Doctor says Augusta VA ignored gastrointestinal complaints

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

 

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.

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.”

VA theft charge against doctor dismissed
VA doctor indicted in theft
TOPIC PAGE: Augusta VA Medical Centers

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