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NURSES AND VETERANS GIVE DAYTON VA LOW MARKS --
Critics say the center is understaffed,
patients complain
about care, long waits at the pharmacy.
Dayton, Ohio VA facility.
Story here...
http://www.daytondailynews.
com/n/content/oh/story/news/local/2
007/08/25/ddn082607vainside.html
Story below:
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Nurses, patients rank Dayton VA medical center
low
Critics say the center is understaffed;
patients complain about care, long waits at the pharmacy.
By Jim DeBrosse
Staff Writer
DAYTON — — When her late husband, Bill, was hospitalized at the Dayton
Veterans Affairs Medical Center for pneumonia in April of last year,
Connie Mullins said she found him one night half in, half out of bed,
his clothing and bed linens soiled.
Mullins said she spent 30 minutes cleaning up her 66-year-old husband
and assisting his roommate without a floor nurse on hand. She said she
eventually found a nurse, smoking in the break area.
"I know there are doctors and nurses at the VA who do care, and they try
to make a difference," said Mullins, whose husband died of congestive
heart failure about a month after the incident. "But they just don't
have enough of them."
Officials at the Dayton VA insist they have more nursing staff available
than they've had for years — a total of 498 positions, compared to 479
last year and 454 in 2003.
Regardless of their numbers, there is "a level of unhappiness" among
nurses at the Dayton VA "about the way they're being treated and being
worked and how they're being paid," said Brett Anderson of the Ohio
Nurses Association, the union that represents VA staff nurses. "And if
nurses aren't satisfied, that goes right to patient care."
A 2006 VA survey found that the Dayton VA Medical Center ranks last
among six VA facilities in Ohio for job satisfaction among employees.
And on a national VA survey of patient satisfaction, Dayton ranked near
or below the bottom fifth — 117th out of 146 facilities in inpatient
care and 137th in outpatient care.
Guy Richardson, director of the Dayton VA Medical Center for the past
two years, said the facility has set goals and formed improvement teams
that have raised survey scores so far this year. Inpatient satisfaction
rose from a score of 73.1 in 2006 to 74.0 in 2007, and outpatient scores
grew from 70.9 to 79.0, officials said.
The Dayton VA held a meeting for its 1,500 staff members in 2006 to
discuss the poor results on the employee satisfaction survey. Out of
that meeting, employees were invited to join "action teams" to address
concerns about promotional opportunities, conflict resolution and senior
management. Employees have been encouraged "to be a part of the
solution, don't just rely on others to solve the problems," Richardson
said.
Anderson said that Dayton VA nurses have major grievances against
management. Since the ONA took over union representation for VA nurses a
year ago, "there have been a ton of unfair labor practices filed at the
Dayton VA," he said. Active union membership among nurses has grown in
the past year from 36 to more than 120, he said.
Nurse pay scales have been a hot issue at the Dayton VA as well,
Anderson said. Salaries in Dayton are the lowest among the six VA
facilities in Ohio, including Chillicothe, he said. A nurse with 10
years experience at the mid-level pay grade earns $72,411 a year in
Dayton, but would make $84,755 in Chillicothe, or 15 percent more.
Anderson said the union plans to negotiate with the Dayton VA, "and
hopefully work out some of those (salary) differences."
But Richardson said nurses' salaries are not negotiable. Instead, they
are based on national scales and adjusted locally to reflect surveys of
nursing salaries at competing facilities in the area, he said. The last
adjustment was in May, he said.
Management problems at the Dayton VA have long been exacerbated by race
relations, employees say. According to the VA's regional Equal
Employment Opportunity office in Cleveland, 75 EEO complaints were filed
by Dayton VA employees over the past five years. That's more than twice
as many as the Cincinnati VA (36) and just four fewer than Cleveland
(79), which has roughly 1,000 more employees.
"Cincinnati is an area that has had a lot of racial unrest, and yet
Dayton is beating them out," Anderson said. "We have a lot of work cut
out for us."
Richardson said the Dayton VA has greatly reduced the number of EEO
complaints by encouraging mediation of disputes within the hospital. So
far this year, only two EEO complaints have been filed from the Dayton
VA. Last year, the number was 21.
