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Tucson VA Inner Circle of deception?

Posted at 7:26 PM, Feb 29, 2016
and last updated 2016-03-01 12:50:22-05
TUCSON (KGUN9-TV) - KGUN9's investigation into the Southern Arizona VA staffing shortage  deepens.
Many Southern Arizona veterans, in pain, have been pleading for better care at the VA for years. After months of digging, we uncovered a high turnover rate of new doctors over the past 6 years that insiders say has led to long wait times for patients -- some nearly a year. Yet the Tucson VA passed an internal audit in 2014 following the Phoenix scandal that exposed phony wait times.
Since our first report aired three week ago, more whistleblowers have come forward describing years of deceptive practices that have been shrouded in secrecy.
At the center of the Southern Arizona VA controversy-- former director Jonathon Gardner, who after 22 years in Tucson, retired in early January, unexpectedly, say whistleblowers.
KGUN9 investigative reporter Valerie Cavazos spoke to more than a dozen current and former medical staff, including doctors, and they all blame Gardner and what staff refer to as his "Inner Circle" of administrators for creating a culture of fear, retaliation, and deception.
Gary Ramirez, who worked at the VA for 10 years, says managers instructed him to manipulate patient schedules by changing the date range months later to meet mandatory 30 day policies. Rameriz said, "I didn't like the secrets. They had an inner circle. They would have the supervisors and the leads and unless they find out a supervisor can't hold a secret then they'd be kicked out of that inner circle." 
Like Pat McCoy, a former Chief of Clinical Informatics, once inside Gardner's Inner Circle. Considered a golden child, she said, until she discovered "secrets" about unethical scheduling practices. 
And when she complained to Gardner in 2010, she says, he told her he looked into the issue and it did not exist. "I was summarily dismissed," she said.
She continued reporting problems to top administrators for more than two years.
*Nurses not being trained to use certain medical equipment
*600 requests for urology appointments stuffed into a drawer by a staff member -- which stopped the appointment clock.

*A backlog - nearly a year -- of patients needing lab procedures.
And she says the VA even went so far as to place phony consults into medical records - as seen here - to meet performance measures  only -- those measures -- or goals -- are tracked by Central VA.
"I believe Mr. Gardner was aware of it all," said McCoy.
Many top "administrators received bonuses" based, in part, on meeting scheduling goals. "A lot of times it's the flavor of the month. It's what needs to be done right now to meet metrics for Central office," McCoy said.
Whistleblowers say Gardner and his Inner Circle ignored, downplayed or dismissed many urgent concerns to hide severe staffing shortages.
This August 2014 email shows a 4-year doctor, who asked for help repeatedly and was told "help is on the way," "struggled to cover a VA clinic by herself for 8 months." "Patients were overbooked" - "becoming a safety problem." Another email reveals staff had been instructed to "overbook patients to meet the VA's metrics." Records show the doctor left the VA - 3 months after sending that email. 
Whistleblowers say morale had been poor under Gardner's leadership -- even with University of Arizona Medical staff who worked with the Tucson VA.
This 2013 UofA Department of Medicine Academic Review reveals relations were "strained" and "deteriorating" and the faculty, including doctors, felt they were "second class citizens." 
The Review Committee reported "a departure of VA senior leadership without replacements left several medicine sections shorthanded." And relations between the UofA and Tucson VA "were not likely to improve under the present leadership, which had not changed for several years." 
A source says the strained relations remain because the UofA couldn't work with Gardner or the current chief of staff, Fabia Kwiecinski, part of Gardner's Inner Circle.
A former 40 year Registered Nurse, who does not want her face shown on camera, left the Tucson VA in 2015 after she says she faced retaliation. Documents show 17 years of good evaluations during her time at the Tucson VA. In 2014, she moved to handling and scheduling thousands of patients by phone. Her supervisor told her she needed to manipulate patient appointments for a doctor.
"The appointment can't be more than two weeks out or the doctor doesn't get financial bonuses. None of his appointments were less than 3 months out. And she showed me how to falsify the documentation in the computer," said the nurse.
And when she blew the whistle to administrators, she says she faced retaliation. Her August 2014 evaluation shows she had a difficult time performing tasks. She says she was told by her manager. "You're not doing a good job. You're not a good nurse. And I thought 40 years of nursing, I never had a bad evaluation," said the nurse.
She says she was later fired.
Two veteran VA doctors, who want to remain anonymous, told me they faced retaliation after reporting care issues -- "stripped of their titles and committees by top administrators." 
Pat McCoy says after three years, she felt she was forced to leave in 2013.
"The ultimate result was they dismantled my department took my title and job role away from me. Downgraded my performance ratings I believe I was retaliated against," she said.
McCoy filed a complaint with the Office of Inspector General in 2014 and it elevated to a criminal investigation. McCoy asked one of the investigators if they substantiated her claims. "And his comment to me the best I recall his words were Pat, we substantiated everything you gave us. He said it was the most negative punitive environment he had ever been in. And that staff actually came out of the woodwork to find them to talk about what was going on in Tucson," said McCoy.
The investigator told her criminal reports go to the US Attorney General for possible prosecution. McCoy says she's been told the report hasn't been released because the investigation is ongoing.
We have tried to reach out to Jonathan Gardner. Over the last week I've tried to contact Mr. Gardner by phone and left voicemails and Cavazos went to his house and hand-delivered a letter requesting an interview. We reached out to the acting director, Jennifer Gutowski, who worked under Garnder. She declined an interview, but sent this statement: 
The executive leadership of the Southern Arizona VA Health Care System (SAVAHCS) will continue to review all issues brought forward by KGUN 9 News coverage. 
(Last) week a team from the Veterans Engineering Resource Center (VERC) arrived to conduct an in depth evaluation of our healthcare processes and will be offering advice as to how to strengthen our current services. The VERC is a program under the VA Office of Quality, Safety, and Value.
If there are any concerns with Veteran care at SAVAHCS we encourage our Veterans, their families and our staff to bring these issues forward to leadership. 
The staff at SAVAHCS are dedicated to serving America's heroes and I want to reemphasize that executive leadership is reviewing the problems KGUN 9 has aired and will continue to address them as appropriate.  

And KGUN9 will continue to investigate.

If you have any information, please contact KGUN9 Investigative Reporter Valerie Cavazos at