VA CON­CEALS SHODDY CARE, STAFF MIS­DEEDS

Lax re­port­ing, se­cret set­tle­ments al­low prob­lem health care work­ers to keep treat­ing pa­tients else­where

USA TODAY International Edition - - FRONT PAGE - Donovan Slack and Michael Sallah

Be­hind the walls of the na­tion’s old­est vet­er­ans’ hospi­tal, the re­ports were grim.

Med­i­cal ex­perts from the De­part­ment of Vet­er­ans Af­fairs blamed one botched surgery after an­other on a lone po­di­a­trist.

They said Thomas Fran­chini drilled the wrong screw into the bone of one vet­eran. He sev­ered a crit­i­cal ten­don in an­other. He cut into pa­tients who didn’t need surg­eries at all. Twice, he failed to prop­erly fuse the an­kle of a woman, who chose to have her leg am­pu­tated rather than en­dure the pain.

In 88 cases, the VA con­cluded, Fran­chini made mis­takes that harmed vet­er­ans at the To­gus hospi­tal in Maine. The find­ings reached the high­est lev­els of the agency.

“We found that he was a dan­ger­ous sur­geon,” former hospi­tal surgery chief Robert Samp­son said dur­ing a de­po­si­tion in a fed­eral law­suit against the VA.

Agency of­fi­cials didn’t fire Fran­chini or re­port him to a na­tional data­base that tracks prob­lem doc­tors. They let him qui­etly re­sign and move on to pri­vate prac­tice, then failed for years to dis­close his past to his pa­tients and state reg­u­la­tors who li­censed him.

He works as a po­di­a­trist in

New York City.

A USA TO­DAY in­ves­ti­ga­tion found the VA — the na­tion’s largest em­ployer of health care work­ers — has for years con­cealed mis­takes and mis­deeds by staff mem­bers en­trusted with the care of vet­er­ans.

In some cases, agency man­agers do not re­port trou­bled practitioners to the Na­tional Prac­ti­tioner Data Bank, mak­ing it eas­ier for them to keep work­ing with pa­tients else­where. The agency failed to en­sure VA hos­pi­tals re­ported dis­ci­plined providers to state li­cens­ing boards.

In other cases, vet­er­ans’ hos­pi­tals signed se­cret set­tle­ment deals with dozens of doc­tors, nurses and health care work­ers that in­cluded prom­ises to con­ceal se­ri­ous mis­takes — from break-

downs in su­per­vi­sion to dan­ger­ous med­i­cal er­rors — even after forc­ing them out of the VA.

USA TO­DAY re­viewed hun­dreds of con­fi­den­tial VA records, in­clud­ing about 230 se­cret set­tle­ment deals never be­fore seen by the public. The records from 2014 and 2015 of­fer a nar­row win­dow into a se­cre­tive, long-stand­ing govern­ment prac­tice that al­lows the VA to cut short em­ploy­ees’ chal­lenges to dis­ci­pline.

In at least 126 cases, the VA ini­tially found the work­ers’ mis­takes or mis­deeds were so se­ri­ous that they should be fired. In nearly three-quar­ters of those set­tle­ments, the VA agreed to purge neg­a­tive records from per­son­nel files or give neu­tral ref­er­ences to prospec­tive em­ploy­ers.

Michael Carome, direc­tor of health re­search at Public Cit­i­zen, said re­mov­ing records from per­son­nel files and pro­vid­ing neu­tral ref­er­ences cre­ate po­ten­tial dan­ger be­yond the VA. “What they are say­ing is, ‘We don’t want you to work for us, but we’ll help you get a job else­where.’ That’s out­ra­geous,” he said.

The VA set­tled with a nurse who man­agers ini­tially found had left a psy­chi­atric pa­tient bound in leather re­straints for hours; a med­i­cal tech­ni­cian who made er­rors on crit­i­cal bone imag­ing charts; and a hospi­tal direc­tor ac­cused of ha­rass­ing fe­male work­ers while his fa­cil­ity fell weeks be­hind in treat­ing vet­er­ans.

The VA has been un­der fire in re­cent years for se­ri­ous prob­lems, in­clud­ing rev­e­la­tions of de­lays in treat­ing vet­er­ans in 2014 and efforts to cover up short­falls by fal­si­fy­ing records.

New VA lead­ers promised ac­count­abil­ity, in­clud­ing in­creased trans­parency and a crack­down on bad em­ploy­ees.

In the years since, the VA has fired hun­dreds of em­ploy­ees who treat pa­tients. De­tails of each case — in­clud­ing the names of fired doc­tors — largely re­main se­cret.

In deny­ing re­quests for in­for­ma­tion, the agency cited fed­eral pri­vacy law and said pro­tect­ing em­ploy­ees’ pri­vacy out­weighed the public’s right to know about prob­lems with vet­er­ans’ care.

Agency lead­ers who took over after Pres­i­dent Trump’s in­au­gu­ra­tion de­clined to dis­cuss how their pre­de­ces­sors han­dled cases un­cov­ered by USA TO­DAY.

In re­sponse to USA TO­DAY’s find­ings, VA Sec­re­tary David Shulkin or­dered that all fu­ture set­tle­ment deals in­volv­ing pay­ments of more than $5,000 be ap­proved by top VA of­fi­cials in Washington. De­ci­sions had been left to lo­cal and re­gional of­fi­cials. The set­tle­ments USA TO­DAY re­viewed in­volved work­ers at more than 100 fa­cil­i­ties in 42 states.

The VA said it will re­view its pol­icy of re­port­ing only some med­i­cal pro­fes­sion­als to the na­tional data bank after USA TO­DAY’s ques­tions about its in­ves­ti­ga­tion of Fran­chini, who did not get a set­tle­ment.

April Wood lives with a per­ma­nent re­minder of Fran­chini’s surg­eries. Dur­ing Army boot camp in 2004, she sliced her hands on a rope in a train­ing ex­er­cise and fell 20 feet into a cargo net.

Her an­kle did not heal prop­erly, leav­ing her no choice but to ac­cept a dis­charge months later. She moved to Maine and sought care for her foot at the VA.

After two Fran­chini surg­eries failed to end her pain, Wood was spend­ing much of her life in a wheel­chair, un­able to work. By 2012, she said her path seemed clear. “I had to be­lieve that some­thing else was bet­ter than that amount of pain,” she said.

On Aug. 28, doc­tors am­pu­tated Wood’s leg. Months later, the VA called. She learned Fran­chini re­signed un­der in­ves­ti­ga­tion. The VA would de­ter­mine both of her surg­eries were flawed. Wood, who lives in Mis­souri, sued the VA.

Fran­chini told USA TO­DAY he did not make med­i­cal mis­takes. When the VA placed Fran­chini on leave after find­ing prob­lems with a sam­ple of his cases in 2010, his at­tor­ney sub­mit­ted two out­side re­views say­ing the VA’s find­ings were not backed up by med­i­cal records. Fran­chini re­signed from the VA while un­der in­ves­ti­ga­tion.

NATHAN PAPES, USA TO­DAY NET­WORK

April Wood chose to have her left leg am­pu­tated after two surg­eries at a VA hospi­tal in Maine left her in ex­cru­ci­at­ing pain.

NATHAN PAPES, USA TO­DAY NET­WORK

April Wood was dis­charged from the Army be­cause of an an­kle in­jury. After two surg­eries that the VA later de­ter­mined were flawed, Wood’s pain got so bad, she let doc­tors am­pu­tate her leg be­low the knee.

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