The independent federal agency, which investigates whistle-blower cases involving government employees, blamed CAVHCS leadership for what it calls "a lack of accountability," according to special counsel Carolyn Lerner.
Lerner originally disclosed the case of the Montgomery pulmonologist in a letter last month to President Barack Obama. But in testimony she prepared for the House Veterans Affairs Committee this week, she gave additional details about how the doctor was caught and what actions were taken by CAVHCS leaders.
"The time line and specific facts indicate a broader lack of accountability and inappropriate responses by the (VA Medical Center) leadership in Montgomery," Lerner wrote to Congress.
The pulmonologist's case also caught the attention of the chairman of the House Veterans Affairs Committee, Rep. Jeff Miller, R-Fla.
"How in the world can this person still be employed at the VA?" Miller asked.
The special counsel has highlighted the case as an example of weak internal oversight of VA doctors and a failure to fully heed the concerns of VA employees who expose wrongdoing. The agency is one of several investigating widespread problems within the VA, including veterans waiting too long to see VA doctors and the VA covering up evidence of the long wait times.
The Montgomery pulmonologist, who has not been named because the case is still under investigation, copied and pasted old patient data collected by other doctors into new records of the same patients. The copied data included the patient's chief complaint, findings of the physician's exam, vital signs, diagnoses and plans of care.
A surgeon first reported the wrongdoing involving six patients late in 2012, according to Lerner's testimony. The surgeon was alerted to it by an anesthesiologist who was doing an evaluation of a patient before surgery.
In response to the complaint, the CAVHCS management monitored the pulmonologist's work and confirmed the data was being copied and pasted. The pulmonologist was placed on a 90-day "focused professional practice evaluation."
But during that 90-day review, the pulmonologist continued the copying and pasting. Yet CAVHCS leadership ended the review, citing "satisfactory performance."
The whistle-blowing surgeon then notified the Office of Special Counsel that the mismanagement was a threat to veterans' health and safety. The special counsel referred the case to the VA's Internal Office of Medical Inspector, which confirmed the pulmonologists' wrongdoing but not the allegations of mismanagement.
The Office of Medical Inspector, however, recommended that CAVHCS review all of the consults performed by the pulmonologist in 2011 and 2012, which is when they discovered it had happened 1,241 times, "far worse than previously believed," Lerner wrote.
"Despite confirming the widespread abuse, Montgomery (Veterans Affairs Medical Center) leadership did not change its approach with the pulmonologist, who was again placed on (focused professional practice evaluation)," Lerner wrote. "Montgomery (VA) leadership also proposed a reprimand, the lowest level of available discipline."
Lerner said her office has asked the VA for more information to determine whether the unscrupulous practice endangered patient health.
"Despite the lack of confirmation on this critical issue, Central Alabama VA Director James Talton publicly stated that the pulmonologist is still with the VA because there was no indication that any patient was endangered, adding that the physician's records are checked periodically to make sure no copying is occurring," Lerner wrote.
A spokeswoman for CAVHCS did not respond to a request for comment Friday.
In the congressional hearing Tuesday night, a top VA health official declined to discuss the specifics of the Montgomery case, but he said it is common practice to take historical information from prior notes and reuse the information that doesn't change.
"But we don't copy and paste material from ... old records into new records as evidence of the current encounter with a patient," said Dr. James Tuchschmidt, acting principal deputy undersecretary for health at the VA. "We would not tolerate that, we would not support that in the organization. That would clearly represent inferior patient care."
Lerner said she was not aware of any serious disciplinary action taken against the pulmonologist.
"So this fits the pattern that we're concerned about, where allegations are concerned, no harm is found to patient health and no corrective action is taken against wrongdoers. And that's really what I think needs to be fixed," she said.
The special counsel has encouraged the VA to review the patient records and the specific actions taken by Montgomery VA officials in response to the misconduct.
Lerner said her office continues to receive "a significant number" of complaints from whistle-blowers from VA facilities around the country. The agency has more than 60 pending cases involving allegations to patients' health and safety.
"These problems would not have come to light without the information provided by whistle-blowers," Lerner wrote. "Identifying problems is the first step toward fixing them."
Acting VA Secretary Sloan Gibson last week ordered a restructuring of the Office of Medical Inspector and named a new interim director "to create a strong internal audit function which will ensure issues of care quality and patient safety remain at the forefront."
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