Tuesday, September 20, 2016

Congressional Hearing at the VA Medical Center, Northport, NY

Tuesday, September 20, 2016
Congressional Hearing at the VA Medical Center, Northport, NY
House Subcommittee on Oversight and Investigations
VAMC Northport, 79 Middleville Rd., Northport, NY  11768
Auditorium, Bldg. 5
9:00 AM

Committee Members & Non-Committee Representatives present:
1) Jeff Miller, Chairman, House Committee on Veterans Affairs
2) Mark Takano, Ranking Member, House Committee on Veterans Affairs
3) Kathleen Rice, House Subcommittee on Oversight and Investigations
4) Lee Zeldin, House Subcommittee on Oversight and Investigations
5) Steve Israel, House Committee on Veterans Affairs
6) Two Staff Counselors
7) Two Staff Investigators

1) Dr. Mayer Bellehsen,  Northwell Health Corp. (formerly LIJ/North Shore Health System
2) Dr. Joan McInerney, Director, VISN 2 (regional office), Dept. of Veterans Affairs
3) Mr. Phil Moschitta, Director VA Medical Center, Northport, NY
4) Dr. Charlene Thomesen, Chief of Psychiatry, VA Medical Center, Northport, NY

Hearing focus: quality of care concerns, the facility’s state of disrepair, leasing and                                                 contract issues, and oversight lapses by management and VHA
Mr. Miller’s opening statement (summary bullets):
  • Air quality in the main Hospital building
  • failure of the A/C units in Radiology
  • Crumbling infrastructure
  • Veteran and non-Veteran unreported suicides connected to the Hospital
  • The lack of control and the abundance of narcotics on the Hospital campus
  • Lack of leadership in top management
  • Ghost Panels
Notes on Hearing:
  • Dr. McInerney - claimed the VA northport has “walk-in” Mental health for 25 years
  • Dr. McInerney - claimed the Facility needed $290 million for capital improvements
  • Dr. McInerney started quoting false numbers on amount and quality of medical care at this Facility
  • Dr. Bellehsen, quoted 150k Veterans in Nassau & Suffolk Counties (Long Island, NY)
  • Dr. Bellehsen, praised Dr. Thomesen and Phil Moschitta for their collaborative efforts in creating a dual treatment Facility for Veterans and Families at a satellite Clinic in Bay Shore, NY
  • The three VA witnesses could not, or would not, answer direct questioning in reference to the working protocols in the Hospital’s Emergency Room (this line of questioning was as a result of one recent, on-campus suicide / they dodged questions about the video surveillance cameras in place at the E.R. triage area / there was an argument over disclosure of Patient information due to HIPPA Law; Mr. Moschitta had no idea that HIPPA was actually a Law he thought it was just a policy) / claim of 57 E.R. visits a day / more back and forth about video cameras / Mr. Moschitta was less than forthcoming on all questions about the E.R. and the Triage protocol, finally claimed he didn’t know much about it
  • Dr. McInerney claimed 24 hour Psychiatric Care available at the Hospital / this should have been Dr. Thomesen’s turn to answer, but she remained silent
  • Ms. Rice started a diatribe on how fantastic the Northport VAMC has been and quoted numbers on “satisfaction” percentages that are totally unbelievable (90%) / she has been drinking the Kool Aide
  •  / Mr. Moschitta picked up on Ms. Rice’s comments and launched into his own diatribe on the glory of the VAMC Northport / Ms. Rice continued to deflect from the agenda
  • Dr. Bellehsen claimed more than adequate “advertising” by Northwell and the VA for the dual Clinic in Bay Shore, NY
  • Mr. Israel brought up the FBI and Suffolk Police investigation into the most recent on-campus suicide / he got stonewalled by the witnesses who stated that the Hospital serves 31.5k Patients annually, and is in the top 10% Nationally in satisfaction ratings
  • Mr. Miller brought up the “Ghost Panels” and the alleged revenue the Hospital garners from this practice / discussion on who ordered this practice and who is involved in effecting the practice / witnesses stonewalled and evaded and stumbled, and finally blamed lower echelon employees for any maleficence
  • Dr. McInerney mentioned the formal name for the “Ghost Panels” - Group Practice Panel Program
  • Dr. Bellehsen claimed dual Clinic billing services only since beginning of 2016
  • Mr. Moschitta claimed that repairing building roofs cost $600k ea. / work being done by Hospital employees / only real cost is for materials / plans to try to enlist U.S. Reservists to do work for free (job training exercise) / the roof repairs he eludes to are being done on the old single family dwellings on the campus
  • Mr. Israel tried discussing the HVAC problems, again / he got no cogent answer from Mr. Moschitta who deferred further questioning to the Secretary of the Department of Veterans Affairs, Bob McDonald / Mr. Moschitta failed to mention that he was going to hold out for $8 million to refurbish the Operating Suites before fixing the air quality problems / he referred to “statement of work” documents / then he claimed only a $50k cost for portable A/C units which were previously tallied at $2.8 million in Mr. Miller’s opening remarks (????)
  • Dr. McInerney claimed mostly Patients were to blame for delays in putting off surgeries due to the O.R. closures / she claimed everyone else was duly accommodated elsewhere
  • Note: way too much time devoted to Northwell’s involvement / most of this was not pertinent to the agenda / House Health Subcommittee was mentioned in reference to billing out to outside insurance, mainly Tricare
  • Veterans in audience were asked for a show of hands pro and con regarding the quality of health care at this Hospital / typically, there was more pro than con
  • Mr. Zeldin mentioned the maintenance requests by the Hospital management were so weak they were almost last in the National priority ranking for which Facilities actually get funds for fixing/replacing infrastructure
  • Mr. Miller & Mr. Takano closed the Hearing
This is just a summary from my notes and published documents available prior to the hearing. A full question and testimony document should be available soon on the House Committee’s website; go to - https://veterans.house.gov/subcommittees/oversight-and-investigations-114th-congress
Of particular note, Mrs. Peter Kaisen (Joan) was in attendance; she is the widow of the most recent Veteran to commit suicide on the Hospital campus - 76 year old Navy Veteran Peter Kaisen - whose death spurred this investigation and ensuing Hearing.
On my way out of the Hearing room, one of the Committee Investigators whispered to me, “He’s in big trouble.” referring to Mr. Moschitta.

