Q&A with VA Medical Center director about hospital problems

Scott Isaacks, interim director of the Ralph H. Johnson VA Medical Center sat down with The Post and Courier last week to discuss the national VA scandal, secret waiting lists and what he wants the community to know about the hospital in Charleston.

Some of his answers have been edited for length.

Q: The VA identified one patient in Charleston that may have died because of a delay in care. Are you confident this was an isolated incident?

A: We've gone back and reviewed that case and looked at the patient's care from start to finish and have now determined that the patient's death was not related to a delay in care. Obviously, that's a big change. Initially, we said it could have been related.

Not only was that reviewed inside this hospital, it was reviewed by a physician outside our medical center and it was determined that the patient's death was not related to a delay in care. We put it out there as a potential, but we've now determined that it was not related.

When we have a patient whose care is impacted negatively in any way, we've got a number of venues that employees can use to bring those issues forward.

I'm not aware of any other patients that have died due to a delay in care.

Q: The time frame for getting a primary care appointment at a VA hospital is supposed to be 14 days. What is the average here in Charleston?

A: Charleston has really been a leader nationally in getting patients in timely. I can tell you that today, any patient that comes to our facility who needs a new primary care appointment will get it within 14 days. We do not have the access issues that are being discussed nationally. Do we have patients from time to time that choose to be scheduled more than 14 days out? Sure. Do we have clinics from time to time that may fall outside the 14 days by a small margin where we've got to increase the resources to get those patients in? Absolutely. In terms of the 14-day metric, the last two completed rating periods, Charleston has not only just met the VA criteria for timeliness, but has really been a leader.

Q: Does the Charleston VA Medical Center maintain secret waiting lists?

A: On numerous occasions over the years, we have validated that there are no secret lists, that the scheduling is appropriate. Based upon the discussion recently, all of my service chiefs that have responsibility for scheduling, I asked them to revalidate that we do not have secret lists, we do not have any unofficial records that are not being put into our system and they validated that that is the case. I am confident in saying that we do not have secret lists, that our patients are being put into our system.

Q: Does it take longer to schedule appointments for treatment here than at the other hospitals in Charleston?

A: I can't talk about the other facilities here in town. I don't know what their wait times are, but I think 14 days has been shown as something that nationally, getting an appointment within 14 days is not easy to do outside the VA. The VA has set a standard that is a very, very high bar to meet. Like I said, Charleston has done a good job meeting that, but I would say in most communities, getting an appointment within 14 days, especially with a specialist, some surgical specialists, those types of physicians, is difficult to do.

Q: Is this medical center subject to any current federal investigation?

A: Not that I'm aware of. I haven't received any notification.

Q: How does the Charleston VA need to improve?

A: I do think nationally there has been a clear message that we need to get patients in timely. In Charleston, we've already been doing that for some time so we're not changing a whole lot about what we're doing. We're just continuing to work hard to make sure we get patients in.

I've heard story after story about the incredible things we're doing for patients, but they're all mad about the parking. We've got a new parking deck that's going to be going up soon - breaking ground before the end of the calendar year, so parking is really the biggest complaint that we get in Charleston right now and we're in the process of addressing that.

Q: How much does the national conversation about the VA trickle down here?

A: I think we've got wonderful staff here, but part of the reason I was very happy to talk to you guys today is when our staff sees this stuff on the news, and they're at church or out in their neighborhood and they meet people who know they work for the VA, it can be hurtful.

The news going on nationally, it doesn't change what we do. Our staff has a passion for taking care of veterans. I can tell you our staff, they're not here because they have to be. They're not here because they couldn't find jobs elsewhere. They're here because this is what they want to do.

- By Lauren Sausser

Air Force veteran Kelly Maguire isn't worried about dying because of appointment delays plaguing Veterans Affairs hospitals across the country.

She just wants to see a doctor.

"The problem that I'm running into is that I have a military disability for my back, but I also take medication," said Maguire, 54, of North Charleston. "I am out of medication and I can't get a refill because I can't get a doctor."

