The tireless self-promotion that Michael Moreland has displayed is unfortunately nothing new: or why mismanagement, over staffing and financial self dealing have been par for the course at the VA since the Harding Administration
Charles R. Forbes one of many VA executives to put their own interests ahead of the interests of veterans. He ended up serving time at Leavenworth.
Charles R. Forbes
President Hardingappointed Forbes to the Bureau of War Risk Insurance on April 28, 1921. Forbes’s salary at the War Risk Bureau was $10,000 a year. On August 9, 1921 Congress passed what was known as the “Sweet Bill” creating the Office of the Veterans Bureau. After World War I, thousands of wounded and disabled veterans did not have adequate facilities for proper care and needed job skills. The Veterans Bureau was created to remedy this dilemma for the World War I veterans who desperately needed medical attention, hospitals, and employment. Across the country there were fourteen regional offices that were semi-independent from Washington D.C. Bureau. Congress awarded the Veterans Bureau millions of dollars in expenditures to take care of the needs of the veterans. In August 1921, President Harding appointed Forbes the first director of the Veterans Bureau. Forbes controlled $500,000,000 (5.99 billion 2009) a year in government expenditures for the World War I veterans
With millions of dollars at his disposal, Forbes hired 30,000 new workers to the Veterans Bureau, many who were personal friends to Forbes. The Veterans Bureau under Forbes was overstaffed and many appointed agents looked for means to justify their paid positions. During his tenure as director, Forbes ignored the needs of the wounded veterans. During the less than two years Forbes held this position, he embezzled approximately $225 million, mainly in connection with the building of veterans’ hospitals, from selling hospital supplies intended for the bureau, and from kickbacks from contractors. The budget for the Veteran’s Bureau during his tenure was $1.3 billion in total. Forbes had rejected thousands of legitimate claims by veterans.
Although 300,000 soldiers had been wounded in combat, Forbes had only allowed 47,000 claims for disability insurance, while many were denied compensation for reasons that Congress called “split hairs”. Even fewer veterans received any vocational training under Forbes’ direction of the bureau. According to the Charleston Gazette, Forbes toured with his contractor friends to the Pacific Coast, known as “Joy-Rides”, inspecting veteran hospital construction sites. Forbes and his contractor associates allegedly indulged in parties and drinking. Forbes and corrupt contractors developed a secret code in order to communicate insider information and ensure government contracts. According to congressional testimony, in Chicago, on one of his many inspection trips, Forbes gambled and took a $5,000 bribe from contractor J. W. Thompson and E. H. Mortimer at the Drake Hotel to secure $17,000,000 veteran hospital construction contracts. Mortimer was the middleman man who had handed Forbes the bribe in one of the rooms at the Drake. Forbes said the $5,000 payment was a loan. Mortimer stated that Forbes had an affair with Mortimer’s wife while on the inspection tours.
After Forbes returned from his inspection tours he began to sell hospital supplies at severely discounted prices. According to a Highbeam Business report, he sold nearly $7,000,000 of much needed hospital supplies for $600,000, a fraction of their worth. Forbes was suspected of receiving kickbacks from contractors. When President Harding ordered Forbes to stop, Forbes insubordinately disobeyed and kept selling supplies.
On January 24, 1923 Forbes awarded the Hurley-Mason Construction company a sizable contract of $1,300,000 to construct a new veteran’s hospital by American Lake. Forbes had resigned his Vice-President position at Hurley-Mason Construction upon assuming federal position under the Harding Administration. By January 1923, rumor was spread by Forbe’s close friends that Forbes would resign the Veteran’s Bureau in on June 1, 1923During the summer of 1922 on one of Forbe’s “joy rides”, Forbes came to Spokane and had visited the F. Lewis Clark House while he was looking for a possible site for a Veteran’s Hospital by Hayden Lake. Forbes was accompanied by Dr. Stanley Rhinehart. The F. Lewis Clark House was one of the most prestigious summer homes in the Pacific Northwest. F. Lewis Clark House had been offered to Forbes and the Veteran’s Bureau at a low cost. Colonel Forbes stayed there for several days. Forbes division office of the Hurley-Mason Construction company had been closed down.
