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Doctor says Augusta VA ignored gastrointestinal complaints

Saturday, May 24, 2014 9:49 PM
Last updated Sunday, May 25, 2014 7:50 PM
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Dr. Raymond Kostromin might be expected to speak of hope and vindication after an Augusta judge last month dismissed a charge of government theft filed against him by the Department of Veterans Affairs.

Dr. Raymond Kostromin says his firing from the Augusta VA followed complaints about delays in care.  SPECIAL
Dr. Raymond Kostromin says his firing from the Augusta VA followed complaints about delays in care.

For the first time in a year, the former primary-care physician at the Charlie Nor­­wood VA Medical Center can see patients in the private sector free of the shadow of indictment.

Except the 50-year-old Army veteran can’t seem to find justice in the pain he and former co-workers say the Au­gus­ta VA hospital caused him for being a “strong advocate” for his patients.

Four years ago, Kostromin spoke out against Augusta VA administrators failing to schedule thousands of screening, surveillance and diagnostic endoscopies referred to the gastrointestinal clinic by primary-care providers. Despite repeated warnings he said he sent his supervisor and the hospital’s chief of staff about appointment requests being ignored, the list grew to 4,580 unresolved procedures and resulted in three cancer-related deaths in August 2012, records show.

Kos­tro­min’s dismissal letter says he was fired for “unprofessional conduct” and accusations that he fraudulently accepted $1,100 in medications and plastic surgery from the federal agency.

Though a Richmond Court Superior Court judge ruled in April that the allegations lacked sufficient evidence, those accusations remain active in the VA system.

“They almost ruined my career,” Kostromin said. Today, he commutes weekly from Augusta to Columbus, Ga., to practice internal medicine at St. Francis Hospital.

“My only saving grace was the state Medical Composite Board keeping my license active, my family keeping me motivated and St. Francis Hospital for taking a chance on me,” he said. “I owe them all a huge debt of gratitude.”

More whistleblowers are coming forward nationwide amid new reports of deadly delays and alleged waiting-list manipulation at VA hospitals.

KOSTROMIN SAID HE started experiencing problems with referring his patients to gastroenterologists when he arrived in Augusta in 2000, and about five to seven years later, substantial backlogs began.

Kostromin says he e-mailed his supervisor in May 2010 with concerns that as many as 2,500 patients the primary care department had referred to the program were waiting a year, some closer to two, for procedures despite new requests every six months.

After three weeks with no response, Kostromin said, he e-mailed his concerns to the chief of staff. When three weeks passed without a response, he took his concerns to the acting interim director, who forced the chief of staff to meet with Kostromin.

Kostromin, who declined to provide names, said he was told in the meeting that Au­gusta officials had restructured the hospital’s gastrointestinal clinic, added staff and turned some screening endoscopies into self-administered fecal exams.

“But still nothing was getting fixed,” said Kostromin, who estimates that he referred 300 gastrointestinal patients annually. “The list was apparently growing and people were dying.”

AFTER THE BACKLOG peaked at 5,100 unresolved consults in August 2012, Kostromin said, delays became a topic of conversation at every monthly staff meeting. At the last meeting he attended in 2013, administrators told primary care physicians that “bad outcomes” were on them, he said. As a result, Kostromin said, physicians began to advise Medicare patients to seek private gastroenterologists because of the long wait.

“They were leaving us out to dry,” he said.

In a statement, spokesman Pete Scovill said the hospital cannot comment on personnel matters, including whether Kostromin e-mailed executive leadership. The statement said an administrative investigation commissioned two years ago by the director of the VA’s Southeast network revealed delays in gastrointestinal care existed in Augusta before 2011.

The VA hospital dismissed claims that Kostromin was targeted for removal.

“No VA employee would be subject to discipline for identifying opportunities to improve veteran care,” the statement said.

In affadavits filed in Rich­mond County Superior Court in April 2013, clinic coordinators, physician assistants, primary care doctors and veterans who worked with Kos­tro­min said he “made waves” and angered VA bureaucracy because of his strong advocacy for patients.

That advocacy included going above VA pharmacists to get his supervisors to approve non-formulary prescriptions requested by patients that were pricier and not offered under the department’s budget.

Don Clay, a retired physician assistant; Lori Evans, a clinic coordinator; and Dr. Shoba Battu, a primary care physician, wrote in affidavits that because of these acts, the VA targeted Kostromin for removal in early 2013.

The three either declined comment or did not return calls seeking comment.

LAST MAY, THE VA inspector general filed theft charges accusing Kostromin of receiving medications and plastic surgery through the VA’s free-services program, for low-income veterans, between Jan. 12, 2010, and Aug. 8, 2011. In court papers, Evans called the charge “ludicrous.” Clay, who helped Kostromin submit medicine requests to the VA, agreed, testifying that Kostromin was eligible to receive prescriptions though his private insurance and that pharmacists who assess applicant files to determine eligibility freely released medications for 18 months.

