CINCINNATI - The Cincinnati VA Medical Center is a hospital on the mend.
One year after whistleblowers went public with their “urgent concerns about quality of care” at the health care home for 43,000 Tri-State veterans, the U.S. Department of Veterans Affairs has installed four Army veterans to lead Cincinnati on a recovery mission.
They are rebuilding medical services gutted by the old guard and establishing a culture of continuous improvement to replace the disorder documented in a joint investigation by the Scripps Washington Bureau and WCPO last February.
“We’ve got dynamic, honest people running the hospital right now,” said Dr. Richard Freiberg, a whistleblower and former chief of orthopedics at the Cincinnati VA. “Yes, it’s on the right track.”
Not every problem is solved.
New VA data shows hospital-associated infection rates increased in the last year and the VA has yet to finalize investigations related to Dr. Barbara Temeck, Cincinnati’s former chief of staff.
She was demoted with full pay last February after the VA said it substantiated whistleblower allegations that she improperly prescribed painkillers for the wife of her boss. The VA’s inspector general has yet to release a final report on Cincinnati. A formal board of inquiry, which took testimony from whistleblowers in October, hasn’t released its findings either.
VA Network Director Robert McDivitt said he expects to see final reports on Dr. Temeck “within a week or so.”
In the meantime, the Cincinnati VA is reviving itself.
One year ago, the hospital was both led and overseen by a group of nonveterans embroiled in controversy. Today, the new director, acting associate director, chief of staff and even the network director are all Army veterans.
“On all the positions, our job was to select the best person,” McDivitt said. “But it certainly is mission-reinforcing for many employees to see veterans in leadership positions.”
Medical Center Director Vivian Hutson, a retired Army colonel who is board-certified in health care management, agreed.
“We are gathering the right people in the right seats,” Hutson said as she led Scripps and WCPO on a tour to showcase the reforms underway in Cincinnati.
“You see that VA symbol at the top of our building,” she said. “We see that as a shining star in the city of Cincinnati. We want this to be the best hospital that veterans would like to come here to get care and the staff are excited to come here to work.”
Surgical care improving
Orthopedics is a prime example of the hospital’s rejuvenation.
Three new surgeons brought sports medicine, orthopedic oncology and spine surgeries back to a hospital that couldn’t provide any of those services a year ago.
“The service is being reconstituted and will be very effective,” Dr. Freiberg said. “Almost every orthopedic issue can now be dealt with well.”
That’s a big reversal for Dr. Freiberg, who said this about his former employer a year ago: “We were serving veterans with almost every imaginable problem and doing state-of-the-art care. Now, we're unable to care for almost all of them."
Dr. Freiberg, who still works part-time at the Cincinnati VA, and other whistleblowers said a cost-shifting strategy forced out experienced surgeons and caused veterans to seek care outside the VA for crucial services like orthopedics and neurosurgery.
The hospital still hasn’t replaced its only neurosurgeon, but its new spine surgeons can cover about 85 percent of the roughly 175 procedures once handled by neurosurgery, said Dr. Mark Molloy, chief of surgical services at the Cincinnati VA. The hospital sends the other 15 percent – mostly complex brain procedures -- to nearby neurosurgeons at Mayfield Clinic and the University of Cincinnati.
“It’s a remarkable recovery,” Dr. Molloy said while accompanying Hutson on the Feb. 9 tour.
Veterans “prefer to be seen in our VA hospital,” Hutson added. “This is their home. This is their one-stop shop.”
No more ‘bones on blades?’
The VA’s sterile processing service has new leadership and $1 million in new equipment, one year after whistleblowers told Scripps and WCPO that surgical instruments were delivered to operating rooms with blood and bone chips from previous surgeries.
The VA’s official response to those claims was a news release last February stating its investigators “did not substantiate any impropriety” regarding the “quality of care for veterans." This preliminary conclusion followed a three-day site visit to Cincinnati. Two months later, VA Nurse Technician Scott Landrum publicly confronted VA officials at a Veterans Town Hall event in Sharonville.
“How in the world can they say that?” Landrum asked at the April 13 event. “Where did those reports go?”
Those questions led to a June report in which Scripps and WCPO documented hundreds of problems in VA operating rooms in the last three years, including 581 “quality events” in 3,571 surgeries in the 2015 fiscal year.
The hospital’s chief of sterile processing recently left the VA for another job and was replaced -- on an acting basis -- by her supervisor, Beth Ackerson, chief nurse of procedural care. In the Feb. 9 tour with Scripps and WCPO, Ackerson repeated what VA officials have been saying for months: No veterans were impacted by problems in sterile processing.
“There has not been a problem in the two years I’ve known, and prior to that nothing reached a veteran,” Ackerson said. “There was no adverse outcome to a veteran.”
