STORY UPDATED 4:36 p.m., 2.22, to include comments from VA spokesman.
MADISON, Wis. – In a mostly positive profile in the Milwaukee Journal Sentinel last week, Victoria Brahm laid out the achievements to date and the challenges facing the Veterans Affairs Medical Center in Tomah.
Brahm, who last month was officially named medical center director of the government-run hospital and clinics, offered a can-do attitude about mending the scandal-plagued medical center.
“I’m an open book and I think I can turn this place around,” Brahm said. “And it needs work. This is our opportunity. This is it. We have to change this culture, all the way.”
But insiders say the government-run medical complex described as “Candyland” for opioid prescription practices that left veterans drugged out of their minds is a long way from changed.
An employee at the VA facility tells Wisconsin Watchdog that while he has seen some areas of improvement, the “culture of fear” described in a Senate committee report last year in many ways remains unchanged.
“(Brahm) keeps saying she is not going to tolerate bullying and retaliation, but I received a phone call today from a person getting bullied by a manager,” the staffer said.
Leadership puts on a good front for the cameras, the source said, but when the reporters and the lawmakers go away, management continues to be evasive and punitive.
Management continues to lower evaluations for staff members who voice concerns about safety matters, the insider said. Brahm, the source claims, is “actively giving bonuses” to some of the same managers who continue to use retaliatory measures to silence staff members who bring issues to light.
More troubling, according to sources, is continued staffing shortages in key areas.
One source says management has made a “conscious choice to understaff” a medical unit.
“There have been times where a shift scheduled went totally through that did not have a registered nurse assigned,” the VA employee said.
While licensed practical nurses and certified nursing assistants staff the unit, they are not allowed by law to assess health conditions and coordinate patient care plans.
“We still have huge nurse turnover because leadership still is bad here,” the source said.
Tomah VA Medical Center spokesman Matthew Gowan in a follow-up email said there are vacancies in nursing service that are “actively recruited as a result of retirements, relocations, etc.,” but nurse staffing is adjusted on a “shift-to-shift basis to meet patient-care needs.”
“We do not consider this a shortage of staff as we are able to meet the care needs of our Veterans,” Gowan said. “We continue to strive to retain the best nurses we currently have on staff.”
The spokesman said the Tomah VA Registered Nurse turnover rate has been steadily declining and has demonstrated a significant decline over the last fiscal year.
“Multiple strategies have been implemented based upon nursing listening sessions, nursing town hall meetings, leadership rounding, etc. One of the top requests was for 12-hour shifts which have been introduced,” Gowan said.
Staffing for the health care complex’s Community Living Centers, or nursing homes, requires a mix of RNs, LPNs and NAs for round-the-clock coverage, according to the VA spokesman.
“An LPN would not be assigned in a CLC without an RN assigned in close proximity for oversight purposes,” Gowan said.
As to retaliation and the medical center’s working environment, Gowan said administration is not aware of “any correlation between reporting patient safety concerns and receiving lower performance appraisals” – a charge leveled by multiple employees.
“There is an appeal process for any employee not satisfied with their rating,” Gowan said. “Additionally, managers are not being rewarded for retaliating against employees.”
Some patients and their families claim patient neglect is a problem at Tomah.
The family member of a longer-term patient described a unit where one veteran was rolled out to drool on a towel for much of the day.
“It takes a while for that kind of phlegm to build up,” said the source, who asked not to be identified because of concerns for her and her father’s safety. “(The veteran) had to have been there from the time he woke up until 2 that afternoon.”
Gowan said administrators have been working to transform the medical center since April 2015.
“Our employees are telling us that they’re seeing the fruits of those efforts,” he said in the email. “In the most-current All Employee Survey, the score for “Workgroup Psychological Safety” rose almost 5%. The score for “Best Place to Work” rose almost 10%.”
Since beginning as acting director in October 2015, Brahm has had an “open door” policy for all staff members, according to Gowan. The facility implemented a “Speak Up” program where employees may anonymously report “just about anything,” he said.
Employees also have taken their concerns to Wisconsin Watchdog and other media outlets, often painting a different picture of the medical center than the front office has.