Monday, September 19, 2016

Deaths, Fraud Allegations and an Inquiry Into a Long Island V.A. Hospital



A series of troubling failings and allegations of wrongdoing have called into question the care being provided to thousands of the nation’s military personnel by the Northport Veterans Affairs Medical Center on Long Island. Credit Johnny Milano for The New York Times

Along the winding drive through the 300-acre compound of Long Island’s only veterans’ medical center, banners line the road stating the presumed values of the institution: integrity, commitment, advocacy, respect and excellence.
But in recent months, a series of troubling failings and allegations of wrongdoing have called into question the care being provided to thousands of the nation’s military personnel by the Northport Veterans Affairs Medical Center, in Northport, N.Y., with charges of abuse that include widespread billing fraud and the failure to report the death of a patient for months after his body was found in a building on the complex.
The problems plaguing the medical center first drew attention after all five of the hospital’s operating rooms were shut down in mid-February, because sand-grain-size black particles had begun falling from the air ducts. Veterans in need of surgery had to go to other hospitals for care, often leading to further delays in their treatment or postponed operations.
The closing of the operating rooms was first reported by The New York Times in May. Representative Lee M. Zeldin, a Republican who represents the First District on Long Island and is a member of the House Veterans’ Affairs Committee, then collected information from whistle-blowers and others and turned it over to the committee, which will hold a public hearing of the committee at the medical center on Tuesday.
The problems at Northport come two years after whistle-blowers revealed widespread dysfunction and corruption at a V.A. hospital in Phoenix, where it was reported that veterans were dying while waiting for care. It soon emerged that there were systemic problems at medical centers operated by the Department of Veterans Affairs around the country.
Despite calls from the White House for the department to be “restructured and reformed,” two years later problems remain and the topic has become fodder for the presidential campaign.
At Northport, the failure to properly maintain the operating room facilities may be the least of the issues that the congressional committee will take on.
Hospital officials, including the facility’s director, Philip Moschitta, have been called to testify. According to a person familiar with the investigation, who was not authorized to speak and requested anonymity, they will also be asked about allegations of widespread fraud, including the collection of thousands of dollars in fees to care for veterans who were never actually treated.
According to internal emails, and current and former employees familiar with the alleged scheme who spoke on the condition of anonymity because they feared retaliation, nurses were directed to make cold calls to veterans and then code those calls to look as though they had been solicited by the patient, not the practitioner, in order to enhance revenue.
One former hospital employee likened the practice to your private physician calling you out of the blue to check up on you, then billing your insurance company for the call. The former employee, who asked to speak anonymously to avoid reprisal, said the practice was a means of padding the numbers.

