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National VA secretary visits, lauds Palo Alto facility

Newly minted Veterans Affairs head Robert McDonald lays out ideas for reform, with local hospital as model

As part of a weeks-long trip across the country, the newly confirmed secretary of the U.S. Department of Veterans Affairs, Robert McDonald, visited the Palo Alto VA Medical Center Wednesday and called it a standard-setting "crown jewel" within the troubled health care system.

McDonald spent most of his visit touring the center and meeting with veterans, employees and local elected officials. He also spoke to the media about the cultural and organizational challenges facing the VA nationwide, pointing to the Palo Alto Health Care System as a model for best practices.

"I think the story here in Palo Alto is outstanding," he said. "I'm here trying to learn the lean process that the team here has been using to perform and perfect this facility so we can expand it throughout the VA."

He referenced the Palo Alto VA's Veteran and Family Advisory Council, which was established in 2010 and meets monthly to share ideas and input with staff. He ate lunch with the group before his press conference.

He also cited an email sent from a veteran from New Jersey who received "superior care" at the Palo Alto hospital. The veteran, who was in the area visiting family, needed a sleeve for his prosthetic leg. He saw a Palo Alto VA physician, who gave him a complete exam and told him his leg was infected, which he hadn't been aware of, McDonald said. The physician showed him how to soak the leg in order to get rid of the infection and then immediately measured and ordered him a new leg. The new leg was made within one week.

"Stories like this aren't told enough -- individual tales of veterans coming to a medical facility a thousand miles from their home," McDonald said. "He was taken care of with class, with dignity, with respect.

"This is the way the system should work for every single veteran in this country."

The Palo Alto VA has largely avoided the spotlight in the past several months as stories unfolded about veterans across the nation who experienced extremely long – and in some cases, fatal – delays in care or about VA staff who covered up a widespread practice of creating secret, unofficial wait lists.

The Palo Alto facility claims shorter-than-average wait times for both primary and specialty care appointments and has recently made efforts to encourage dialogue and transparency about any issues. In July, the facility hosted a town hall meeting with Palo Alto VA Director Lisa Freeman and Reps. Anna Eshoo and Jackie Speier.

However, last month, a nonpartisan, independent watchdog group released a report that detailed the story of a Palo Alto pharmacy employee who said he experienced retaliation and a gag order from his superiors after speaking up about errors and delays in the delivery of medication to patients. Stuart Kallio, an inpatient pharmacy technician supervisor, said he was placed on administrative leave in June after writing a string of emails to his superiors, beginning in February, that described the pharmacy as being incompetent and led by uncaring management, with consequences to patient care.

One of those superiors was Director Lisa Freeman, who stood next to McDonald during Wednesday's meeting. Freeman is currently on temporary leave from her position in Palo Alto, having been called to lead the troubled VA Southwest Health Care Network in Arizona in early July.

On the first day of Kallio's suspension, he repeated his complaints in an email to Freeman about "gross mismanagement" and a pharmacy in a "perpetual state of failure," as well as accused the VA of retaliation.

"For almost two years now I have been communicating my concerns regarding the VAPAHCS Palo Alto Division Inpatient Pharmacy up the chain of command up to and including your office," he wrote. "Your response has been to unlawfully retaliate against me."

When asked about the allegations on Wednesday, McDonald responded, "There are no bad whistleblowers."

"I encourage every employee to speak up and to tell us how to improve -- to criticize us," he said. "We need that."

To illustrate his point, he described his approach to organizational structure as an inverted pyramid, with the head or CEO at the bottom instead of the top.

"The CEO or the secretary is on the bottom and the people who are on the top are those people who serve the veteran every single day," he said, making an inverted triangle with his hands. "Anybody who's got an idea of how to do something better, we should celebrate that, not somehow chastise them or ostracize them."

McDonald also stressed that staff vacancies must be filled in order for the VA to move forward, citing large staffing shortfalls at the other hospitals he has visited in recent weeks.

He said the Palo Alto system is more focused on expansion than filling staff deficits, but $2.3 million of the Department of Veterans Affairs budget has been earmarked to help the Palo Alto Health Care System specifically "accelerate access to care."