Kostromin provided payment reports that show his health insurance was billed $607 between February 2010 and August 2011 for non-narcotic medications that included antidepressant and erectile dysfunction drugs. Health records entered into the Augusta VA system Oct. 14, 2010, show the hospital removed a small cyst on his cheek. Kostromin said that was the plastic surgery he allegedly stole. Though the Augusta VA did not elaborate on Kos­tro­min’s eligibility, it confirmed he received a determination from the VA Health Eligibility Center for services and prescriptions, and that they were aware of it.

“I am horrified and embarrassed that Dr. Kostromin has been wrongfully accused when I fully know that it was not his fault,” Evans wrote in her affidavit. “The VA has done him wrong.”

KOSTROMIN APPEALED THE allegations and his firing to Augusta VA officials and the medical center’s human resources chief Oct. 2, but four weeks later, the decision was upheld on charges of receiving services for which he was ineligible and unprofessional conduct.

“I have concluded that the sustained charges against you are of such gravity that mitigation of the proposed penalty is not warranted, and that the penalty of removal is appropriate and within the range of reasonableness,” Michelle Cox-Henly, the chief nurse and interim director at the time, wrote in Kostromin’s dismissal letter filed Oct. 28. She said she based her decision on Kos­tro­min’s appeal hearing, his personnel file, the seriousness of his crime, and any mitigating or extenuating circumstances.

Since then, Kostromin said he has contacted the VA inspector general, U.S. Sen. Johnny Isakson and the House Committee on Vete­rans Affairs to provide background on delays in Aug­usta and try to get his employment reinstated. All three offices have confirmed opening casefiles with the doctor.

“The Department of Vete­rans Affairs is thoroughly reviewing the situation and will provide a more complete response as soon as possible,” a May 15 letter from the VA’s Congressional and Legislative Affairs office stated to verify it is looking into Kostromin possibly being the victim of targeting and unlawful firing.

AFTER NINE YEARS as an Army physician and 11 as a veteran’s doctor, Kostromin said he has no plans of returning to the VA, but hopes the review is completed sooner than later. The Augusta VA said it “plans to continue to adhere to personnel rules in managing matters related to Dr. Kos­tromin as we would for any other employee.”

“They went to many lengths to put me in jail,” he said. “I hope they do the same to review my case and possibly reinstate my employment history.”

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dvdbiggs 05/25/14 - 02:32 am
Support For Strong Patient Advocates

I agree with Doctor Kostromin that he was targeted for being a strong advocate for the patients. I too was a strong advocate for the patients at the VA in Augusta and I too was targeted for harassment. I had taken my complaints to management and I even strongly voiced my concerns at a Town Hall Meeting. After the meeting I was told by the Union President that the Employment Relations person said that she was going to have me fired. He told her that she could not as I was protected by the Whistle Blower Act. I had reported my complaints to the IG and after this incident the IG did come in to investigate. I never heard the final results of the IG investigation, but I assume that I was just portrayed as a disgruntled employee. My complaints pertained to billing patients and taking money out of their government checks. We had received payment from insurance companies and the payments were not getting posted in a timely manner. This resulted in monies being taken out of the patients government checks. A video tape was made of this Town Hall Meeting and it should still be on file. GREAT WORK Doctor Kostromin and I wish you the best in your new position. I can truly understand why you would never work for the VA again. We need more professionals like you at the VA Hospitals. I personally know the professionals that wrote affidavits for Doctor Kostromin and they are excellent professionals.

Young Fred
Young Fred 05/25/14 - 02:19 am
I have to commend

Wesley Brown.

So few dig. So many accept.

I hope the AC realizes you're a "keeper"

nocnoc 05/25/14 - 07:21 am
1st we hear that the VA delayed treating, mistreated

and killed VET's here in AUGUSTA

Then we hear it happen at other locations nationally.

Then we read in the paper a headline Augusta VA not on the list.

Then we see this incident brought up the next day.

Are they changing VA PR spokespersons daily or hourly now?
Because it sure sounds like a lot of lies, and they are having a hard time keeping up with what the official truth is each day.

curly123053 05/25/14 - 09:02 am
VA Thugs

This proves to me that the VA has THUGS running things for our Vets. America is going to hell with the leadership the sheeple have elected into office. A lot of people need to be sent to prison in the upper in this administration in my opinion. It's time to take this country back from the evil leaders by whatever means.

Little Old Lady
Little Old Lady 05/25/14 - 09:27 am
Veteran's treatment

I know a veteran who has been treated for ulcerative colitis for over 10 years by private doctors. He had a colonoscopy every year. All of these files and records were taken to the VA. They sent him a fecal test. When it showed he had a problem, his primary care person contacted him. He told her that all of his records pertaining to this condition were in the VA records. They were not. They did not have anything he had personally taken there and gave to the records person.

Here is a line from the letter he received from his primary care person who is a nurse. "You have declined colon cancer." YA THINK. I am certain it should have read, "You have declined testing for colon cancer." This is the caliber of person taking care of this veteran. No wonder there are so many problems there.

military 05/25/14 - 09:39 am
Augusta VA

as NOCNOC commented you will only hear from the VA what they want you to hear--the senior VA administrators have been allowed to run rough shot over their physicians for years with absolutely no accountability-even now after the House Committee on Veterans Affairs investigated them what have we heard-?? NOTHING-no one has stepped up and taken responsibility for how a backlog of over 5000 GI procedures could have happened-they are all apparently above the law and are still gainfully employed at the Augusta VA-this is truly a sad state of affairs for Augusta.