All five of the Northport’s operating rooms were shut down in mid-February because sand-grain-size black particles had begun falling from the air ductsCredit Johnny Milano

In all, the calls apparently generated roughly $1 million in payments for more than 200 veterans, according to the emails.
A number of the nurses directed to make those calls appeared concerned about the activities, and a package of their email correspondence was turned over to the House Veterans Affairs’ Subcommittee on Oversight and Investigations. A copy was obtained independently by the Times.
Instead of receiving overtime pay for the hours spent logging calls, which might have raised suspicions, the nurses earned comp time, according to the emails.
One nurse wrote that the veterans were being used as “cash cows,” which the hospital administration wanted “to milk for $9 million.”
The worth of each veteran in the scheme: $4,285.71.
“Lots of questions that make me a little uneasy,” one nurse wrote. “What would be the best place to get accurate information on whether this is an ethical move?”
Another email complained about the workload. “I also find it unfair to expect this amount of work on already overburdened nurses,” it said.
A response read, “Notice how management is tracking the R.N.s and tallying their calls. This will no doubt be used to retaliate — keep track of that. Notice how only comp time is being issued vs overtime to hide any $ going to support said telephone encounter billing fraud.”
At another point the same nurse was even more blunt. “I would advise against engaging in this telephone billing fraud,” the nurse wrote. “Nothing has been put it writing and no written guidance/instructions have been disseminated to obfuscate the fraud.”
Some of the nurses, on the other hand, boasted of their activities at a meeting of clinical service directors, proudly proclaiming the efforts to re-engage 2,000 patients and bring them back to Northport.
When asked who had authorized the efforts, Walinda West, deputy director for media relations at the Department of Veterans Affairs, said only that it was a recommended practice for primary care teams “to follow up with patients who are due for care, or who have preventive care needs.”
But according to the nurses’ emails, management was asking “clinical staff to make phone calls that count as appointments with NEW patients, to increase access.”

The death in March of Anthony J. Cox, a veteran, shown in 1984, who was working at Northport and enrolled in a drug rehabilitation program, was not reported even though his body was found on the campus.

The committee is also looking into the circumstances surrounding the suicide of a veteran, Peter A. Kaisen, 76, in a Northport parking lot on Aug. 21, and why the death in March of Anthony J. Cox, 51, a veteran who was working at Northport and enrolled in a drug rehabilitation program, was not reported even though his body was found on the campus.
The circumstances surrounding Mr. Cox’s death and the discovery of his body remain murky. The autopsy report, obtained by The Times, said he had died of a fentanyl compound overdose; fentanyl is a synthetic opioid more powerful than heroin and, according to a recent government report, is responsible for an increasing number of overdose deaths in New York and across the country.
According to the police report, Mr. Cox stopped responding to phone calls on a Friday; his body was discovered on a Monday morning.
When Mr. Cox’s mother, Judith Wood, 77, a retired nurse and a United States Air Force veteran, arrived from South Carolina to claim her son’s body and learn what had happened, she said she was met with systemic silence at the Northport campus.
“No one would tell me anything,” Mrs. Wood said. “I was not allowed to go where he lived; we kept getting the runaround. Everyone shut us down. There’s something screwy about that place.”
The death of Mr. Cox was never formally announced by the medical center, and it was not reported to the group that accredits and certifies health care organizations, or to local congressional offices as what is known as a sentinel event, an unanticipated death or serious injury.
For two months after Mr. Cox was found dead, the medical staff continued to make notes on his chart as if he were alive.
“Patient will see me on 5-23. Patient was a no-show. No testosterone will be filled unless he follows us in the clinic,” one clinician wrote in Mr. Cox’s electronic medical records, which The Times obtained from his family. Other notes indicated that offices at Northport had made calls to Mr. Cox.
A spokesman for the Northport medical center declined to comment, and said in an email statement that “we look forward to participating in Tuesday’s hearing and providing the committee with information about the high-quality care provided at this facility.”
Representative Zeldin expressed frustration with the Department of Veterans Affairs, which he said was “stonewalling congressional efforts to investigate.”
In July, congressional investigators submitted questions for Mr. Moschitta, the medical center’s director, but have received no response.
Representative Jeff Miller, Republican of Florida and chairman of the House Veterans’ Affairs Committee who will lead the hearing, said in a statement that “with or without the Northport V.A.’s cooperation, we will continue working closely” with Mr. Zeldin’s office “to investigate this matter until all the facts are at hand.”