Four days later, the Cincinnati VA clarified that position, confirming a 2013 incident that Scripps and WCPO reported in June. A Korean War veteran required a second operation to remove “microscopic fiber” left in his eye during eye surgery.
“The fiber was from the silicone covering at the tip of an instrument used during the first surgery,” the VA explained in a statement. The hospital now uses “a disposable silicone tip” and has seen “zero instances of fibers in patients’ eyes” since then.
The VA also said “there is no evidence that any veterans have been harmed” by the 581 incidents documented in 2015.
Ackerson said the VA has beefed up its oversight of sterile processing and relocated the room so it’s closer to operating rooms. The roughly $6 million project began with the relocation of a VA kitchen in 2013 and was completed soon after Hutson’s arrival in October.
“I can’t comment on what happened in 2015,” Hutson said. “But from the time that I’ve been here, I have confidence that we are providing safe, quality patient care.”
Room for improvement
The VA’s network director in charge of Cincinnati said he has “every reason to believe that Cincinnati had and currently has an active quality assurance process.”
But Robert McDivitt is concerned about an increase in infection rates from MRSA, bacteria that resists antibiotics and is associated with hospitals and nursing homes.
VA data reviewed by Scripps and WCPO show MRSA infections per 1,000 bed days have quadrupled at the Cincinnati VA since 2013. At the end of September, Cincinnati’s MRSA infection rate was worse than more than 90 percent of VA hospitals nationally.
“We have not yet put in a specific plan for Cincinnati,” McDivitt said. “We certainly will talk to them.”
Hutson described MRSA rates as “something that we needed to address. But I have not had a brief yet as to what’s contributing to it and what actions we need to take.”
The Cincinnati VA reported 32 patients with MRSA infections since the beginning of its 2012 fiscal year. There were nine cases in the 2016 fiscal year, which ended Sept. 30. The hospital has logged an increase in MRSA cases in four of the last five years.
This happened as MRSA rates declined nationally.
“Individual analysis of each infection in FY2016 has not demonstrated any obvious patterns, shortcomings in practices, or common-point source upon which focused efforts can be applied,” said Dr. Stephen Kralovic, an infectious disease specialist for the VA, in a prepared statement.
Beyond MRSA, infection rates are higher than a year ago in two other categories: Catheter-associated urinary tract infections and blood-stream infections linked to central lines.
The VA has yet to provide an explanation on those increases.
McDivitt said Hutson is “very attuned to patient safety” and will get to the bottom of Cincinnati’s rising infection rates.
“One of the things she’s done in her four months there is to make patient safety a visible, daily discussion point at their morning meetings,” he said. “If they see that something that happened yesterday that they need to work on today, they are putting plans in place and moving forward. I think that’s part of an active, engaged safety culture.”
More than ‘instant improvements’
Hutson is a fan of the morning huddle, a standing meeting where union leaders, department heads, doctors and nurses are free to bring up issues and concerns. She also believes in “action plans” with measurable goals that can be monitored over time.
“We will have someone who is an accountable lead with a committee or work group working on that specific area,” she said. “And then we will have action steps.”
One example is the hospital’s new strategic plan, which Hutson promised in a mid-October interview with WCPO and delivered after a Nov. 7 strategic planning event for executive staff, service chiefs and program managers.
The resulting document identified 14 new goals for the hospital toward which the hospital is expected to demonstrate “measurable results” by September.
Cincinnati veteran Mathew Millis has already noticed an improvement.
“Better appointment times, everybody acts a lot better, hospital’s a lot cleaner,” Millis said while waiting for a bus near the medical center’s main campus. “Every time I had to come down here there were a lot of issues, especially with the pharmacy. You used to sit in there for hours. Now, you might sit in there for an hour tops.”
In her first four months, Hutson has earned rave reviews from her bosses and employees, including former VA Secretary Bob McDonald. The former Procter & Gamble CEO called Hutson “the kind of selfless leader we want” at the VA.
“During our meeting earlier this year it was apparent that her history of service as an Army Veteran outside the VA system allowed Vivian Hutson to bring a fresh perspective to the challenges facing Cincinnati,” said Sen. Sherrod Brown, an Ohio Democrat who used his seat on the Senate Committee on Veterans Affairs to push for change here. “While there’s no question things are moving in the right direction, our job is never done, and I will continue assessing the changes being made at the Cincinnati VA to ensure accountability.”
Even as Hutson changes the Cincinnati VA, it’s causing a “change in mindset” for her. After a military career in which she received new assignments every two to three years, Hutson is now hoping Cincinnati will be a post where she can make more than just “instant improvements.”
Her husband and 14-year-old son plan to relocate to Cincinnati from Alaska this summer.
“I’m here for the long haul,” she said.