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"VA Accountability: What has Happened to Hampton?"

House Veterans Affairs Committee, Oversight and Investigations Subcommittee Hearing

September 24, 2024 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked):

• Mr. Paul S. Crews: Veterans Integrated Services Network 6 Director, U.S. Department of Veterans Affairs

• Mr. Frederick Kotler, MD: Interim Medical Inspector, U.S. Department of Veterans Affairs, Office of the Medical Inspector

• Mr. Walt C. Dannenberg: Acting Executive Director, U.S. Department of Veterans Affairs, VA Hampton Health Care

• Dr. Jennifer Baptiste: Deputy Assistant Inspector General for Healthcare Inspections, U.S. Department of Veterans Affairs, Office of Inspector General

Keywords mentioned:

• Patient safety, whistleblowers, retaliation, staffing shortages, infrastructure challenges, VISN oversight, culture of safety, accountability, OIG recommendations, telehealth, recruitment, retention

IN THEIR WORDS

OPENING STATEMENTS FROM THE SUBCOMMITTEE

• Chairwoman Jen Kiggans opened the hearing by expressing her commitment to addressing the numerous issues facing VA facilities, particularly those reported at the Hampton VA Medical Center. She described whistleblower reports detailing patient safety concerns, a hostile work environment, and poor leadership. The Chairwoman mentioned alarming conditions in the surgical department at the Hampton VA, including unclean operating rooms and the lack of clinical staff. She reaffirmed her commitment to overseeing leadership improvements at the Hampton VA and ensuring that the facility and department fulfill their obligations to veterans.

• Ranking Member Frank Mrvan acknowledged the hard work of the Hampton VA staff but recognized the facility's significant challenges concerning leadership changes and staffing shortages. He attributed some of the issues to the nationwide strain from the COVID-19 pandemic and frequent leadership turnover. Ranking Member Mrvan expressed hope that the new leadership at the Hampton VA would improve the culture and address patient safety concerns. He committed to working alongside the Committee and VA leadership to implement meaningful reforms at the Hampton VA.

SUMMARY OF KEY POINTS

• Mr. Paul Crews shared his personal connection to the VA, describing his 30-year career in healthcare and his dedication to veteran care. He recognized the serious concerns raised about the Hampton VA, pointing to patient safety concerns and leadership accountability. Mr. Crews reported that his team had conducted numerous oversight visits and had implemented several recommendations from the VA Office of Inspector General (OIG) to improve conditions. He reassured the Subcommittee that further steps were being taken to address the facility's ongoing issues and improve overall care quality.

• Dr. Jennifer Baptiste provided an overview of the OIG’s oversight of the Hampton VA. She detailed several reports revealing significant deficiencies in clinical care, leadership disengagement, and failures in patient safety programs. Dr. Baptiste claimed that the facility lacked essential structures, such as a cancer care program, and that leaders failed to follow proper processes. She stated that while improvements had been initiated, it would take time to rebuild trust and improve the overall culture at the Hampton VA.

• Chairwoman Kiggans asked about common themes in the OIG’s critical reports of the Hampton VA over the past three years. Dr. Baptiste responded that there were several recurring issues, including poor care coordination, inadequate communication of test results, disengaged leadership, and deficiencies in the facility’s quality review processes.

• Chairwoman Kiggans also inquired about how VISN 6 could improve its oversight of Hampton's leadership. Dr. Baptiste noted that the VISN should have taken a more proactive role, given the repeated concerns raised over multiple years.

• The Chairwoman then questioned if staffing shortages contributed to patient safety issues, noting her own observations of overworked staff during a visit. Dr. Baptiste explained that the focus of earlier reports was on individual patient care rather than staffing adequacy, though she acknowledged that staffing and workload could influence care coordination.

• Chairwoman Kiggans shifted her questions to Mr. Crews, asking if he agreed with the OIG’s conclusion that VISN 6 had poorly managed the facility. Mr. Crews accepted responsibility for VISN 6's oversight and described actions taken, including increased oversight visits and process improvements. He reiterated his commitment to ensuring high-quality care for veterans.

• Ranking Member Mrvan asked the witnesses about the VISN’s role in monitoring data trends such as joint patient safety reports and harassment complaints. Mr. Crews explained that VISN 6 reviewed patient safety reports daily and intervened when necessary by reviewing care and coaching teams to improve care coordination.

