Donovan Slack

USA TODAY

WASHINGTON — Although Veterans Affairs Secretary Bob McDonald has asserted that more than “90%” of the VA’s medical centers have “new leadership” or “leadership teams” since he took over the troubled agency in 2014, a USA TODAY investigation found the VA has hired just eight medical center directors from outside the agency during that time.

The rest of the “new leadership” McDonald cites is the result of moving existing managers between jobs and medical centers. Some managers were transferred to new jobs despite concerns about the care provided to veterans at the facilities they were previously managing.

USA TODAY determined that of 140 medical center directors, 92 are new since McDonald took office in July 2014. That's 66%. Of those, only 69 are permanent placements; the rest are interim appointees. And all but eight of these directors already worked at the VA.

VA officials said McDonald cited an erroneous statistic and the actual percentage of new medical center leaders is 84%. That figure includes new chiefs of staff, associate directors and other top executives, even where center directors remained the same. The agency considers a center as having new leadership if one member of its top management team has transferred from another center or job.

“I said very carefully, and I’ve always said ‘leadership or leadership teams’ — both are important,” McDonald said in an interview. “In some cases, you’ve got directors who are doing a great job, but they’ve got a chief of staff who’s not and you’ve got to change that person.”

McDonald said the number itself is “almost irrelevant” and what’s important is that he and other VA leaders are “trying to attract top talent, to get them in the right seats on the bus, in order to make outcome changes for veterans.”

VA Undersecretary for Health David Shulkin said salary constraints, a lengthy hiring process and other factors have limited the agency’s ability to attract non-VA applicants.

“We tend to use lots of numbers and that can be confusing, and what I’m trying to do is simplify the message, so here’s my message: I need help,” Shulkin said. “I need the right leaders to come in and to take these positions of responsibility on behalf of the country, and I don’t care if it’s 90%, 80%, or 60%. I know I have openings and I don’t have the applicants.”

USA TODAY scoured hundreds of documents, news accounts and web archives to build a database tracking VA personnel moves since the wait-time scandal broke in 2014, starting with a Phoenix VA facility where 40 veterans had died awaiting care. That case revealed widespread mismanagement of VA facilities and led to McDonald’s appointment with a mandate to fix veterans' care.

President Obama has echoed McDonald's pride in the VA's transformation, saying on a recent CNN forum that “we have, in fact, fired a whole bunch of people who are in charge of these facilities.” In fact, the VA only moved to fire seven medical center directors. One of them quit and another retired first.​

Of the 69 permanent directors installed since McDonald took over, 49 transferred from a different VA medical center, while 12 came from different jobs within the same hospital. The moves included promotions, for instance from associate director to director of a medical center.

In 22 cases, the VA moved directors from one center to another, sometimes to more complex hospitals, but at other times, to less complex facilities. In Ohio, directors in Chillicothe and Columbus simply switched places.

Some of the directors came from facilities where they faced issues ranging from low-ranking quality of care to wait-time falsification to mismanagement identified by outside investigators.

Among them:

• Kathleen Fogarty cut veterans’ access to outside care to help overcome a multimillion-dollar deficit as director of the Tampa, Fla., VA, in 2011 and repeatedly denied publicly that she was doing it, according to the Tampa Bay Times. In March 2015, the VA transferred her to the director’s post at the Kansas City, Mo., VA.

• Joe Battle, who had been the director of the Jackson, Miss, VA, replaced Fogarty in Tampa. The Office of Special Counsel, which investigates whistle-blower claims, concluded in 2013 that Battle had downplayed serious problems with veteran care in Jackson, “calling into question the facility’s commitment to implementing serious reforms.” During his tenure in Jackson, doctors prescribed narcotics to patients they hadn’t seen, schedulers slotted veterans into “ghost clinics” that didn’t exist, and the American Legion, two years after he took over, said it was “appalled” by conditions at the facility.

• Robert Walton went from director of the Harlingen, Texas, VA, to director of the San Antonio VA in November last year. During his tenure in Harlingen, the facility ranked among the lowest in the country in quality and efficiency by the VA’s own metrics and investigators found schedulers had routinely falsified veteran wait times under pressure from supervisors.