Forbes resignation, however, would come earlier than June 1, 1923 as his friends had predicted. When President Harding was informed that Forbes had disobeyed a direct order to stop selling hospital supplies Harding summoned him to the White House in January 1923. Forbes pleaded with Harding to allow him to go to Europe to settle family matters. Harding allowed him to flee to Europe only on the condition he would resign from the Veterans Bureau. While in Europe, he voluntarily resigned from office on February 15, 1923. When Forbes took Elias H. Mortimer’s wife to Europe with him, Mortimer decided to testify against him in a Congressional investigation that started on March 2, 1923. Upon his return from Europe, Forbes visited President Harding at the White House. The six foot tall President grabbed Forbes by the throat and began violently shaking him “as a dog would a rat”. Forbes was saved from this attack when a guest who had an appointment with the President interrupted the altercation. President Harding was angered over Forbes’ duplicity in stopping the Perryville shipments. The Senate investigation revealed Forbes had left 200,000 unopened pieces of mail from veterans at the Bureau. Belligerent before the Senate committee, Forbes renounced involvement in illegal activities. Mortimer provided damaging information that Forbes took a $5,000 payment in Chicago and got kickbacks for land deals and building contracts for Veteran hospitals. Forbes was indicted and tried by jury in 1924.
Forbes was prosecuted and convicted of conspiracy to defraud the U.S. Government, fined $10,000, and sentenced to a prison term of two years. He was put in prison on March 21, 1926. He served one year, eight months and six days at the Leavenworth federal penitentiary. Forbes was prisoner number 25021. On entering prison Forbes said, “I don’t suppose any prison is a pleasant place to go, but I shall try to make the best of it.” Forbes had appealed his trial, however, the United States Circuit Court of Appeals in Chicago upheld his conviction.
ASA Blasts Proposed Change To VA Nursing Guidelines
The American Society of Anesthesiologists is calling “ill-conceived” a draft document from the Veterans Health Administration that, it claims, would require nurse anesthetists to practice without physician supervision and in the process jeopardize patient safety.
The ASA says the new rules abandon “team-based anesthesia care” led by physicians and undermine the quality of care in VA hospitals in the service of further expanding the scope of practice of advanced practice nurses (APRNs) and other so-called physician extenders. But the language of the Nursing Handbook—a draft copy of which the ASA provided to reporters—is sufficiently vague to raise some questions about the society’s interpretation of its intent and impact.
n a Sept. 9, 2013, conference call with reporters, Jane Fitch, MD, the incoming president of the society, said the ASA was “deeply disappointed” with the amended handbook. Allowing nurses to practice unsupervised raises “significant” concerns for the safety of patients in the VA system, Dr. Fitch said.
“The language of the policy indicates independent practice,” said Roxanne Pipitone, an ASA spokeswoman. “The handbook doesn’t get into procedure-specific scenarios for any of the four advanced practice nursing roles,” which, along with CRNAs cover certified nurse-midwives, clinical nurse specialists and certified nurse practitioners.
Dr. Fitch, who herself was a certified registered nurse anesthetist before receiving her medical degree, said the two positions “are in no way equivalent.” CRNAs receive far less training—five to seven years compared with 12 to 14 for physician anesthetists, and one-tenth the number of hours, she said.
Although Dr. Fitch said CRNAs often do not have even a college degree, according to the policy: “A CRNA is an APRN who has completed a master’s or doctoral degree and board certification in the specialty of anesthesia. CRNAs practice in all settings in which anesthesia services are delivered including traditional hospital surgical suites and ambulatory surgical centers.”
However, Ms. Pipitone said the society does not “interpret this to mean that the VA will only allow nurse anesthetists with advanced degrees to practice independently. There is nothing in the new handbook that addresses segmenting nurse anesthetist by education received, whether they have a two-year associate degree RN or three-year diploma RN. Regardless of their education or training, they all practice as nurse anesthetists.”