• The Ranking Member also followed up on the complexity of oncology care, asking Mr. Crews to clarify how VISN 6 had addressed these challenges. Mr. Crews confirmed that the Hampton VA now had cancer navigators and a tumor board, which had been implemented after OIG reports pointed out deficiencies in cancer care coordination.

• Ranking Member Mrvan pressed Mr. Crews further on whether VISN 6 had been proactive or reactive in the past. Mr. Crews stated that since his arrival in 2021, VISN 6 has become more proactive and has used real-time data to monitor facilities. Dr. Baptiste added that staff were not consistently entering patient safety reports, which limited the data available for review, emphasizing the need for leadership to encourage staff to report safety issues.

• Rep. Matt Rosendale expressed concern over repeated issues at the Hampton VA, comparing them to problems faced at Fort Harrison in Montana. He asked Dr. Baptiste to elaborate on why Hampton leadership had not been addressing issues raised by staff or whistleblowers. Dr. Baptiste explained that leadership was often unaware of problems due to staff not entering safety reports and ineffective quality reviews.

• Rep. Rosendale also asked how VISN 6 leaders could shift from passive to proactive oversight. Dr. Baptiste suggested that the VISN needed to be more engaged with facility issues and not wait for facility leaders to request assistance.

• Rep. Rosendale then inquired about the number of recommendations made by the OIG over the three reports and how many had been implemented. Dr. Baptiste reported that all recommendations from the first report had been implemented, two recommendations from the second report remained open, and all recommendations from the third report were still active.

• Rep. Bobby Scott asked the panel whether there were objective standards to measure healthcare quality. Dr. Baptiste affirmed that there are numerous objective metrics that the VA uses to assess care quality.

• Rep. Scott inquired whether the recommendations made by the OIG would be fully implemented. Mr. Crews confirmed that they were actively working on them, meeting bi-weekly with the facility teams to ensure progress.

• Rep. Scott then focused on the difficulties in attracting qualified medical professionals. Mr. Crews responded that Hampton faced challenges due to limited pay authorities, and he stated that they needed additional budget authority to remain competitive.

• Following up, Rep. Scott also asked if the 150-year-old facility posed challenges to providing quality care. Mr. Crews acknowledged that the age of the infrastructure did present difficulties, especially in maintaining air handling and water management systems.

• When asked if Hampton could absorb the growing veteran population, Mr. Crews mentioned several expansions, including a new 200,000-square-foot healthcare center scheduled to open in 2025 and collaborations with Department of Defense partners to address capacity issues.

• Chairwoman Kiggans discussed why employees were not entering patient safety reports. Dr. Baptiste explained that staff either did not know how to enter reports or feared retaliation for doing so. Chairwoman Kiggans then asked what steps were being taken to ensure employees at Hampton felt safe from retaliation. Mr. Walt Dannenberg detailed the implementation of a daily management system to allow employees to report issues and regular town halls to address concerns, including training on how to file safety reports.

• The Chairwoman then asked Mr. Dannenberg what his top three priorities were since assuming leadership. He listed implementing a daily management system, coaching the executive leadership team on high-reliability practices, and ensuring open communication with frontline staff. When asked about addressing the provider shortage, particularly in anesthesiology, Mr. Dannenberg explained they were utilizing national contracts and collaborating with Department of Defense partners to fill gaps.

• Ranking Member Mrvan inquired whether or not a recently released VA directive on VISN roles was adequate. Dr. Baptiste replied that the directive was not sufficiently scoped, as it only addressed the role of the VISN director and omitted other key positions.

• Ranking Member Mrvan also asked about the balance between virtual and in-person investigations. Dr. Frederick Kotler explained that while virtual investigations started during the pandemic, the majority of investigations were now conducted in person.

• The Ranking Member then asked how Hampton was addressing staffing needs for upcoming facility expansions. Mr. Dannenberg described efforts to retain current staff, recruit new talent through various methods, and increase clinic space.

• Ranking Member Mrvan followed up on how VISNs can work together to support facilities like Hampton with staffing shortages. Mr. Crews highlighted a collaboration between VISN 6 and the Bronx VA, where telehealth services were used to support care for over 6,000 veterans, with plans to expand these efforts.

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