo of Vietnam Vet David Antoon. “Nearly four years ago”, reads the piece, “government inspectors investigating a complaint by retired Air Force Col. David Antoon threatened to cut off Cleveland Clinic from receiving Medicare payments after being stonewalled by hospital officials. The Vietnam combat veteran had accused the hospital of failing to fully investigate his charge that someone other than his authorized surgeon had performed prostate cancer surgery and left him gravely injured.
Hospital officials refused to show the inspectors all of the notes in Antoon’s complaint file, and the doctor who claimed to have done the procedure declined to talk to surveyors about how the hospital handled the case, CMS inspection reports show. Antoon, a commercial 747 pilot in civilian life until the operation left him incontinent and impotent, is baffled that medicine has no organization like the National Transportation Safety Board to address safety failures. “You cannot keep things concealed in aviation,” he said. But in healthcare, “They’re just gathering data points from patient complaints. And every data point is a damaged life or a death.”Indeed, David. And as Forbes contributor Lipman concludes writing about the VA scandal: “… I was struck in particular in this instance by the vast disconnect between the perceived performances of the VA hospital system as a whole and the individuals who are managing the system. According to the macro-level VA data – the preventable deaths, the chronic slowness, the overall inefficiency – the system appears broken. Yet contrast this to the consistently glowing performances of the individuals responsible for managing these failing operations.
According to Rep. Jeff Miller (R-Fla.) the chairman of the House Committee on Veterans’ Affairs, whose hearings and comments have been widely reported in the media, of the VA’s 470 senior executives, none received the two lowest ratings in the five-grade VA evaluation system over the past four years – while approximately 80 percent received the top two grades for being outstanding or fully successful. The same percentage, around 80 percent, received performance bonuses last year.”
How are we supposed to know whom to trust? These failures in management and oversight undermine our safety, our confidence in health care, and the great work of committed clinicians and leaders who bust their tail every day to give us quality health care. We’re all victimized when poor performance is tolerated, patients must file suit to get answers, and whistle-blowers face retribution. If we want Congress to tackle the battle, we’ve got to convince them it’s important.
Meantime, there can be no sincere comfort, thanks and reassurance for our veterans.
