Dr. Hollenbeck on her work with veterans and being a whistleblower…

I moved to Jackson, Mississippi with my husband, for his work, in 2008. When I started looking for jobs for primary care physicians up popped an advertisement for the VA hospital in Jackson; and I only needed my current and active state medical license to work in the federal system. I interviewed and accepted a job and started in a clinic—and it was the worst job I had had in decades in medicine. Not enough doctors and too many unsupervised nurse practitioners taking care of the sickest patients back to back to back that I had ever seen; Veterans waiting months and months for appointments, then rescheduled again and again further out because good physicians were quitting. They were then booked into clinics under the name of a doctor or nurse practitioner who no longer worked in primary care—what I called “ghost clinics”. The desperate Veterans then walked into a clinic to be seen and waited four to six hours or even longer to get worked into a fully booked schedule. They went too long between appointments so vital laboratory tests for diabetes and its complications weren’t checked; they ran out of key medicines and gave up trying to get refills in a dysfunctional system.

Veterans’ kidney functions worsened but no one told them when they did get tests done. That vague but new chest pain, or pain between the shoulder blades, or nausea or shortness of breath mowing their lawn when that had never been a problem—all what we call anginal equivalents or symptoms of possible heart disease—they let those go and then finally came in to see an inexperienced nurse practitioner who missed the diagnosis and sent them home with an inhaler and an anti-inflammatory medication. They came in with a persistent cough and got three different antibiotics over weeks which made no difference in their symptoms because the underlying cause was heart failure; or lung cancer. There was no way to truly know how many Veterans died as a result of this kind of what I called “ugly chaos” because some died at home or went to private medical facilities and died later—and no one looked back and connected the bleak dots.

I wrote to my hospital leadership, including the chief of primary care and the chief of staff (both physicians) and the medical center director (a civil engineer and career bureaucrat —a job mismatch startlingly present in most VA hospitals) that running these kinds of clinics was illegal and unethical and dangerous and impossible. Conscientious physicians had their hearts in their mouths that they would miss a key medical issue because of the time pressures and because no one could keep up with messages and test results and finishing notes even when staying hours late at work. I asked if this leadership group would go to a doctor’s office that ran this way. If not, why did they think it was okay for the Veterans?

I came forward as an official federal whistleblower to the Office of Special Counsel (Dept. of Justice) in July 2012, (even before the Phoenix VA scandal exploded) citing the above as well as the illegal prescribing (and overprescribing) of narcotics by unlicensed nurse practitioners. I had kept detailed records and everything I reported was “substantiated” by the VA’s own internal investigation. I testified twice before the House Veterans Affairs Committee, and did interviews with print media, including the New York Times and appeared on television networks, including CBS News. I had the honor of being on the cover of my Brown University medical school magazine under the headline “Whistleblower” with the article inside entitled “Truth To Power”. The VA was forced to make internal policy and oversight changes, recruited more doctors—and Jackson leadership changed but some were only sent elsewhere in the VA system. No one was fired.
Later in 2012 I transferred to the Compensation & Pension department in the Jackson VA where we do disability exams for the Veterans. We review records from multiple sources for our reports, from military service to VA facilities to outside medical care. I have watched as another group of good primary care physicians has come and gone for the same reasons as before—and I read in the VA electronic medical record and hear from the Veterans about the same kind of ugly chaos.

In one New York Times article the reporter had captured my core when she quoted me telling her that seeing the Veterans at the mercy of such a system, and not being able to change it, “breaks your heart”. As I have watched the delays in care and systemic VA failures and scandals continue it is still breaking my heart; Veterans still say to me at the end of an exam “You’ve been so kind” and I tell them everyone should be kind to them. Especially. I get stopped in the halls by patients I took care of in primary care and I give them my best information on how to push the system, including going to their US congressional representative. And I tell them not to give up because I am heartened to finally see a physician as Secretary of Veterans Affairs, Dr. David Shulkin, who comes from what we call the “real medical world” outside the VA. He has already instituted the VA Choice Program so that Veterans can be seen by private physicians in a timely fashion for all types of medical care—because he immediately knew that the “ugly chaos” could not go on.

As I said in my acceptance speech as one of three VA physicians named “Public Servant Of The Year” by the Office of Special Counsel in 2014, I’m a Boston girl and had walked the ground where the American Revolution started. I thought that standing up for what is right is in our American DNA. People told me I put my career on the line, and that is factually true—but it was either stand up or give up so I felt I had no choice. I needed to follow my moral North Star. Because as I’ve said and continue to say, “It’s about people’s lives.” In a broad sense, it as simple as that—and it is simply “sinful” to fail to take care of the life of a Veteran.

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