Some people familiar with the issue said the ASA’s aggressive response to what could be considered a matter of worst-case interpretation of an ambiguous policy indicated Dr. Fitch’s desire to assert her political bona fides as incoming president of the society on the eve of her ascension to the position. Dr. Fitch campaigned on a theme of “I didn’t know what I didn’t know” as a nurse anesthetist—a refrain she stressed more than once during the conference call. Indeed, the email alerting reporters to the call identified her as “President Elect of the American Society of Anesthesiologists and Former Nurse Anesthetist.”
Short on Specifics
The document does not highlight any new clinical duties for CRNAs in the VA system. But the ASA points to this passage as expanding nurses’ scope of practice intolerably:
“APRNs [advanced practice nurses] practice as independent providers without regard to State Practice Acts under a set of approved privileges. Advanced practice nursing education provides the foundation for APRN core privileges. Core privileges as defined by the profession are those sets of clinical practice, procedures or interventions that all APRNs are qualified to perform based on their educational background and training.” It then lists core privileges including the taking of a history and physical examination, prescribing under an earlier VA directive, developing a care plan and ordering diagnostic and laboratory studies.
Dr. Fitch said the ASA first learned about the policy change about five months ago. The group tried to meet with VA officials to discuss the document on three occasions but was rebuffed, she added.
In a July 2, 2013, letter to Robert Petzel, MD, the undersecretary for health in the Department of Veterans Affairs, the ASA said it was “concerned about the impact of these policies on surgical anesthesia care within the VHA. The policies are particularly troublesome given the population serviced” by VA hospitals
.VA patients are nearly 15 times more likely to be in poor health than the general population, according to the society—raising their risk for complications during and after surgery. “We believe that physician involvement is in the best interest of all patients and is particularly appropriate and necessary for VHA patients,” the letter stated.
The ASA has been working with members of Congress—unsuccessfully, so far—to urge the VHA to reverse the policy change. The ASA also issued a “Call to Action” to members urging them to contact their Congressional representatives about the proposed policy change, which, it argues, is in conflict with the VHA’s anesthesia service handbook.
Forty states currently allow CRNAs to practice without physician supervision, while only one, New Jersey, mandates oversight by an anesthesiologist. But health care providers who work in the VA system fall under federal licensing laws, which trump state regulations. As a result, a CRNA working at a VA hospital in a state that required physician oversight would be permitted the wider scope of practice. Approximately 700 to 800 anesthesiologists, and a similar number of CRNAs, work in the VA system.
The VHA declined to make someone available to discuss the new policy. But Gina Jackson, a spokeswoman for the agency, said current policy “recommends that CRNAs and/or anesthesiologists work in a team together with the other nurses and physicians caring for our veteran patients, and does not require physician supervision of CRNAs. As a member of the anesthesia team, CRNAs are subject to the same professional practice review, evaluation and monitoring as all anesthesia providers.”
Ms. Jackson added, “The proposed Nursing Handbook and APRN full practice policy support the anesthesia team–based model of care that fully utilizes the knowledge, skills and abilities of CRNAs.”
VA Anesthesiologists Wary
However, the new policy evidently caught the VA’s own anesthesia providers by surprise. An internal email from the department’s central anesthesia service sent after the ASA teleconference stated that the VA’s nursing service made the change “without input from the National Anesthesia Service.” According to the email, several versions of the handbook are circulating, although “all drafts we have seen propose an increase in independence” over current policy.
“With input from our Field Advisory Committee (FAC) we have submitted several questions and concerns to ONS [Office of Nursing Services] regarding the proposed change in status. Concerns have also been submitted by Primary Care Physicians. To date, ONS has not responded to our questions,” according to the email, which concludes, “At this point there are more questions than answers.”
Robert Katz, MD, chief of the anesthesiology service at the North Florida/South Georgia VA, based in Gainesville, said the new policy “will definitely have an impact” if it goes through. The typical CRNA working independently handles ASA status 1 and 2 patients, Dr. Katz said. In his facility, three-quarters of patients are ASA status 3 and 4, primarily elderly with many medical problems.
