After being deemed high risk in January, the flagship Department of Veterans Affairs hospital in Washington has continued to deteriorate in quality during the first six months of 2018.
The hospital was designated “critical” and its performance is under administrative review, including possible changes of leadership, according to a memorandum sent to the D.C. hospital July 17 from Carolyn Clancy, then executive in charge of the Veterans Health Administration. The memo was obtained Wednesday by Stars and Stripes.
“Unfortunately, we have not seen the amount of improvement desired over the past two quarters and now see benefit in utilizing additional measures to support the facility in stabilizing the hospital’s quality to the extent that it can be sustained,” Clancy wrote.
According to the memo, the hospital isn’t getting better, despite public assertions from VA officials over the past several months that problems there were being fixed.
In March, the VA Office of Inspector General released a scathing report detailing a “culture of complacency” at the hospital that allowed widespread failures to persist for years, putting veterans at risk and weakening core functions of the hospital.
Since then, inspection reports from the Food and Drug Administration and the VA’s National Program Office for Sterile Processing have revealed ongoing problems. The reports, obtained by Stars and Stripes this spring, detailed instances of dirty syringe bottles, unsanitary conditions, rooms in disarray and staff and supply shortages that led to canceled procedures.
The Washington facility is one of 15 VA hospitals that have a one-star rating – the lowest possible out of five – based on quality comparisons among 170 VA hospitals nationwide. The VA announced in February it would take a “new aggressive approach” to improve its low-performing hospitals, including quarterly reviews.
Clancy’s “critical” rating is based on the latest performance report from the second quarter of 2018.
The areas of greatest concern at the Washington hospital, Clancy wrote, are access, mental health, employee satisfaction and “avoidable adverse events.” Additionally, VA officials are concerned about the “large deterioration” in the past year in preventable hospitalizations and adjusting patients’ length of stay.
An administrative review by VA headquarters will be held in the “very near future,” Clancy wrote last month. Leaders of the Washington hospital would be required to attend and show quantifiable evidence of improvement.
“A discussion of changes in leadership needed for achieving the medical center’s quality objectives and sustaining them will be included in the review,” she warned.
Senior leaders now require monthly briefings on the hospital and will reassess the facility every one to three months, she said.
The VA said Wednesday that the Washington hospital had “demonstrated large improvements” in the past year on nurse turnover and specialty care.
“Despite this progress, VA notified facility leaders July 17 it has not seen the amount of improvement desired over the past two quarters and is taking additional measures to support the facility,” the VA wrote in a statement. Officials declined to answer any questions.
The Office of Inspector General first warned of problems at the Washington hospital in April 2017, prompting then-Secretary David Shulkin to fire the hospital director, Brian Hawkins. Army Col. Larry Connell took over for one year, until he was reassigned this spring amid an investiga-tion into whether his appointment broke federal protocol.
The hospital’s chief of staff, Charles Faselis, was in charge of the facility for two weeks until another temporary director was named. Adam Robinson is now leading the hospital but is ex-pected to stay in the position only through next month.
Raymond Chung is filling in as the acting director of the regional network that oversees the Washington hospital. He was copied on the memo.
Since the memo was written, Clancy has taken a new position at the VA as an undersecretary for discovery and advancement. Richard Stone took over Clancy’s position as executive in charge of the VA health care system.
© 2018 the Stars and Stripes
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