In October, the U.S. House of Representatives approved legislation to cut bonuses and performance awards for the Department of Veterans Affairs (VA). The measure went to the Senate in November and was the result of a scathing report from the Government Accountability Office about VA staff bonuses. Critics of the VA cite an enormous claims backlog and questions of quality of care.
Twenty-percent of Veterans' Affairs doctors and providers had been disciplined for everything from leaving surgery to misreading charts. But they still received a performance bonus.
A Professional Standards Board found that a radiologist failed to read mammograms and other complex images competently. The radiologist’s privileges were reduced. But that person got an $8,200 bonus anyway. A surgeon who was supervising residents left the operating room and medical center before the surgery was completed, allowing residents to continue the surgery without supervision. The surgeon was suspended without pay for 14 calendar days. But he received an $11,000 bonus anyway.
Parts One and Two of this series of reports highlighted how much was being spent and began focusing on specific V.A. hospitals. (see: http://www.examiner.com/article/phoenix-va-employees-received-big-bonuses)
“Your point on this subject is well taken,” said Jose Garcia, an officer in Catholic War Veterans. “I don't agree with the present system on bonus awards. As a retired VA employee the system for bonuses is not a fair system and does play favorites with some employees. I do believe that some persons are entitled to receive a bonus based on their work and accomplishment. Since some or most are not hourly employees and normally work a 40 hour week with no overtime, they either receive comp time for over time and not equal to the time worked, such as time and a half. In those case I can understand the bonus.”
This report will describe more of the troubling news from the GAO and focus on one of America’s largest V.A. hospitals, the Michael E. DeBakey medical center in Houston, TX. The GAO report said: VHA does not provide adequate oversight to ensure that its medical centers are in compliance and remain in compliance with performance pay and award requirements.
VA’s performance pay policy does not state a purpose for this pay, and has not reviewed the performance pay goals that have been established across VA medical centers and networks. Without stating a purpose for the pay and reviewing the goals, VA cannot determine the purposes these goals support, and the relationship between performance pay and providers’ performance is unclear, according to the GAO.
DeBakey may be rolling over in his grave over this. As you enter the DeBakey V.A. Medical Center you pass below two paintings of him... one from the 1940s when he was an Army officer inventing the mobile Army surgical hospital (MASH) system and one from more recent times when he and colleague Denton Cooley were pioneering artificial heart implants. Now those images of DeBakey are looking down on one of the most inept health care systems in America.
One physician refused to see assigned patients in the emergency room because the physician believed patients had not been triaged appropriately by the emergency department nurse. As a result, 15 patients waited more than 6 hours to be seen, and 9 patients left without being seen. The physician was reprimanded. But the physician received a $7,500 bonus anyway.
“I am at a loss to understand why the VA has a bonus program anyway which pays large amounts of cash. Police and firefighters don’t,” said Breck Porter, a Veteran, former member of a national veterans group and current editor of The Police News. “I am amazed every time I go to the Houston VA to see how many employees sit around with nothing to do but trying to act like they are busy. Disgusting.”
A VA policy states that supervisors are to discuss established goals with individual providers within 90 days of the beginning of the fiscal year, but it does not specify how medical centers are to demonstrate compliance with this requirement. Because the policy does not specify when the approving official should sign required forms, officials at four medical centers (randomly selected by the GAO) had not all interpreted and implemented the policy correctly, and the medical centers differed in how they documented approval when administering performance pay.
One physician could not be reached when he was required to be available, which delayed patient care. The physician engaged in inappropriate behavior that had a negative impact on the patient care environment. The physician “yelled” at other staff, and the outbursts were regularly witnessed by patients, contributing to an atmosphere of fear and poor morale in the emergency department. The physician was suspended for 3 days with pay and received a letter of alternative discipline. And he also received a $10, 500 bonus.
Bonus documents showed bonuses were paid before they were approved and that some forms were not signed by the approving officials at all. One physician practiced with an expired license for 3 months until the medical center discovered the situation. The physician was reprimanded, but received a $7,600 bonus.
Some VA medical center officials told the GAO that they did not consider the performance-related personnel actions when making performance pay determinations, while others told the GAO that they did but that they did not document it.
HOW DID THE STAFF IN HOUSTON DO?