If the new policy simply means that CRNAs can work independently but don’t have to, and they are assigned to the healthier patients with an anesthesiologist nearby in case something goes wrong, “it probably isn’t going to affect what we do all that much. But if they are assigned to do really sick patients with no back-up from a physician, I think that would not be a good idea. I would expect that a fair number of really sick patients might get into trouble.”
Frank Purcell, senior director of federal government affairs for the American Association of Nurse Anesthetists (AANA), said the VA change, which his group has been aware of for some time, is not a change at all but a “confirmation of what advanced practice nurses do”—not only in the VA system but elsewhere. Mr. Purcell said the draft document implicitly endorses a call from the Institutes of Medicine to allow CRNAs and other APRNs to practice independently. “This is something that physicians and nurses, some of the most distinguished experts in health care, have recommended.”
And Mr. Purcell disputed the notion that the nursing handbook disbands the care team in VA hospitals. “Nurse anesthetists would be continuing to serve in the interests of the veterans who are under their care and serve as part of a group of expert health care professionals. In the VA system, no provider of any type, physician or nurse, is an island.”
In an Aug. 30, 2013, letter to the VHA, the AANA and the Association of Veterans Affairs Nurse Anesthetists praised the new handbook while objecting to what the groups said were “inaccurate and misleading statements” from the ASA about the document.
For example, the letter states, “neither the VHA draft Nursing Handbook nor the term ‘Licensed Independent Practitioner’ [LIP] suggest that CRNAs and other APRNs would be ‘required’ to function without physician involvement should the VHA designate APRNs as LIP. Understanding that the VHA looks to the Department of Defense for information and healthcare delivery standards, the agency should be aware that branches of our U.S. Armed Forces have recognized CRNAs as LIP for a decade or more, and that those military CRNAs have compiled an outstanding safety record delivering care in major stateside hospitals and in the most austere conditions in theater.”
BATTLE CREEK, Mich. (WOOD) – The federal government shutdown is impacting a lawsuit filed by a West Michigan veteran against the U.S. Department of Veterans Affairs.
Niki Cummings filed the federal lawsuit in April, claiming a doctor and another staff member at the Battle Creek VA Hospital inappropriately accessed her medical records and then shared that information with others.
Cummings was a contract employee who ran a home for women veterans at the time.
Her contract was terminated and a settlement of more than $46,000 was paid to her, according to court records.
A notice filed with the court says the VA and Cummings have reached a settlement in the lawsuit, but because of the federal government shutdown, the attorneys who need to sign the agreement have been furloughed.
It’s not yet known when the settlement agreement will be signed.
CHARLESTON, W.Va. — Veterans’ hospitals in Beckley and Huntington prescribed powerful painkillers at some of the highest rates in the nation from 2001 to 2012, according to a new report.
The Center for Investigative Reporting, a national nonprofit journalism organization, recently released more data in conjunction with an ongoing series on the nation’s veterans. It found the fatal overdose rate for VA patients is nearly double the national average.
A national report released Monday found West Virginia leads the country in fatal overdoses, most of which involve prescription drugs.
More than 175,000 veterans live in West Virginia, one of the highest per-capita populations in the country, according to census data.
The Beckley VA Medical Center provided more than 150 prescriptions per 100 patients, the second-highest rate in the country during that period, according to the report. The Huntington VA Medical Center provided 145 prescriptions per 100 patients, the fourth-highest rate.
Any center providing more than 100 prescriptions per 100 patients is above the national average.
In addition to census data, the Center for Investigative Reporting relied on information collected through Freedom of Information Act requests filed with the U.S. Department of Veterans Assistance.
It looked at four types of medications in particular: oxycodone, hydrocodone, morphine and Methadone.
The data reflects little change in the number of patients each year but a massive jump in the number of prescriptions for the four medications.
From 2001 to 2012, nearly 165,000 patients were treated at the Beckley VA and more than 250,000 prescriptions were issued, according to the report.
In 2001, 13,865 patients were treated and 4,743 prescriptions were issued. With 60 fewer patients in 2012, there were 27,242 prescriptions.
There were never more than 14,450 patients treated by the Beckley VA during that period. Prescriptions peaked in 2011 at 28,524.
