Department of Veterans Affairs: Alleged Improper Personnel Practices at the Ambulatory Care Center in Las Vegas, Nevada

Published by the Government Accountability Office on 1999-03-19.

Below is a raw (and likely hideous) rendition of the original report. (PDF)

      United States

GAO   General Accounting Office
      Washington, D.C. 20548

      Office of Special Investigations


      March 19, 1999

      The Honorable Harry Reid
      United States Senate

      Subject: Denartment of Veterans Affairs: Alleged Imuroner Personnel Practices at the
               Ambulatorv Care Center in Las Vegas. Nevada

      Dear Senator Reid:

      This letter responds to your December I, 1998, request that we investigate alleged improper
      personnel practices by the Department of Veterans Affairs (VA) at the Addeliar D. Guy HI VA
      Ambulatory Care Center in Las Vegas, Nevada. Specifically, your office received information
      from several Las Vegas veterans organizations alleging that the ambulatory center’s Chief of
      Staff, Dr. Anthony Salem, maintains a “hit list” for the purpose of disciplining or terminating
      ambulatory center employees who are known to be strong advocates of health care for

      In summary, we found insufficient evidence to substantiate the allegation of a hit list.
      However, a number of the individuals we interviewed during the course of our investigation
      raised concerns about the quality of health care at the center, which we describe in this letter.
      These concerns have been referred to the VA Office of Inspector General.


      The Addeliar D. Guy III VA Ambulatory Care Center opened in August 1997 as a state-of-the
      art facility that includes a nuclear radiology capability, an ambulatory surgery suite, and a
      women’s center. It is one of five components of the Las Vegas VA Medical Center, which
      serves nearly 200,000 veterans. The other components are the Michael O’Callaghan Federal
      Hospital, which provides intensive, medical-surgical, and psychiatric care; a day treatment
      center; an outreach center; and a readjustment counseling service.

      Insufficient   Evidence   of a Wit   List”

      Representatives of several veterans organizations alleged in a November 1998 letter to your
      office that nine employees of the Addeliar D. Guy III VA Ambulatory Care Center had been

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                                              GAO/OSI-99-5R Alleged Improper Personnel Practices by VA Official

threatened with termination or discipline by the ambulatory center’s Chief of Staff for being
strong advocates of veterans.

Six employees named in the letter told us that the Chief of Staff had not threatened them with
disciplinary action or job removal. Indeed, three of these employees were unaware that they
had been named in the letter as targets of the Chief of Staff. Furthermore, the Chief of Staff
had high praise for the performance of several of these employees.

The remaining three employees told us that the Chief of Staff had threatened them with
dismissal or reassignment based on poor performance; but they asserted that the real reason
for the Chief of Staffs actions was their outspoken support of health care for veterans. The
Chief of Staff told us that he had removed one of these employees as the acting Chief of
Radiology and reassigned her to a staff radiologist position because of ineffective
management. He confirmed that he had threatened to fire another doctor because he had
received numerous patient complaints concerning the employee’s job performance. He also
confirmed that he had put a third employee on notice that if his performance did not improve,
he would take the necessary steps to remove him. This employee told us that the Chief of
Staff had assigned him additional duties, which he refused to do. He stated that he had filed
an Equal Employment Opportunity complaint against the Chief of Staff for harassment, which
was resolved through the Alternative Dispute Resolution process. The ambulatory center
Director told us he supported the Chief of St&fs decision to make changes in the radiology
department and confirmed that his office had received many complaints about the second
employee discussed above. The ambulatory center Director did not express a view about the
third employee.

Although none of the persons we interviewed could provide sufficient support for the
allegation that the Chief of Staff had a hit list, many of the people we interviewed believed
that such a list exists. The Chief of Staffs management style, described by center employees
as confrontational, and low employee morale contributed to this opinion. In addition, the
Chief of Staffs criticism of several center employees for sending e-mail messages that
complained about the lack of proper health care for veterans or advised patients to contact
their congressional representatives helped to foster this view. Although the Chief of Staff
denied the existence of a hit list, he stated that he understood how his statements and
management style could have contributed to the belief that such a list exists.

Health    Care Issues Raised During the Investigation

During the course of our investigation, ambulatory center employees and representatives of
veterans organizations raised concerns about the quality of care administered at the
ambulatory center and other components of the Las Vegas VA Medical Center. Among other
things, they noted the following:

 l   lack of specialty care in such areas as cardiology and urology,
 l   lack of MRI (magnetic resonance imaging) or mammogram service at the ambulatory

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B-282 124

l    nonuse of an electroencephalograph machine in the neurology department,
0    excessive waits by patients having medical appointments,
l    failure to fix airflow in surgical suites,
l    difficulty in recruiting doctors and nurses, and
l    excessive reimbursement to the U.S. Air Force for services performed by the Michael
     O’Callaghan Federal Hospital.
We did not independently investigate any of the health care concerns raised during our
investigation. However, ambulatory center management acknowledged their existence and
agreed to take actions regarding them. The ambulatory center Director told us that, among
other things, he would review specialty care, reimbursement, and other arrangements
between the Las Vegas VA ambulatory center and the Michael 0’Callagha.n Federal Hospital.
He stated that VA expects to correct the airflow problem in the ambulatory center’s surgical
suites by July 1999. The Director also stated that to improve dissemination of information
and reduce “rumors” about a hit list, he would work with veterans organizations and hold
town hall-type meetings with ambulatory center staff. The Chief of Staff outlined his goals,
including expanded specialty care sessions, improved overall clinic operation, and increased
resident .doctor training.

Scope and Methodology

We conducted our investigation from December 1998 to February 1999 at the Addeliar D. Guy
III VA Ambulatory Care Center in Las Vegas. During our visits to the ambulatory center, we
interviewed the nine employees identified in your December 1,1998, letter; the ambulatory
center’s Chief of Staff; other center managers; cognizant medical staff; and several members
of advocacy groups for veterans.

We will provide copies of this letter to the Department of Veterans Affairs and will make
copies available to others upon request. If you have any questions or need additional
information, please contact Assistant Director Stephen Iannucci at (202) 512-6722.

Sincerely yours,

Robert H. Hast
Acting Assistant Comptroller
 General for Special Investigations


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