• Deborah Amdur went from director in White River Junction, Vt., to director of the troubled Phoenix VA last December. In Vermont, the VA's Office of Inspector General found routine scheduling manipulation directed by supervisors and a doctor told investigators that management pressure to increase productivity led to missed cancer diagnoses. Amdur retired in August citing “personal health reasons.” Several weeks later, the inspector general released the results of another investigation at the Phoenix VA that found more scheduling improprieties.

• RimaAnn Nelson, who was director of a VA benefits and outpatient clinic in the Philippines, took over for Amdur in Phoenix. She previously had been director of the St. Louis VA when 1,800 veterans were potentially exposed to HIV and hepatitis because of poor sterilization. A follow-up investigation during her tenure found some of the problems hadn’t been adequately addressed.

VA officials declined to comment on many of the transfers, citing privacy laws, but said that in general, they were consistent with federal guidelines. They said the vast majority of the moves were promotions. In at least one case, a director requested a transfer for personal reasons and the VA approved it.

"You can't have a robust human resource system unless you are providing opportunities for progression," McDonald said. "I'm sure the process we follow for promotion or for transfer to a larger facility is the government-regulated process, which is a fair process dictated by Congress and I'm sure the people who moved to new facilities were, you know, deserved that movement."

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Shulkin said the Phoenix crisis and ensuing media scrutiny triggered an exodus of leaders at the VA, and the agency hasn’t been able to attract enough applicants to fill those slots. He said VA officials have filled as many as they could with a mix of inside and outside candidates. Shulkin said there are still more than two dozen directors’ jobs open.

They are being filled right now by acting or interim directors, who have cycled through posts frequently at times, destabilizing leadership at some facilities. St. Louis had eight temporary directors between 2013 and this month, when the VA promoted an associate director to fill the role. Los Angeles had four; Oklahoma City and Phoenix had five.

Shulkin said one of the issues is salary: Pay for VA medical center directors without specialized medical degrees is capped at $185,100, but in the private sector, the average pay for overseeing a medical center was $349,000, according to 2015 statistics cited by the VA. The agency has asked Congress to increase the pay cap, but that effort has stalled on Capitol Hill.

Shulkin said another problem is the federal hiring process, which can take seven months on average for a medical center director and is “heavily weighted” toward applicants with federal government experience. He said he has been working to change that and said three non-VA candidates are currently in the pipeline to take jobs as medical center directors.

“Is it fast enough? No,” he said. “Are there enough people responding to my call for assistance? No. But you know I hope somebody reading this might have a reaction that says ‘You know what? Maybe I will, maybe I’ll consider sending in my CV, this would be a way to give back.'”

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At the Phoenix VA, Shulkin approved Nelson's transfer there because he said she took immediate action to fix problems at her prior posting in St. Louis and he feels comfortable with her leadership skills.

“In my assessment she was an effective leader and the type of leader I need in my toughest place in the country right now, which is Phoenix,” he said.

In Tampa, Battle said in a statement that investigators thoroughly reviewed problems at his previous facility in Mississippi. “We addressed any recommendations for improvement and took actions as appropriate,” he said, adding that under his leadership, Jackson passed all accreditation reviews on quality of care.

In San Antonio, VA spokeswoman Nenette Madla said the Inspector General and the VA Office of Accountability Review cleared Walton of wrongdoing at his previous post in Harlingen. She did not address quality of care.

Kansas City VA officials did not respond to multiple messages seeking comment on Fogarty’s record. Fogarty told The Arizona Republic in 2014 that she balanced the budget at her previous post in Tampa by reducing the amount of time veterans spent in non-VA hospitals. She also said she has a record of fixing troubled VA facilities during her more than 30 years with the agency.

Amdur could not be reached. She has retired from the VA, and a home number listed for in public records is disconnected. Amdur told The Arizona Republic earlier this year that she was the one who asked the inspector general to investigate wait time manipulation during her tenure in Vermont. “As information from the investigation was revealed, we made changes immediately," she said.

Whatever the case, Phoenix VA whistle-blower Brandon Coleman told USA TODAY that it looks like “bad apples, instead of being fired, are put into other facilities. “And then the VA acts like the problem’s solved," he said. "‘Nothing else to see here, please move on.’”

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