In Houston, Texas, the government largess reads like hogs to the feed with staffers receiving more than $6 million in bonuses over the past twelve months. In this reporter’s Freedom of Information Act request, he gave the option of releasing names, but it was most important to publish bonuses paid to certain job classifications.
Mary Reid, the Privacy Officer at Michael E. DeBakey medical center mailed the names of 1,312 people receiving bonuses and another set of charts showing bonuses paid to an additional, unnamed, 1,700 staffers – listed by job description. Mary Reid was not on the list of staffers receiving bonuses, nor was her job classification.
The main breakdown for Houston:
SPECIAL CONTRIBUTION AWARDS $800,179.44
PERFORMANCE AWARD $1,944,950
PERFORMANCE PAY $3,562,959
Staffers at the Traumatic Brain Injury Center of Excellence at the Houston V.A. collected some nice bonuses in the past year. A supervisor of the TBI center who also supervises other research arms, Laura Petersen, received a $15,000 bonus and a second $5,000 “special contribution award,” but the acting director of the center, Harvey Levin, a world renowned leader in neurosciences, did not. Two of Levin’s nueroradiologists, who also teach at the Baylor College of Medicine in Houston, Shalini Mukhi and Rajan Agarwal, received $9,000 and $12,000 respectively. A behavioral assessment physician, Dr. David P. Graham, who also teaches at Baylor received $8,288 in bonus money for work in the TBI center. Helene Henson, an “investigative physician” who also teaches at Baylor and works for the TBI center received $11, 250.
More than 420 physicians received bonuses at MEDVAMC with the largest amount being $15,000 and the smallest being around $3,500.
The Director of the Houston V.A. Medical Center, Adam Walmus, received a performance award of $14,160. Frances Burke, who at one time was the editor of the hospital e-newsletter, but was listed in the “administrative personnel category,” received a $3,000 bonus. A human resource department staffer, Clifton Jackson, received a bonus of $450. His boss, Human Resources Manager Mark Muhammad, received a performance award but Reid would not disclose how much.
Four hundred named registered nurses received bonuses with Thelma Gray-Becknell topping the list with two $5,000 special contribution awards.
Two hundred unnamed nurses received performance awards as high as $2,800 and many of these bonuses exceeded other job classifications such as radiology technicians and nurse anesthetists. “Unnamed personnel” in the chart provided by the VA have their privacy protected, others don’t. Dozens of unnamed clerks received as much as $2,250 while other job descriptions such as one pathologist received only $750.
Martha Barragan who runs the Transit Benefits Office (free bus and train passes for VA employees) received two awards totaling $1,500.
Fern Taylor, who manages a portion of the clinic for our returning troops from the Middle East Wars, received $750.
Eighty clerks received bonuses ranging from $750-2,000.
Other job categories and their Average Bonus:
Dental assistants/hygienists $1,275
Licensed Practical Nurses $1,000
Licensed Vocational Nurses $1,000
Registered Nurses $1,000
Nurse’s aides $1,000
Pathologists and technologists $1,300
Occupational Therapists $1,275
Physical Therapists $1,000
Radiology Technicians $1,275
Respiratory Therapists $1,000
Social Workers $1,100
Houston V.A. physicians and surgeons, whether full or part-time, received bonuses ranging from $7,500-15,000. One-hundred-and-sixty wage rate employees, such as housekeeping and engineers, received bonuses ranging from $750-2,025.
The entire staff of dieticians received bonuses ranging from $750-2,800. GEHA, one of the federal employees’ largest health insurers, reports on its homepage that 65-percent of the people it surveyed were overweight or obese. Among male veterans 73.0% were at least overweight, 32.9% were obese; female vets were 68% overweight and 37% obese according to the American Journal of Preventive Medicine. Only 27.8% of veterans who receive health care at the VA are of normal weight, according to the Journal of General Internal Medicine. Less than 5% of eligible veterans participated in the VA’s Weight Management Program (managed by some VA dieticians) according to the Centers for Disease Control.
The GAO report concluded that without a performance pay policy that clearly specifies how to document decisions or compliance with requirements, VHA does not have reasonable assurance that documentation includes all necessary information, a condition that is inconsistent with federal standards for internal control activities. In response to the GAO report, the VA’s Deputy Under Secretary for Health for Operations has established a task force to look into the criticisms. If the House bill passes the Senate, it will only reduce bonus payouts by 13-percent to a total of $345 million per year.
In part four, we will hear from the Veterans of Foreign Wars.