Hydrocone far outpaces prescriptions at the Beckley hospital for any of the other medications included in the report. In 2002, there were about 3,600 prescriptions for 14,450 patients. In 2012, there were 21,672 prescriptions for 13,805 patients.
The Huntington VA treated more patients during the period and doled out almost twice as many prescriptions as the Beckley center, the report says.
The Huntington VA saw 340,167 patients and issued almost 494,500 prescriptions. There were 24,610 patients in 2001 compared with 16,779 prescriptions. There were about 4,000 more patients and a total of 44,558 prescriptions in 2012.
The number of patients peaked in 2006 at 29,543, with prescriptions reaching their highest total – 56,332 – in 2008.
Again, hydrocodone was prescribed the most. In 2001, there were 7,166 prescriptions compared with 24,610 patients. With about 28,500 patients in 2012, there were 32,141 hydrocodone prescriptions.
The report doesn’t specify if there is any overlap in patients treated at either hospital from year to year, but it is likely given population totals for the area.
Prescriptions for the four medications nationally have increased by 270 percent since 2001, compared with a 41 percent increase in VA patients during the same time span, according to the report.
Hydrocodone-acetaminophen was the third-most prescribed medication through Medicare in the country in 2010, according to a report from ProPublica, another nonprofit investigative journalism platform.
The report found the medication was the top prescribed drug in 2010 for all West Virginians participating in Medicare Part D, the program’s prescription drug plan.
A spokeswoman for the Beckley VA said she could not immediately comment but said she might be able to provide some information in the near future. A spokeswoman for the Huntington VA referred comment to the national VA. No one answered a call placed Monday afternoon to the national office of VA media relations.
A spokeswoman for the state Department of Veterans Assistance did not immediately respond to messages.
National VA representatives sent a statement to the Center for Investigative Reporting saying the VA is working to address any issues with prescription drug abuse by veterans.
I’ve been contacted by a reporter who is interested in speaking to lawyers who are representing veterans involved in the delay in referring veterans for colorectal screenings at the Dorn VA in Columbia,SC and GI consults at the Charles Norwood VA in Augusta GA. If you are interested, please contact me and I will forward your information to the reporter who will contact you directly.
“Moreland is really on the Move”
He’s taking the $63,000 bonus money and running!
In what is hopefully the last edition of “Moreland on the Move,” VISN 4 Director, and tireless self promoter, Micheal Moreland has announced that he is keeping his $63,000 bonus and is “retiring” on November 1, 2013. By retiring and giving VISN 4 the opportunity to recover from the discontent, distrust and discord that has plagued it for the last two years, the man who lists on his resume as his specialty “Finding solutions to unsolvable problems,” may have actually taken the first step in solving the biggest problem that faces VISN 4: Michael Moreland.
During his last month on the job, we are going to be updating this post with some of the highlights of Mr. Moreland’s career. If there are any Congressional investigations, OIG reports or AFGE posts that we’ve missed, please send us the information and we will add them. We want to recognize the man who inspired our own “got bonus?” campaign.
Chairman Miller Statement on Michael Moreland’s Retirement
WASHINGTON, DC – After today’s announcement that Department of Veterans Affairs Veterans Integrated Service Network 4 Director Michael Moreland will be retiring, Chairman Jeff Miller released the following statement:
“Michael Moreland is the poster child for the widespread and systemic lack of accountability throughout the Department of Veterans Affairs. His arrogance and insensitivity throughout the entire Legionnaires’ disease tragedy was incredibly hurtful to the families of those who died and absolutely shocking to all veterans and taxpayers familiar with the ordeal. Moreland’s absolute refusal to take any responsibility whatsoever for five preventable veteran deaths that he oversaw has tarnished his legacy of more than 30 years of government service and badly damaged the reputation of the department as a whole. VA leaders have been saying for months that Moreland’s outrageous $63,000 bonus is under review. Now it’s up them to do the right thing by immediately announcing the results of that review and taking all steps necessary to recoup Moreland’s bonus.” – Rep. Jeff Miller, Chairman, House Committee on Veterans’ Affairs