VA undersecretary for health defends appointment of new director in PhoenixPosted: Updated:
Veterans Affairs Undersecretary for Health David Shulkin visited the Carl T. Hayden VA Medical Center in Phoenix Wednesday morning.
Shulkin met with employees, stakeholders, congressional representatives and veteran groups to introduce new Phoenix VA Health Care System Director RimaAnn Nelson.
Nelson was appointed director after Deborah Amdur retired for health reasons in August. Nelson previously was the director of the VA Regional Office in Manila, Philippines, and the medical center director for the St. Louis VA Health Care System.
The Phoenix VA was at the center of a national scandal that exposed widespread mistreatment of veterans, which included long wait times and forged documents that may have led to the deaths of dozens of vets. The system enrolls about 85,000 veterans.
Nelson's appointment came with some controversy. U.S. Rep. Kyrsten Sinema, D-Arizona, and U.S. Rep. Matt Salmon, R-Arizona, wrote a letter to President Obama, asking that he take another look at the appointment.
Nelson's past problems include:
• About 1,800 patients were potentially exposed to HIV at the St. Louis VA under her leadership.
• St. Louis VA had the lowest satisfaction rating of any VA facility in the country.
• Nelson was transferred to small VA clinic in the Philippines.
Sinema said she was outraged at the appointment of Nelson and had requested that VA officials brief her on possible candidates. According to Sinema, she was never given any information about Nelson.
Sinema said that appointing someone with such a checkered past does not instill a lot of confidence with our veterans.
Shulkin addressed some of the concerns on Wednesday.
"Ms. Rima Nelson is a nurse, an oncology nurse, who has been in the VA Health Care System for 23 years so she knows what it means to take care of veterans," Shulkin said. "I was looking for somebody to come to Phoenix who had the experience within the VA system because we've had so many leaders who've come through over the past couple years that we needed somebody who was not going to learn the VA system but knew how the system operated."
Shulkin said when Nelson became aware that the St. Louis staff wasn't following the VA protocol on cleaning dental equipment, she shut down the dental clinic for seven days so it could be inspected.
Shulkin said the Office of the Inspector General found that 100 percent of the dental equipment was being sterilized, but the staff had deviated from the VA's protocol on cleaning prior to them being sent to sterilization.
The inspection found that the risk to the veterans was extremely low but it wasn't zero, so Nelson shut the clinic down and notified all 1,800 veterans to let them know what had occurred, Shulkin said. He said they were followed and there's no evidence that any of them contracted anything harmful.
"We want leaders who know how to make decisions, who act on behalf of veterans and put patient safety as the top priority," Shulkin said.
He also addressed the reports that St. Louis had the lowest patient satisfaction in the entire VA Health Care System.
Shulkin said when Nelson arrived at the St. Louis VA in 2009, it did have the lowest patient satisfaction scores and had suffered from multiple leaders coming in and out. He said when Nelson left in 2013, there had been major improvements in patient satisfaction.
"In fact, those scores went up 11 points. Going up 11 points in this satisfaction survey that's measured is a significant improvement, a phenomenal improvement," Shulkin said. "So we saw again a leader who took a situation with low patient satisfaction and made significant improvements."
There was an issue with Nelson's leadership in the Philippines after reports of veterans not getting the right medications.
"That issue was solved and dealt with in May of 2013," Shulkin said. "She arrived in the Philippines in July of 2013. So, again, the facts support that this really had nothing at all to do with her leadership. So when we looked at these issues, we actually saw a leader who was decisive, acting with veterans' interests and capable of managing this type of complex organization and that's the reason why we believe that she is the right leader for us here at the Phoenix VA."
Shulkin also brought up a recent Office of Inspector General report that was released on the consult situation in Phoenix.
"There were reports out there that hundreds of veterans died waiting for consults, once again, here in VA," he said. "The facts are that if you take a look at the Inspector General report, and I'm quoting from it directly, of the 215 veterans who were tracked because of consults that were canceled, there is a possibility that one of them may have had a contribution of that consult delay impacting their health, resulting in a veteran's death."
