Resignation comes after newspaper reports low employee morale and veterans' dissatisfaction with care.

NOTE from Larry Scott, VA Watchdog dot Org ... We have another "retirement" of the VA hospital director ... or, it appears, he was forced out. 

We have two articles about this ... first is about the "retirement" ... second is the article that lit the fuse.

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VA hospital chief to step down

BY JOHN RAMSEY - THE FAYETTEVILLE OBSERVER

http://www.newsobserver.com/news/local_state/story/175522.html

FAYETTEVILLE The director of the Fayetteville VA Medical Center announced his retirement Wednesday, three days after The Fayetteville Observer reported dissatisfaction among employees and patients at the hospital.

The announcement follows the Observer's report Sunday on low patient satisfaction and poor morale among hospital employees. The hospital had the lowest scores on government surveys of patients and workers among the eight VA hospitals in North Carolina and Virginia.

"Everyone needs to be focused on patient care," said Bruce Sprecher, a VA spokesman for the region. "This change in leadership will hopefully be the catalyst to improving the work environment, which should ultimately help improve patient care and satisfaction and staff performance."

Three congressmen from North Carolina - Reps. Mike McIntryre, Bob Etheridge and Larry Kissell - met with a regional VA director Daniel Hoffman on Wednesday in Washington about the quality of care at the Fayetteville facility. McIntyre said his office has heard from dozens of veterans who raised concerns about the Fayetteville VA.

U.S. Sen. Richard Burr also plans to meet with the VA official about the center.

Bruce Triplett's last day in charge of the hospital will be Nov. 20, but his retirement won't be official until March 1, according to a news release from the VA regional office. During that time, Triplett will lead the effort to eliminate homelessness among veterans in the mid-Atlantic region.

Ralph Gigliotti, director of the Durham VA Medical Center, will be interim director of the Fayetteville hospital starting Nov. 23.

Triplett has served 30 years with the VA, and took charge of the Fayetteville facility on Nov. 26, 2006. Triplett, a Mississippi native, previously was director of the Network Support Team-West at the VA Central Office in Washington.

Triplett said Wednesday that he has been eligible to retire for a year and that now seemed an appropriate time.

He called the Observer's report Sunday one-sided, saying privacy issues kept him from rebutting some of the claims. He also said that during his tenure, he has raised the VA from a national rank of 137th in performance standards to 58th. He pointed out that the VA has had no layoffs or pay cuts in the past few years, unlike private-sector businesses.

"The patient satisfaction and employee satisfaction were low before I got here," he said. "My disappointment is that I couldn't make it move up fast enough, or faster."

Survey results

In the two-state region, the Fayetteville VA employees reported the lowest marks in 12 of 13 categories in a survey measuring job satisfaction. Scores in eight categories were significantly lower than at other VA hospitals.

The lowest scores came when employees were asked to rate promotion opportunities, senior management, work conditions and praise.

Don Talbot, a retired Army veteran and commander of American Legion Post 32, has spent several months speaking with employees and patients about problems at the hospital. Talbot said he has heard from veterans who feel as if some doctors ignore their problems. Patients also are unhappy about having to find a ride to the Durham VA to get certain specialty medical treatment.

"I think he relied too much on his staff and did not get into the hallways and understand his facility," Talbot said. "Once the facility started clamoring for attention, he was out of touch."

The Fayetteville VA serves a veteran population of about 171,800 in southeastern North Carolina and northeastern South Carolina.

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Fayetteville VA hospital worst in job satisfaction

By John Ramsey
Staff writer

http://www.fayobserver.com/Articles/2009/11/01/943114

Workers and patients at the Fayetteville Veterans Affairs Medical Center rate the hospital lower than their counterparts at seven other VA hospitals in North Carolina and Virginia, according to two recent government surveys.

Veteran advocates, employees and patients frustrated with the VA say the surveys reflect a larger issue: The hospital has overwhelming morale problems that require major reforms.

The Fayetteville hospital director says the poor marks from employees and patients are frustrating, but satisfaction is not the same as quality. In Fayetteville, home to the Army's largest installation, the VA provides high-quality health care, he said.

In the two-state region, the Fayetteville VA employees reported the lowest marks in 12 out of 13 categories in a survey measuring job satisfaction. Scores in eight of those categories were deemed statistically meaningful and significantly lower than scores at the other VA hospitals.

More than 87 percent of the 850 Fayetteville employees - from doctors to janitors - responded to the survey.

The lowest scores came when employees were asked to rate promotion opportunities, senior management, work conditions and praise.

In a separate government survey, patients were asked about their satisfaction with their care. In Fayetteville, 45percent of inpatients and 41 percent of outpatients rated the service they received as very good or excellent. The average in the region for the same timeframe - July 2008 to February 2009 - was 60 percent for inpatients and 52 percent for outpatients. A regional VA spokesman said the patient surveys are poor measures of quality because hospitals don't get credit for patients who rate their service as "good" instead of "very good" or "excellent." Some of the questions are also poor, he said.

Bruce Triplett, director of the Fayetteville VA hospital on Ramsey Street, said his staff has tried to develop ways to improve morale, including a new employee satisfaction committee.

But part of the reason Fayetteville may have a low job satisfaction score, Triplett said, could be the 63 percent minority population of the staff.

"I've been told that minorities tend to score lower on satisfaction surveys than others," Triplett said.

Triplett said he's not sure whether the low scores on the employee survey concerning senior management are a reflection on him, because he doesn't know how employees who took the survey interpreted the term "senior management."