Tomah VAMC employees have told Wisconsin Watchdog that prescription drug abuse remains a problem.
“While this has changed some ways drugs are processed, the problem with over-prescribing and veterans’ abuse of medication still lingers,” a source who works at the hospital told Wisconsin Watchdog in December. The source asked not to be identified for fear of retaliation.
“We have many veterans who lash out at the pharmacy and pharmacist and technicians who see the dispensing practices as insane,” the source added.
But internal data released by the health care facility suggests Tomah has made considerable improvement since early 2015, when investigative reports first surfaced about the facility’s opioid abuses and what a Senate committee report would describe as a “culture of fear.”
The report snapshot released by the Tomah VA hospital found:
- A 48 percent reduction in the amount of veterans receiving both opioids and benzodiazepines, the class of highly addictive sedative and muscle relaxant drugs.
- A 49 percent decline in the number of veterans receiving greater than 100 morphine equivalent milligram daily dosages.
- A 73 percent drop in the number of vets receiving greater than 400 morphine equivalent milligram dosages.
The Tomah VA Medical Center’s alarming opioid over-prescription practices led to the August 2014 death of 35-year-old veteran Marine Jason Simcakoski, according to multiple federal investigations into the hospital.
Dr. David Houlihan, the facility’s chief of staff, was fired in late 2015 following investigative reports and whistleblower accounts of painkiller addiction abuse and retaliation against employees who dared bring the problems to light. Last month, a state board stripped Houlihan of his medical license and declared the physician, referred to as the “candy man,” ineligible to practice medicine in Wisconsin.
Brahm told the Milwaukee Journal Sentinel she was frustrated that her concerns about Houlihan didn’t lead to his dismissal earlier.
“There wasn’t enough solid evidence to say, ‘He really is going to kill someone.’ That wasn’t strong enough for me to say, ‘I’m calling the press,'” she told the publication.
But that seems to be a different account then testimony by Brahm’s boss.
In a sworn deposition released last year, VA regional office Network Director Renee Oshinski, said that before the Tomah scandal broke, Brahm had received significant evidence of opiate abuse. Brahm, who was the regional office’s nurse executive at the time, determined that there was no truth to the reports, according to the deposition.
“I was astounded that they were all unsubstantiated,” Oshinski told investigators from the Senate Committee on Homeland Security and Governmental Affairs, as reported in the Daily Caller. “With the number of things here, I would have thought there would have been some partially substantiated or whatever. I mean, just based on the number, that it’s not a normal response that we would have.”
Myriad federal investigations and media accounts have since proved valid the whistleblower reports of abuse inside the medical center.
“An ongoing look at Dr. Houlihan’s prescribing practices” was “something that Vicki Brahm and Donna Leslie (VISN 12 Pharmacy Executive), were involved in” as part of their duties in the regional office, Oshinski said in the deposition.
Oshinski said Houlihan and Brahm worked closely on hospital matters.
“Dr. Houlihan would choose to call (Then-VISN 12 Network Director) Dr. Murawsky [the regional office’s director] or Vicki Brahm,” she said under oath.
In January, Oshinski was “pleased to announce” that Brahm was officially selected as director of the Tomah VA hospital, removing the “acting” medical center director title Brahm had held since Novmber 2015.
VA drug problems
Drug problems persist in the VA health care chain, according to a report this week by The Associated Press.
Federal authorities have increased their probes into the Department of Veterans Affairs medical centers following a sharp rise in opioid thefts, missing prescriptions or unauthorized drug use by VA employees since 2009, according to government data obtained by The AP.
“Doctors, nurses or pharmacy staff at federal hospitals — the vast majority within the VA system — siphoned away controlled substances for their own use or street sales, or drugs intended for patients simply disappeared,” the investigation notes.
“Aggravating the problem is that some VA hospitals have been lax in tracking drug supplies. Congressional auditors said spot checks found four VA hospitals skipped monthly inspections of drug stocks or missed other requirements. Investigators said that signals problems for VA’s entire network of more than 160 medical centers and 1,000 clinics, coming after auditor warnings about lax oversight dating back to at least 2009,” according to AP.
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