Shulkin was referring to a veteran who had a delay in a treadmill test and said had that stress test been done in time, it may have had an impact.
"That is a situation that we take very seriously," Shulkin said. "The Office of Inspector General report, we are taking very seriously because it indicates that we have more work to do and that we have issues to address, but I want to be perfectly clear, there is no evidence, as has been reported in some cases, that there were hundreds of veterans that died because of consult delays or canceled consults."
Shulkin added that the Inspector General report indicates there has been significant progress from April 2014 when the wait time issue arose in Phoenix. He cited hiring hundreds of additional staff members, 70,000 square feet of additional space, adding a fast-track system to the emergency room, lower wait times, fewer open consults and increased patient satisfaction.
Shulkin said that the VA's consult numbers are down and that 96 percent of the open consults are in the orthotics and prosthetics. He acknowledged that they still have work to do.
Nelson said she has seen the importance of public service and is looking forward to serving as the new permanent director in Phoenix.
She started her career in the VA as a nurse and taking care of veterans.
"Serving veterans, the men and women who served us, was just an incredible mission and one that has kept me here for 23 years," Nelson said.
She said she met with the staff, veteran service organizations and congressional representatives earlier Wednesday.
"I know right off that we have a great group that's here to work to support veterans and to really continue the work that's already been started here at the medical center," Nelson said.
She said she met with employees and talked with them about what went on in St. Louis.
"The message I said was I don't believe that any employee comes to work to do a bad job and, therefore, if something goes wrong in a system, I need to know about it. I cannot fix what I don't know," Nelson said.
She said she wants them to bring any issues to her.
"That's what happened in St. Louis," Nelson said. "Employees came to me and brought issues to me and as soon as I became aware of them, I took action, I took immediate action, because what I told our veterans, if I cannot guarantee your quality and safety when you walk into your VA I'm going to shut things down.
"I'm a nurse, that's my background, and I want our employees to feel that they work within a culture of safety because without that, we cannot even begin to build trust and we need to regain the trust of our veterans and trust with each other," she continued.
Shulkin also introduced Dr. Maureen McCarthy, who replaces Dr. Darren Deering as the chief of staff.
"These two women are part of that solution to make sure that we address all those issues," Shulkin said.
Statement by Sen. John McCain:
"Today, I participated in a meeting with Undersecretary for Health of the Veterans Health Administration Dr. David Shulkin and other senior leaders from the VA regarding the appointment of Rima Ann Nelson to be the new Director of the Phoenix VA Health Care System. In the meeting, I repeated the concerns I raised in my letter to the VA last week about the new director's qualifications to lead, especially regarding news reports indicating Ms. Nelson oversaw troubling mismanagement at the St. Louis VA Medical Center that potentially affected the health of 1,800 veterans. I also expressed my concerns about Ms. Nelson's total lack of experience implementing the Veteran Choice Card, on which tens of thousands of veterans in Phoenix depend to receive timely, quality access to care. Finally, I underscored the importance of having the most qualified and capable leader at the Phoenix VA to change the culture that, as we learned from yesterday's Inspector General report, has continued to fail our veterans.
"As ground-zero of the scandal in veterans' health care, the Phoenix VA clearly has a long way to go to fully reform. As I said in the meeting, it is unacceptable that Ms. Nelson is the seventh director in three years – no organization can operate efficiently with such a high turnover rate. We know that real reform can only take place with committed leaders at the top who will change the culture of misconduct by enforcing accountability and putting veterans' health care needs first. I will not rest until we reform the system in Arizona and around the country, and will be monitoring the transition of leadership at the VA closely to ensure our veterans receive the world-class health care they have earned and deserve."
Statement from Rep. Ann Kirkpatrick:
"After leaving today's meeting with Undersecretary Shulkin, I felt better than when I walked in. The meeting was productive and included an in-depth introduction to the Phoenix VA's new leadership. I have expressed my repeated concerns about the many ways the Phoenix VA is failing our veterans -- these are troubling, systemic problems that too often start at the top. So today I urged everyone in the room to work together so they can finally succeed in delivering the highest quality of care, cooperation and communication to Arizona's veterans."
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