Did Obama’s Bill Fix Veterans’ Health Care? Still Waiting.


An Army veteran, Henry Banks Sr., waited for prescription drugs at a Veterans Affairs medical center in Fayetteville, N.C., in March 2015. Credit Patrick Semansky/Associated Press

When President Obama signed a sweeping $15 billion bill to end delays at Department of Veterans Affairs hospitals two years ago, lawmakers standing with him applauded the legislation as a bold response that would finally break the logjam.
It has not quite worked out that way.
Although veterans say they have seen improvement under the bill, it has often fallen short of expectations. Nowhere is the shortfall more clear than in the wait for appointments: Veterans are waiting longer to see doctors than they were two years ago, and more are languishing with extreme waiting times.
According to the agency’s most recent data, 526,000 veterans are waiting more than a month for care. And about 88,000 of them are waiting more than three months.
“We’re making progress, yes,” Senator Johnny Isakson, the Georgia Republican who is the chairman of the Senate Veterans Affairs Committee, said in an interview. “Whether it is enough is another question.”
The push for legislative overhaul started with reports that dozens of veterans had died waiting for care at a hospital in Phoenix, while leaders hid delays and collected bonuses. An investigation by the White House found similar manipulations at dozens of hospitals, and it led to the resignation in May 2014 of the secretary of veterans affairs at the time, Eric Shinseki.
Recently, Donald J. Trump, the Republican presidential candidate, has seized on problems in health care for veterans, calling the waits for appointments “totally inexcusable” and saying that, if elected, he would crack down on employees who fail to serve veterans.
“We’re going to take care of our veterans like they’ve never been taken care of before,” Mr. Trump told the audience at the Veterans of Foreign Wars convention last week.
In a speech on Monday to the thousands who had gathered for the Disabled American Veterans national convention, Mr. Obama called the nation’s responsibility to veterans “a sacred covenant,” and he said his administration had made strides housing homeless veterans and reducing a backlog of benefits applications. But he acknowledged that improving health care is still a work in progress.
“Veterans who at times have struggled to get care at the V.A., you deserve better,” he said.
Here is a breakdown of the fixes to the system that are required under the federal law, the Veterans Access, Choice and Accountability Act, and how some have faltered.
Cutting the Wait for Care
The Fix: The new law offered a two-pronged solution for the wait time problem: Let some veterans go to private doctors to provide immediate relief for the system, and hire thousands more doctors to meet long-term demand.
Did It Work? It’s complicated, but not so far.
The Breakdown: The department has added millions of square feet of new medical space. It also processes patients 10 percent more efficiently, according to agency data.

President Obama and the veterans affairs secretary, Robert McDonald, on Monday after they attended the Disabled American Veterans national convention. Credit Al Drago/The New York Times

