Veterans Affairs Secretary David Shulkin said in a radio interview on Friday that he has a number of New Year's resolutions to improve the huge agency he operates. Shulkin, a holdover from the Obama administration, told radio host Tom Temin that the VA is seeking to improve interoperability with other relevant agencies, such as the Department of Defense, in order to improve patient outcomes. The interview came after Shulkin has been blasted for the VA's practice of hiring medical providers whose licenses have been revoked in the past.
Besides integrating medical records and networks with other departments, Shulkin wants to coordinate research and efforts with the National Institutes of Health and the Public Health Service. One issue of concern, said Shulkin, is that finding and hiring qualified medical practitioners for VA hospitals has become more difficult, especially in regions where there are no large medical schools. Shulkin wants to Congress to help in creating more medical graduation locations and a service-based repayment program for medical school loans. He is also seeking to improve efficiency by possibly reducing of some of the VA’s inventory of little-used and ageing facilities.
Shulkin said that Congress has given additional authority to the VA, for example, to hasten the firing of poorly-performing employees. He told Temin, “I do believe that being able to remove people from the workforce who have not been constructive is going to result in those employees that remain feeling better about their jobs and improving their morale.”
Shulkin has been in hot water for the last month due to revelations about poor-performing medical practitioners that have incensed members of Congress, veterans, and the public. An investigation by USA Today revealed that the VA had allowed its hospitals nationwide to hire physicians and medical practitioners whose medical licenses were revoked. The practice continued for for 15 years in contravention of federal law. According to guidance issued by the VA in 2002, local hospitals were given discretion to hire clinicians after “prior consideration of all relevant facts surrounding” any revocations and if they still retained a license in one state.
However, federal law dating from 1999 prohibits VA from employing any health care worker whose license has been rescinded by any state.
According to USA today, VA officials in Iowa City hired Dr. John Henry Schneider, despite the fact that he listed on his application form numerous malpractice claims and settlements. While he still had a license in Montana, Wyoming had revoked his license after one of his patients died. When the VA was asked about Schneider, it moved to fire him in November 2017. He ultimately resigned. The agency claimed that VA hospital officials relied on “incorrect guidance” when hiring Schneider in April 2017. The VA has admitted this week that this was national policy.
Malpractice claims against Schneider included cases allegations that he left patients maimed, paralyzed or dead. A 65-year-old patient died from an infection in 2017 after four brain surgeries performed by Schneider in a span of four weeks. Schneider denies that he provided substandard care, blaming other providers or circumstances.
VA Secretary David Shulkin has since ordered the rewriting of the guidelines and is seeking to remove any other health care workers with revoked licenses. VA health care providers who have prior sanctions short of revocation will be reviewed.
Other VA hospitals fell into the practice of hiring health care providers with past license issues. discipline. In Oklahoma, a VA hospital hired a psychiatrist who had been disciplined for sexual misconduct who then went on to have sexual relations with a patient. In Wisconsin, the VA hired a psychiatrist previously disciplined for medication violations who then over-prescribed narcotics to VA patients. In another case, the Louisiana VA hired a psychologist despite having a record of felonies.
Members of Congress of both parties have demanded answers from the VA. For example, 14 senators from both parties wrote to Shulkin earlier this month asking about the hiring and oversight of health care workers with known histories of malpractice and license discipline. That followed missives from Montana Democratic Sen. Jon Tester and Iowa Republican Sens. Joni Ernst and Chuck Grassley, who said it was "unacceptable that it was only as a result of USA TODAY’s report that the VA determined that hiring this neurosurgeon was illegal.”
In December, members of the House of Representatives of both parties wrote letters to VA Secretary Shulkin that expressed “extreme concern.” They wrote in a joint letter, “The hiring of doctors who have had their medical licenses revoked in any state is already prohibited," and added, "However, it appears the laws and regulations establishing that prohibition are not being followed by VA.”
Rep. Mike Coffman (R-Colo.) called for Shulkin to identify VA health care workers with malpractice complaints and settlements or sanctions for poor performance. Coffman said he is afraid that the VA is a “dumping ground” for poorly-performing providers who are unable to find employment or malpractice insurance in the private sector. Medical workers employed by the VA do not have to carry malpractice insurance. Taxpayers pick up the tab.
Reform at the VA is hampered, said Shulkin, who said the agency has 66,000 regulations. He wants to reduce them by 80 percent. Guidelines regarding VA hiring practices fill 1,267 pages with additions and addendums added since 2002. On page 239 of the VA hiring guidelines, VA hospitals are granted permission to engage health care workers with revoked licenses, despite the 1999 law prohibiting it.