Denver Combs, head of the Montgomery County Veterans Services Commission
for 20 years and now owner of a veterans benefits consulting service,
said he feels conditions at the Dayton VA "are getting worse, mostly
because of budgetary constraints. They are having a lot of problems, and
I think a lot of it is that they are definitely understaffed."
In the 2006 patient satisfaction survey, fewer than three-quarters (72.7
percent) of the Dayton VA's established patients said they could get an
appointment as soon as they wanted, earning the Dayton VA a rank of 138
out of 146 VA facilities nationwide. Dayton did much better in
scheduling appointments for new patients, however, with 86 percent of
veterans saying they got their first appointment as soon as they wanted,
for a national ranking of 70th.
Richardson said the Dayton VA has increased the number of primary care
physicians at its clinics from 20 to 28 and is looking to fill six
remaining vacant positions. As a result, he said, its clinics currently
meet the national standard of being able to schedule an appointment
within 30 days of a patient request.
Pharmacy complaints top the list of grievances he hears from veterans at
the Dayton VA, Combs said.
Connie Mullins said she typically waited an hour for prescriptions at
the pharmacy for her late husband. "There would be one person working
there with a whole room full of veterans, 15 or 20 of them," she said.
Richardson said Dayton has hired a new chief of pharmacy within the past
six months and is looking at ways to automate its prescription refill
system.
One of the Dayton VA's biggest staffing challenges has been recruiting
physicians in sub-specialties, Richardson said. The facility has yet to
replace two cardiologists and two digestive specialists who retired last
year.
Several veterans and their families have questioned the quality of
cardiology care at the Dayton VA.
Mullins said doctors there failed to discover that her husband, who had
a history of high blood pressure, was suffering from congestive heart
failure.
When he fell in early April of last year and broke four ribs, he was
given pain medication at the VA and sent home to recuperate, even though
Mullins told doctors that she was concerned about his swelling and
difficulty in breathing. "They said that was normal," she said.
In a follow-up visit a week later, Mullins again expressed fears about
her husband's breathing, yet no one listened to his lungs, she said.
Less than a week after that, he was taken by ambulance to Miami Valley
Hospital, where doctors removed more than a quart of fluid from his
lungs, she said.
He was hospitalized at Miami Valley for 10 days and, at his request,
later died at home, she said.
Richardson said he could not comment on the Mullins case for reasons of
confidentiality.
"There are some out there who say you get real good medical care, and
some who don't," said Ron Dickensheets, a trustee of the Vietnam
Veterans of America Chapter 97. "It's the luck of the draw as to what
doctor you get."
Dickensheets said he won't go to the Dayton VA for his medical care,
alleging that four veterans in his chapter have died of heart conditions
in the past five years after VA doctors abruptly changed their heart
medications.
Richardson said he wasn't aware of the complaints involving the four
cardiology patients at the hospital.
Mullins said her husband's final months of experience at the Dayton VA
were a deep disappointment.
"He would sit there and cry at times and say, 'They promised to take
good care of us.' I wasn't asking for special treatment for Bill — just
to treat him with respect and do the right thing. Not just for him, but
for all veterans who served their country.
"They haven't lived up to their promises," she said.
Veterans Health Services
Both local and national VA officials say they have adequate budget and
staffing to meet the needs of the nation's veterans, including those who
are newly returned from Iraq and Afghanistan. A spokesman for the
national VA office in Washington, D.C., said the proposed VA budget for
2008 of $87 billion marks a 77 percent increase from the budget in
effect when President Bush first took office in 2000.
National Veterans Health
Administration System
Budget
1996: $38.6 billion
2007: $81 billion
Veterans Treated
1996: 2.9 million
2007: 5.7 million*
Dayton Veterans Affairs Medical Center
Budget
2003: $172.6 million
2007: $217.1 million
Nursing Staff
2003 — 454
2007: 498
Veterans Treated
2003 — 33,440
2007: 30,715**
*Projected for Fiscal Year 2007, ending Sept. 31.
**Actual figure for the first three quarters of Fiscal Year 2007. For
the same period in 2006, total was 30,426.
Sources: U.S. Department of Veterans Affairs,
Dayton Veterans Affairs Medical Center
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Larry Scott --
