xml:space="preserve">
xml:space="preserve">
Advertisement
Advertisement

The VA's dysfunction is driven by a 'culture of fear'

I read with interest Secretary of Veterans Affairs Robert A. McDonald's recent commentary about the truly remarkable accomplishments of top-notch health care professionals affiliated with the Veterans Healthcare Administration ("VA is critical to medicine and vets," Oct. 23).

However, my recent experience as a patient at the James H. Quillen VA Medical Center in Mountain Home, Tenn., revealed a darker reality about VA health care.

Advertisement

On Oct. 15 I underwent what was to have been the last of three procedures for the treatment of bilateral kidney stones, which had afflicted me severely in the preceding weeks. I was to have the last two stones removed from my left ureter by lithotripsy, using laser energy to fracture the stones into pieces small enough to be safely removed.

I awoke in the recovery room to learn from my urologist that nothing of the sort had been accomplished. The laser, provided by an outside contractor, malfunctioned and was unusable. Ironically, a similar piece of equipment purchased by the VA not long before was languishing in a storage closet — useless, I was told, because of contract issues, perhaps involving government inefficiency and waste.

Advertisement
Advertisement

My urologist had proposed to immediately use instead ultrasonic shock waves to fracture the stones. But apparently the operating room nurse and her supervisor refused to allow him to act according to his best judgment. It appears they had not read the consent documents carefully and mistakenly believed that my permission to proceed in such a manner wasn't appropriately documented.

My urologist was apparently told there would be "a bunch of investigations" and "everyone would lose their jobs" if he persisted and a situation was created where I might possibly sue the VA for performing a procedure without adequate consent.

I don't know precisely what happened because I was unconscious on the cystoscopy table when all this unfolded. This information was provided to me by my urologist who is, so far, the only VA employee to acknowledge or apologize for my maltreatment.

Instead of receiving the health care I needed, I suffered a week of intense bladder spasms, frequent urination with constant passage of blood and clots, groin pain, low grade fever and nausea until I finally submitted to yet another operation that would have been completely unnecessary had I received the care I needed, wanted and consented to on Oct. 15.

Advertisement

The most disturbing aspect of this is that I am a general surgeon who works at the Quillen VA Medical Center. I suffered this maltreatment at the hands of friends, valued colleagues and co-workers, so dense and pervasive is the dysfunction and culture of fear that motivates so much that is wrong in VHA.

This culture of fear is driven relentlessly from the top leadership down throughout our organization. It is a culture that demands fealty to individuals over ideals and, most of all, furthers the careers of senior leaders and executives over the interests of individual veteran patients.

This culture of fear is causing mistakes to be made, care to be denied or refused unreasonably, performance data to be falsified and complications to be under-reported to the VA Surgical Quality Improvement Program. All of this I have personally witnessed since I joined the VA 12 years ago after retiring from the Air Force.

If this can happen in a dysfunctional system to an experienced and knowledgeable health care professional, imagine what might happen to a less well-informed patient who would likely suffer in silence.

"Fixing access" will not be enough. The entire VA needs nothing short of a cultural revolution, a complete realignment of the focus and priorities of leaders at all levels.

We need leaders who inspire their subordinates to the pursuit of excellence and discipline through sterling examples of integrity and selfless service rather than marginalize and punish the truth-tellers.

We need leaders at all levels focused on what is right for our veterans above any other career concerns; who are willing to follow the example of the numerous rank-and-file employees who individually took excellent care of me. This might prevent my recent experience from being repeated on a more vulnerable veteran.

I don't think there have been any discernible changes in the culture perpetuated by the entrenched VA bureaucracy that are apparent so far to lower-ranking, non-managerial VA workers such as myself. Until that happens, nothing important will have changed.

Dr. Thomas E. Scott, Johnson City, Tenn.

Recommended on Baltimore Sun

Advertisement
Advertisement
Advertisement
Advertisement
Advertisement
Advertisement