She's been trying to schedule an appointment through the Ralph H. Johnson VA Medical Center in Charleston since mid-May. Hospital staff told her more than once that they'll call back to set the date and time. They haven't yet, she said.

"It's probably a wonderful hospital. I don't know because I can't get to it," she said. "I'd love to be waiting for an appointment at this point."

The problem isn't unique to Charleston. Marine Corps veteran Greg Topliff, who lives in Warrenville and uses a VA clinic in Aiken, said he was recently told to wait three weeks to see his regular physician.

"I don't know if that's all over the place, or just a one-time incident," said Topliff, 65, who was diagnosed this year with diverticulitis. "I was under the impression that they're going to cut down the wait times. They certainly didn't cut down the wait times on that one."

A memo published in April shows that the VA acknowledged that 23 patients across the country, including one in Charleston, six in Columbia and three in Augusta, may have died because they were not treated within an appropriate time frame.

The resulting scandal over allegations that some VA hospitals, particularly a VA medical center in Phoenix, kept patients on secret waiting lists for months in an effort to manipulate their wait times has since cost the head of the VA his job - Eric Shinseki resigned under fire in May.

While it's still unclear how widespread the problem is, the news that some veterans may have been kept waiting more than 100 days for appointments and may have died because of delays in care has called into question the ability of the VA health care system to meet millions of veterans' health care needs.

Veterans who qualify for benefits through the Veterans Health Administration should be scheduled for an appointment with a VA provider within 14 days, according to department guidelines. That's apparently not always the case.

U.S. Sen. Tim Scott, R-S.C., recently called for an investigation into the unfolding scandal.

"Last week, I demanded a full senatorial investigation of the shameful treatment our veterans have gotten, and will work diligently to see it through," Scott wrote in a May 31 email to constituents.

Scott Isaacks, interim director of the Ralph H. Johnson VA Medical Center, said Monday that further review determined a delay was not a determining factor in the Charleston patient's death.

"We put it out there as a possibility, but we've gone back and reviewed that case and looked at the patient's care from start to finish and have now determined that the patient's death was not related to a delay in care," Isaacks said.

The Charleston VA, operating on a $350 million budget, serves 60,000 veterans, schedules 700,000 appointments annually and employs about 2,000 people. Isaacks said more than 99 percent of patients are scheduled for an appointment in Charleston within 14 days.

"I wish everyone had this quality of care," said Navy veteran Paul Hedden, 68, of James Island. "I've never had to wait terribly long for anything."

There are no secret waiting lists at this facility, Isaacks insisted.

"I've heard story after story about the incredible things we're doing for patients, but they're all mad about the parking," he said. "Parking is really the biggest complaint that we get in Charleston right now and we're in the process of addressing that."

The medical center is expected to break ground on a new $9 million garage later this year, but parking hasn't always been the Charleston VA's biggest problem.

In the early 1980s, former U.S. Sen. Strom Thurmond, R-S.C., called for an investigation into the Charleston facility after an unsupervised medical student botched a surgery that left a man paralysed and forced top hospital officials out of their jobs.

"The problem continued even after numerous federal investigations that began in 1970," VA sources told The Post and Courier in 1983.

Fifteen years later, the U.S. House of Representatives Subcommittee on Oversight and Investigations convened a hearing on mismanagement issues at the Charleston hospital. Much more recently, an April audit by the VA Office of Inspector General uncovered some local medical center employees were circumventing protocol and making unauthorized purchases with their VA-issued credit cards.

Isaacks acknowledged that the hospital isn't perfect, but said recent national headlines aren't changing the way it operates.

"We want to get better every day, but this is a good facility and we hear it time and time again," he said. "When we have individual issues, isolated issues that come up, we're going to address them. I really want our patients in Charleston to know and our staff to understand that this is, I think, a good hospital that's providing good care."

Reach Lauren Sausser at 937-5598.