The acting secretary of the Department of Veterans Affairs said Thursday that the main reason for scheduling problems at the Charlie Norwood VA Medical Center is a shortage of clinicians, adding that too few nurses and doctors has created more work, stress and higher turnover at the Augusta hospital.
“It should not take so darn long to hire someone,” Sloan Gibson said during a visit to the hospital, part of a nationwide tour of VA facilities he is taking to speak with veterans and employees about obstacles to providing timely, quality care. “We need to make sure we’re talking to staff more frequently and understanding their needs. The employees here truly care.”
Gibson said he had a standing-room-only meeting with hospital staff and that the top complaint was that leadership was not engaged enough with rank-and-file personnel to improve operations.
Because of longstanding nursing and physician vacancies at the medical center, Gibson said, employees have had to take on extra responsibilities, which is causing many to leave for better jobs.
“In the business world, you cannot operate like that,” he said.
The hospital’s nursing service has 782 full-time positions, 151 of which are vacant, said Clare O’Geary, the deputy nurse executive.
Augusta VA spokesman Pete Scovill said 27 of the hospital’s 157 full-time physician positions are vacant, including chief of staff and surgery, according to job postings.
Through the help of Georgia Regents University, which the Augusta VA works with as a teaching hospital, Director Bob Hamilton said, the medical center has identified a strong candidate and should have a new chief of staff by next month.
Gibson said hospital leadership is increasing recruiting efforts and accelerating hiring in dermatology and neurology specialties, where constraints have been identified.
He said the success of the hiring efforts will be reflected in an ongoing audit of VA wait times.
Gibson said that as of July 2, Augusta officials have reached more than 400 veterans and reduced the number of those waiting at least 90 days for an appointment from 26 patients to two. The number of new enrollees who have not had an appointment in the past decade despite requesting one has decreased from 133 to 45.
In achieving the hospital’s top priority of getting veterans off waiting lists and into clinics for medical appointments, Gibson outlined a list of measures that are being taken. They include:
• Increasing overtime and adding evening and weekend hours to see patients. Gibson said additional capability has been identified in the optometry clinic and that a Saturday clinic will be opened this month, creating
room for 12 more appointments each session.
• Coordinating with the community to increase available services in certain specialties such as ear, nose and throat; ophthalmology; dermatology; and neurology.
• Ensuring that $250,880 from the VA’s budget is awarded to Augusta to accelerate access to care.
• Increasing the use of established contracts with community partners and adjusting primary care physician workloads to better schedule veterans waiting to be seen by a doctor.
Gibson said that after eliminating electronic wait lists, the VA plans to turn its focus to systemic issues and address instances of willful misconduct by holding the guilty accountable.
Most notably in Augusta, he mentioned the 4,500 delayed gastrointestinal consultations and the three cancer-related deaths in 2011. He also showed concern about the four open retaliation cases the Office of Special Counsel is investigating in Georgia, one of which might include former primary care physician Raymond Kostromin, who has filed a formal complaint alleging that he was targeted for removal for speaking up about delays in
gastrointestinal referrals at the Augusta VA.
“That’s absolutely unacceptable,” Gibson said of the hospital’s botched gastrointestinal clinic. “That is not consistent with the standards of care, not here or anyplace in the VA.”
Gibson said he can’t take any personnel actions until the VA’s Office of the Inspector General has completed its review. However, he said he has not been to a location that is working more aggressively than the leadership in Augusta to resolve its problems.
He said the hospital has placed a daily focus on identifying gastrointestinal patients and scheduling them for screening endoscopies.
“Working through these processes is one of the ways we earn back trust,” he said. “The other way is through more robust communication and transparency.”