But instead of going down, the average wait time for primary care has gone up slightly since 2014, according to the data. More troubling, the number of veterans waiting longer than 30 days has increased by nearly 50 percent. And those who must wait more than three months has more than doubled.
Even so, Robert McDonald, the secretary of veterans affairs, says the longer waits are because the care at veterans hospitals is getting better.
Most veterans have other sources of health care, either a program like Medicare or private insurance, Mr. McDonald said in an interview, but they move to cheaper health care through the Department of Veterans Affairs if it is reasonably accessible. “As we have improved the care, what we have discovered across the country is more and more people want to come to the V.A.,” he said.
In some communities, the waiting problem is much worse. In July, veterans in Roseburg, Ore., waited twice as long to see a specialist than the average veteran. In Denver and Fayetteville, N.C., more than one-fifth of all patients must wait more than a month for appointments.
Watchdog groups and federal audits suggest that it is hard to accurately assess progress because the agency’s estimates are unreliable. Veterans say that staff members at the department still manipulate the books to make the next available appointment appear as the veteran’s first choice — a trick that makes waits appear minimal even if they stretch for months.
Government audits recently confirmed the practice in Houston and Albuquerque. In Colorado Springs, a recent audit found records were changed to show that veterans had same-day appointments when they actually waited an average of 76 days.
Sending Veterans to Private Doctors
The Fix: The law set aside $10 billion for private care. Any veteran waiting more than 30 days for an appointment or living more than 40 miles from a Department of Veterans Affairs clinic has the choice of going to a private doctor.
Did It Work? Yes, but it has created its own delays.
The Breakdown: Nearly 800,000 veterans have used the so-called Choice Program to make appointments with private doctors. But lawmakers and veterans groups say the program was hastily constructed.
“Long story short: It has major problems, not the least of which is the pure confusion that veterans and even V.A. employees have in working the program,” said Garry Augustine, director of Disabled American Veterans.
Veterans are required to call a private contractor to authorize and schedule appointments with private doctors, a process that veterans have said can take weeks. By the time a veteran sees a doctor, Mr. Augustine said, waits can be the same or longer than they would have been at a veterans hospital.
If a private doctor decides a patient needs an additional scan or test that was not authorized for the visit, paperwork must go back to the department; that can add several more weeks.
“The bottleneck is still back in the V.A.,” said Dr. Sam Foote, a retired physician who was one of the primary whistle-blowers in the scandal.

Sharon Helman, the Phoenix medical system director at the center of a scandal on wait times for veterans, could get her job back. Credit Veterans Affairs Department, via Associated Press

Also, many private doctors report waiting months to get reimbursed. “We are hearing doctors say they won’t take part in the program because they aren’t getting paid,” said Representative Jeff Miller, the Florida Republican who is chairman of the House Veterans Affairs Committee. He added that the agency has $100 million in unpaid bills in his state.
The agency says it is working to streamline its scheduling and payment process, while adding more doctors to cut waits.
Hiring More Doctors
The Fix: The law gave the department $5 billion to hire the 28,000 health care providers the department estimated it needed to meet demand.
Did It Work? Yes, but not as well as hoped.
The Breakdown: The veterans health system has added about 19,000 employees — 68 percent of its goal. That includes more than 6,700 nurses and 1,551 doctors.
But, at the same time, the number of medical staff members either quitting or retiring has increased 30 percent since 2011, according to a report last week by the Government Accountability Office.
The agency says the losses are driven by improvement in the overall economy, but the report notes that 21 percent of departing employees said they left because of “dissatisfaction with certain aspects of the work, such as concerns about management and obstacles to getting the work done.”
It is unclear how many positions in the system are still unfilled. An agency spokeswoman said it cannot track vacancies for specific job categories.
Firing Employees Who Hid Wait Times
The Fix: The law made it faster to fire executives who concealed the scandal, and it limited their appeals in an effort to cut a firing process that could take years down to 28 days.
Did It Work? No.
The breakdown: At the signing of the bill, Mr. Obama said: “If you engage in an unethical practice, if you cover up a serious problem, you should be fired. Period.” But since then, just nine people have been fired for manipulating wait times, according to the agency. And some of them, including Sharon Helman, the Phoenix medical system director at the center of the scandal, could get their jobs back.
Ms. Helman was fired in 2014, but she contested her termination in federal court, arguing that the new rules limiting her right to appeal were unconstitutional. A ruling is pending. In May, however, the Justice Department announced that it would not contest Ms. Helman’s claim, and in June, the Department of Veterans Affairs said it would stop using the enhanced firing authority.
The move has angered many in Congress, who are now working on more new rules to make it easier to fire agency executives.
“If you don’t have accountability, and you know your job is safe whether you perform or not, it’s hard to make any progress,” Mr. Isakson said. “Right now, that is what we have at the V.A.”