He also said the Palo Alto VA has "been able to manage" by bringing in additional resources, providing overtime, increasing capacity and taking advantage of community partnerships. For example, to decrease wait times for dental care -- one of two areas McDonald referred to as "problematic" for Palo Alto -- patients are being referred to community partners.

The facility's other problematic area, sleep studies, has more than 300 patients on an electronic wait list, signifying they've waited more than 90 days for an appointment. However, McDonald pointed out, sleep studies have multiple steps and patients are often seen at a clinic but kept on that list until their evaluations are fully complete.

McDonald detailed other efforts his department has already undertaken or plans to implement to further improve access to care and encourage best practices at every level of the health care system.

He said he has initiated a review of the performance plans for all the VA's senior leadership and will amend them for the next fiscal year. He also said he plans to completely eliminate the VA's system-wide 14-day metric for scheduling appointments "and any goal that diverts focus from care for veterans."

Scheduling staff at Palo Alto and across the country have also been required to complete a mandatory training.

Next month, every VA medical center will also be independently reviewed by the Joint Commission, a nonprofit health care accreditation organization that's evaluated the hospitals before. McDonald said he also plans to launch a nationwide review of the culture within the Veterans Health Administration and "seek recommendations on central, structural elements necessary for reinforcing a strong ethical environment across our health care system."

McDonald also emphasized the value of and need for town-hall meetings as a channel for providing real input. On Wednesday morning, he attended such a meeting with all Palo Alto VA employees. He said he's asked leaders across the country to conduct regular open town-hall meetings by the end of September with all members of their organizations, from doctors and veterans to staff and union leaders.

"I want everybody involved," he said. "In order to get out of this crisis and turn it into an opportunity where we better serve veterans, we need everybody's help."

McDonald, former CEO of consumer good giant Procter & Gamble, ex-Army officer and graduate of West Point, was unanimously confirmed by the Senate just last month. He replaced Eric Shinsheki, who resigned in late May amid the explosion of allegations about widespread, controversial scheduling practices, delays in care and mismanagement at VA hospitals.

Comments

 +   Like this comment
Posted by GreenAcres
a resident of Green Acres
on Aug 21, 2014 at 8:36 am

This reads like a press release issued by the Palo Alto VA. The only info here is that the Proctor and Gamble marketing guy called it the crown jewel, and that there's a whistleblower who disagrees. This article needs more metrics so the reader cam understand if PA VA performance is really outstanding. For example, how does this VA compare to others in caseload, staffing, and throughput, patient satisfaction and costs. The story about the visiting vet from new jersey is just an anecdote. At the least the author should link to other work assessing real performance. This is publicity, not reporting.


 +   Like this comment
Posted by John Thomas-Whitcomb Mccoy
a resident of another community
on Aug 21, 2014 at 10:42 am

The VA system in Menlo Park and Palo Alto have taken hits throughout the decades and the national VA system has been considered a JOKE for many decades and by veterans themselves! Veteran friends of the family have consistently made unfortunate jokes about the 'damned VA' either taking far too long for a appointment or the the 'sub par' medical care to the point the the veteran deciding never to go back. I am NOT making this up just growing up in Palo Alto one constantly heard verbal shots being taken at the VA and their POOR performance. So this has NOTHING to do with the current President nor his cabinet, it is endemic to the system and nothing more. This finger pointing by all of the politicos at each other is nothing but cheap attempts at vote gathering! They all have themselves to blame for the disgusting conditions within the VA today!


 +   Like this comment
Posted by John Thomas-Whitcomb McCoy
a resident of another community
on Aug 21, 2014 at 11:04 am

BTW and FYI I am the eldest Grandson to Charles C. and (Mary) Edith Thomas and eldest son of their daughter Virginia McCoy nee Thomas, Paly graduate '41. They built the existing home now addressed at 1454 Dana Avenue in the mid nineteen thirties for the sum of $6k. When built the address for their home in that section of Crescent Park was 454 Dana.

Thank you.