Junket103 05/25/14 - 11:18 am
Problem Won't Go Away

The only real solution to this problem is to close the VA health care system and start over. The VA is a bureaucracy that is out of control and completely unmanageable. It doesn't matter if you change the leadership at the highest level or even the local level. A bureaucracy does what it does best, protect the bureaucracy.

The best way to insure veterans receive good medical care is to have competition. The only way to have competition is to let the consumer chose. Close the VA health care institutions and use the savings to provide every veteran with a premuim health insurance benefit. That way if a veteran doesn't like his provider or hospital, he or she can go elsewhere. Pretty soon those providers that don't offer good customer service or high quality care will be out of business.

IBeDogGone 05/25/14 - 01:31 pm

We cannot continue to let our Veterans get poor healthcare and even die. It is time to do away with doctors who are specialist and let the Primary Care Provider refer these patients to outside specialist. If the program is run correctly I do not believe it will not cost anymore than the present system and will be much more effective.

edcushman 05/25/14 - 04:08 pm
"The only real solution to

"The only real solution to this problem is to close the VA health care system and start over. The VA is a bureaucracy that is out of control and completely unmanageable."
Well said, Obamacare is the next VA

slowrider 05/25/14 - 05:11 pm
great article, thankful for exoneration of a good man

I have worked with, and been taught by, Dr. Kostromin. He is a great guy, and an excellent doctor. It does not surprise me that he would stand up against wrongdoing, and grow vocal against administrators standing in the way of logical, important patient care.

I would love some follow up from Ms. Cox-Henly, at how these "sustained charges of such gravity" could have not been reconciled with the documentation mentioned in this article.

I hope Dr. Kostromin receives every penny of compensation from our government in hopes of atoning for this nightmare. I look forward to follow up on this case. He needs his name completely restored.

DoggieMom 05/25/14 - 05:23 pm
ACA & American Veterans

To fix this malignant VA System, we need to scrap it and start over.
All Veterans should receive Free ACA policies, no premium, co-pay, nor deductibles, regardless of income (if they served, they earned this right).
Then they may pursue care wherever they wish.
Fire ALL VA administration, and use the VA hospitals for any Smericans who wish to pursue care at these now open facilities. Make them follow the same rules as every other hospital in America (starting with proper licensing of all care providers).

As part of the ACA, all health insurance & hospitals must become non-profits. It is immoral & unethical for an insurance CEO or a hospital CEO to receive multi-million dollar bonuses for denying care to the the very patients that pay their salaries.

Finally, our government needs to look closely at countries with successful national health insurance, and figure out the actual cost per person. Then set the premiums accordingly. Our premiums should have dropped with the start of the ACA, not increased by 5x.

This is not a Republican or a Democratic issue, it's an American issue. If we want it to succeed, then it needs to work for 300 million Smericans, and all 85 million Veterans. Not just the 8 million that signed up on the broken web site! America needs to designate $$$$$ to making this work, and stop sending $$$$$$$$$$$$ to other countries until we have taken card of our own.
That's just a start on fixing the problem. If we don't want to make the necessary changes, then scrap the ACA, and at least stop penalizing those who have always paid for their health care premiums. At least give our Veterans more consideration, and respect their sacrifices to keep our country free.

DoggieMom 05/25/14 - 05:27 pm

Americans, sorry, my keyboard is acting up!!

GuyGene 05/25/14 - 06:53 pm
Thanks commenters..

As a service connected disabled Vietnam combat vet, I appreciate your concern for us veterans. I had surgery at the old Forest Hills VA way back right after returning from Nam. I had a good surgeon who went into private practice back then. BUT - I've had the run around by the VA ever since those days. Whew, a nightmare. I like my VA doctor (THANKS, Dr. Battu!!) but I can tell something is wrong with the system. But, your comments here, and this article do give me a bit of hope... We shall see. But, I've been saying "we shall see" for over 44 years.

KSL 05/25/14 - 08:34 pm
Scrap obamacare and start

Scrap obamacare and start over.

thauch12 05/25/14 - 10:58 pm

More crap journalism from the Chronicle. THIS IS NOT NEWS. There has been a backlog at the Augusta VA GI clinic...and we've known about this for months. To claim this "resulted in three cancer-related deaths in August 2012, records show" is absolutely UNPROVABLE and borderline slander.

The only thing this article added was the fact that there is a former VA doc out there who was accused of theft by the agency who now substantiates much of what we already know as part of (what seems like at least) a personal vendetta against an organization he believes has done him wrong.

Anyone who has been around long enough knows the VA is NOT the greatest healthcare facility. Thank God a majority of people with VA benefits are also eligible for Medicare and can go elsewhere for care if they take the initiative to do so. Give it a rest and stop trying to create a scandal where there isn't one...

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Augusta VA supervisor sentenced to prison
In what the judge called a "tragic case," a former Charlie Norwood VA Medical Center supervisor was sentenced Thursday to 27 months in federal prison for making false statements in medical files.