The director of the group that administers the employee survey said hospitals are told to compare their scores to their previous years' scores, not to other hospitals. But hospitals are encouraged to pick up the phone and ask their peers what they are doing right to receive higher scores, she said.

"Does it mean something if Fayetteville is lower than everybody else? It probably means they need to work on that, but it doesn't necessarily mean they're bad," said Sue Dyrenforth, director of the VHA National Center for Organizational Development, the arm of the VA that administers the surveys.

It's important to figure out what low scores mean, she said. Management can use the results to find which departments are most unhappy and why, she said.

Any score above a 3.0 out of 5 isn't considered negative, she said. Dyrenforth said the biggest red flag on the survey is the 2.8 score on satisfaction, compared with a survey two years ago.

"They're saying, 'I think it's getting worse,' " she said.

To make the surveys more meaningful, she said, VA staff can break them down by work group to see which areas of the hospital have the highest and lowest morale scores.

"If you're really serious about improving a hospital, what we've learned is you need to be really serious about employee satisfaction, and you need to look at it in a detailed way over time," she said.

Employees interviewed by The Fayetteville Observer have said there's been a longstanding atmosphere of favoritism and retaliation at the VA hospital.

The hospital's previous director, Janet Stout, and three senior administrators were found by the VA's Office of Inspector General to have created an appearance of preferential treatment at the hospital in a number of personnel moves in 2003 and 2004. The Inspector General's Office completed an investigation in 2005 and recommended that the VA's regional director take action against the administrators.

That atmosphere of retaliation remains, according to about 10 employees interviewed by the Observer.

One recently fired surgeon has filed a federal lawsuit against Triplett and other top VA brass, claiming she was fired in retaliation for filing a claim with the Equal Employment Opportunity Commission.

The lawsuit gives an account of Dr. Barbara Wilson's final months at the VA.

Wilson, a hand surgeon, began seeing a psychiatrist in March when the stress of an overly hostile work environment became difficult to handle, the suit says. The psychiatrist diagnosed her with adjustment disorder but explicitly said Wilson was still fit to perform her job. The stress, said the psychiatrist, was not due to seeing patients, the suit says.

But shortly after Wilson began seeing the psychiatrist, her boss made her stop performing surgery and transferred her to the library. Shortly after she formally complained about being moved unfairly, she was fired, the suit says.

Triplett said he can't comment on the case because it's a personnel matter. Wilson's lawyer also declined comment.

Other VA employees, who asked not to be identified for fear of retaliation, said they believe Wilson got a raw deal.

In addition to Wilson, at least a dozen other medical providers have left the hospital this year, according to a list provided to the Observer.

Triplett said the hospital is in a constant state of recruitment. Some people may have left because of the hospital, but others left because of community issues such as schools, he said.

Don Talbot, a retired Army veteran and commander of American Legion Post 32, has spent several months speaking with employees and patients about problems at the Ramsey Street hospital. Talbot said employees are afraid to speak out because of a culture of intimidation and retaliation. He said he has heard from veterans who feel as if some doctors ignore their problems. And, Talbot said, veterans shouldn't have to find a ride to the Durham VA to get specialty medical treatment.

The Fayetteville VA serves a veteran population of about 171,800 in southeastern North Carolina and northeastern South Carolina. Those men and women deserve a top-notch hospital, Talbot said.

Triplett said he's not aware of any substantiated claims of retaliation, and that he'd put a stop to it if alerted.

Triplett said patient complaints are about convenience, not quality of care. Their frustrations come from a lack of specialists at the hospital, which requires them to travel elsewhere for care. Patients also get frustrated over courtesy issues such as returning phone calls, Triplett said.

Last year, in response to patient complaints, the Fayetteville VA started a program called CARES - or the "be nice" campaign - encouraging employees to be friendlier.

Specialists are difficult to recruit to Fayetteville because the hospital doesn't have a research facility or ties to major universities, like the VA hospital in Durham, which has ties to Duke University, he said. That's why many patients have to be referred to other hospitals such as Durham's VA.

It recently took several months to find a cardiologist to work in Fayetteville, Triplett said, and the hospital still has to contract with other cardiologists during the day. And some heart patients still must be sent to Durham for care.

But, he said, the inconveniences of being sent to another hospital for treatment don't speak to the quality of medical care provided by the VA, which Triplett said has improved since he arrived as director three years ago.

"I do want to make the point that quality care is being provided whether I send them to Durham or whether I send them out into the community," Triplett said.

U.S. Rep. Larry Kissell, whose district includes part of Cumberland County, has asked the secretary of Veterans Affairs to start an investigation in response to several complaints sent to his office.
Patient's view

Patients interviewed by the Observer complained of misdiagnosed problems and unfriendly physicians.

Mary Kizer, a longtime VA patient, is terrified of the emergency room at the Fayetteville VA.

Kizer's medical records show that in 2005, a Fayetteville VA doctor diagnosed her with gastritis because of debilitating pain in her stomach.

When Kizer went to another hospital after a year, the doctors immediately recognized that a shunt running down her back had become coiled. They removed it, and the pain subsided, Kizer said.

Kizer had a fractured wrist misdiagnosed as a sprain at the Fayetteville VA, and was recently placed in a bed with someone else's blood dried on the railings.

Her records indicate that the VA tested the dried blood and found it didn't have any communicable diseases, but that provides her little comfort.

Kizer said if she could afford health care outside the VA, she'd never return because some of the doctors treat patients "like dirt."

"It's so bad that every time I go out there, my blood pressure gets so high," she said. "I'm afraid to go there. I just don't trust them anymore."

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TOPICS: veterans, veterans' benefits, VA, Department of Veterans' Affairs, Fayetteville, low morale