 +   Like this comment
Posted by A-Veteran
a resident of Another Palo Alto neighborhood
on Aug 21, 2014 at 11:13 am

> This finger pointing by all of the politicos at each other is nothing but
> cheap attempts at vote gathering! They all have themselves to blame
> for the disgusting conditions within the VA today!

This is very true. But the voters—meaning you and me—keep sending these same people back to Washington, year after year. How many of us demand any kind of accounting from the Anna Eshoos and Jackie Speiers as to where the 3 trillion dollars in this year's budget will be spent, and what kinds of results we should expect from this incredible amount of money entrusted to people like these two.

Shouldn't we be looking more deeply into their actions, rather than at their shiny faces, or their expensive clothes, when they make their infrequent visits to our communities, and ask: "how many veterans died this year, waiting for VA care?" If they can't answer, or won't answer—why are we going to give them our votes, and return them to Congress.


 +   Like this comment
Posted by Enough!
a resident of Charleston Meadows
on Aug 21, 2014 at 12:27 pm

Palo Alto VA took very good care of my dad.


 +   Like this comment
Posted by Vote red white and BLUE
a resident of Charleston Gardens
on Aug 21, 2014 at 1:06 pm

All those complaining about the VA need to start voting Democratic. It's the republicans that keep slashing VA budgets (see February's vote.)

Even Bernie Sanders and McCain's bill got slashed this last month, by at least 5 billion, iirc.


 +   Like this comment
Posted by Vote red white and BLUE
a resident of Charleston Gardens
on Aug 21, 2014 at 1:08 pm

You can't go into our two longest wars, create thousands of new veterans, and expect to cut budgets and save money on the back of new veterans - if they VOTE.


 +   Like this comment
Posted by member
a resident of Adobe-Meadows
on Aug 21, 2014 at 2:43 pm

I want to say that many years ago my father, who was a WW! vet, had excellent treatment at the PA Veterans Hospital,
and that my brother-in-law, a WW!! veteran also had good care and we had no complaints about the service each of them received. Unfortunately, the shift has gone to we must take care of the Illegals, food, education, medical attention etc. Since there is only so much money to go around, it is used by our politicians (both parties) to appeal to the most people AND WE KEEP VOTING THEM IN!!! I quite agree with the person who wrote that it is up to us to get honest people in office who want to help ALL OUR NEEDY and this includes the Elderly and Homeless.

When we vote, we should vote out the entrenched and get intelligent new blood who might think carefully of what the lobbyist really wants and what he is paying to vote for.


 +   Like this comment
Posted by EJ
a resident of another community
on Aug 21, 2014 at 3:16 pm

I am at the palo alto va right now in the exam room waiting for the dr to show up. Running 9 minutes late. Ill see how late she ends up. I just started treating with the va recently and have had a mixed experience. There is a definite need for training for the scheduling staff. To that I can attest. The care I have received so far has been decent and I haven't had any crazy waits. I am supposed to be setup for a sleep study myself. In September I have to sit through an hour long presentation and then I gues I join that Long list.

Ok done typing and doctor is now 16 minutes late. Zzz


 +   Like this comment
Posted by A-Veteran
a resident of Another Palo Alto neighborhood
on Aug 21, 2014 at 5:26 pm

> You can't go into our two longest wars, create thousands of new veterans,
> and expect to cut budgets and save money on the back of new veterans

This statement is not particularly true. For starters, the VA Medical budget has almost doubled in the past ten years. The most recent VA spending bill has increased the spending for private-sector care by many billions of dollars.

> new veterans ..

The following is from the 2012 Annual Report from the PA VA:

VAPAHCS Enrolled Veteran Patients
World War II.....9%
Korean War Era..15%
Vietnam War Era.59%
OEF/OIF/OND Era..8%
Other............9%

As you can see--the bulk of the Vets treated in the local VA Medical Center are Vietnam Vets.


 +   Like this comment
Posted by Peter Carpenter
a resident of Atherton
on Aug 21, 2014 at 7:31 pm

Peter Carpenter is a registered user.

I have been a PA VA patient for twelve years. Due to my service connected illness I am seen 3-4 times a year.
I receive excellent care, the staff is very competent and thoughtful and they have never been late for an appointment.


 +   Like this comment
Posted by NavyVet
a resident of another community
on Aug 22, 2014 at 7:36 am

The key issue in this story is how Mr. McDonald will handle Mr. Kallio's situation, as it will demonstrate whether or not VA's culture is changing. Will Mr. McDonald take any action against Ms. Freeman for the retaliation against Mr. Kallio? Will Mr. McDonald live up to his word that whistleblowers should be rewarded and not attacked? Potential whistleblowers will continue to remain quiet (and unlawful or inappropriate actions will continue to occur) until VA's leadership demonstrates that blowing the whistle will not ruin the whistleblower's career.


 +   Like this comment
Posted by Crescent Park Dad
a resident of Crescent Park
on Aug 22, 2014 at 8:46 am

A big thank you to all of the thread respondents who have served our country!


 +   Like this comment
Posted by Wilson
a resident of Another Palo Alto neighborhood
on Aug 22, 2014 at 9:27 am

> Will Mr. McDonald live up to his word that whistleblowers
> should be rewarded and not attacked?
Agreed.

A goodly number of people have come forward in the past few months to report on problems in their hospitals. It is important that all of these cases are resolved, and the outcomes publicized.

Pressing this point a bit--it would be a real win if the new Sec. of VA would create a more open method for people to report problems within their work units that got visibility beyond their immediate management. No organization is perfect, so creating an environment where problems can be openly discused, and hopefully solved locally, would be better than mess that is currently festering in some VA hospitals.


 +   Like this comment
Posted by John
a resident of College Terrace
on Aug 22, 2014 at 9:01 pm

The VA Palo Alto needs to be investigated just like any other VA. It should not be labeled a jewel. It has received more money for bldg. expansion than any other VA, The campus is in a beautiful area and the buildings are shiny and new. This should not mean it gets a free pass by the leaders and politicians. One day it is decried and the next day it is lauded,depending on the politician. Leaders should not be making sweeping statements. What was the outcome of the Livermore audit and pharmacy whistleblower claim? The public deserves an answer.


 +   Like this comment
Posted by The Devil Lives In The Details
a resident of Another Palo Alto neighborhood
on Aug 24, 2014 at 8:59 am

The following link says it all about Anna Eshoo's election year pandering to veterans in her district, and the public in general—

Apple's Tim Cook Visits VA Hospital With Anna Eshoo:
Web Link

It's not surprising that a highly visible Silicon Valley CEO get a photo-op, with the new leader of the VA—himself a former CEO of a globally known consumer retailing outfit. Of the three, Cook/McDonald/Eshoo, none have any medical background, which the VA has been shown to be failing to deliver in many cases. So--where are the doctors that make the Palo Alto VA such a good place to seek medical care? Why aren't they speaking to the key issues, as they see them?

It makes sense that the new Secretary make visits to the high-profile hospitals in the VA system. This article does not mention if McDonald will be visiting the Phoenix hospital during his current tour, however. One does has to wonder if this trip was at the request of local Congressional representatives—promoting Silicon Valley products, and the bids for re-election by the current office holders, rather than for the benefit of the veterans/staff of the Palo Alto VA Medical Care facility?

On the plus side, McDonald does seem to be saying many of the right things that need to be said. But as we all know—talk is cheap. It takes money to ride the train. Some of the problems facing the VA system can be solved by firing the individuals who created the problems, or tolerated them to exist. To date, the chief Administrator of the Phoenix VA Hospital has not been fired, but still on paid administrative leave.

Only time will tell. Let's hope that the new Secretary is not just on board for a year or two--disappears as soon as the Obama train wreck has cleared the station on its way to the dust bins of history.


 +   Like this comment
Posted by Frank
a resident of another community
on Aug 24, 2014 at 2:16 pm

My experience at the Palo Alto VA ranged from atrocious to good. I was prescribed tricyclic anti-depressants for tension headaches. The side effects almost killed me according to the emergency physician. The good experience was with a colonoscopy. The staff in that section of the hospital were excellent.


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