Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, March 29, 1992 TAG: 9203290220
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
SOURCE: LESLIE TAYLOR STAFF WRITER
DATELINE: LENGTH: Long
And she shouldn't. It is her fourth news conference in less than one month.
Her voice cuts through the muffled silence. She talks of low employee morale and stressful work conditions that she says have resulted in deteriorating patient care at the Department of Veterans Affairs Medical Center in Salem.
She maintains that the core of the problem is the "mismanaged" move to the new $55 million clinical addition, designed to consolidate acute medical and surgical beds into one building.
Not all who work at the center agree with her approach, but to Lee, making public what she charges is a VA medical center spiraling out of control under the weight of mismanagement, seemed a final necessity.
"A lot of people say, `Don't air your dirty laundry,' " Lee said. "But when you can't get to the washing machine, you have to get rid of the dirt somehow."
Lee has taken on the Department of Veterans Affairs, the nation's third largest federal agency.
When working from within at the Salem VA Medical Center got her nowhere, she went public and drew the attention of national union and VA officials, including Veterans Affairs Secretary Edward Derwinski.
The attention was sharp last week, when the decomposed bodies of two veterans who had been psychiatric patients were discovered on the center's grounds.
Derwinski postponed the April 3 dedication of the new clinical addition, citing recent "turmoil" at the center as his reason.
To Lee, the discovery of the two bodies was "the last straw," she said.
Airing concerns publicly is nothing new to Lee. In her six years as president of the federation local at the Salem center, she has rattled a few cages with protests and picketing.
But this time, she says, the concerns she shares with many of the union's 600 members have not been ignored.
Last month, Lee stepped out from behind closed-door meetings with Salem VA management and made numerous allegations against Director Clark Graninger, Chief of Staff Larry Edwards and other management. To some, it appeared to be just another blues-crying effort by the union.
But Lee's bravado had an odd kind of domino effect. She says the fear that had kept employees from speaking out appeared to ease somewhat.
Her phone rings constantly with employees spinning tales of staffing shortages and concealed video cameras. One employee told Lee that stress had become so overwhelming that she'd checked herself into a psychiatric hospital. The employee - who also talked to this newspaper - was calling Lee from her hospital bed.
Media attention crept outside Southwest Virginia.
The Federal Times, a national trade newspaper for federal employees, ran a front-page story. A reporter from a magazine in California called Lee for comment for a story about "Article 99," a recent movie about problems of overcrowding and understaffing at some veterans' hospitals.
The union's national office in Washington got involved.
National President John Sturdivant urged Derwinski, who for three years has headed up the massive Department of Veterans Affairs in Washington, to intervene.
And when the dust settled, Washington VA officials dispatched a review team to the Salem center to investigate the union's allegations. The team spent last week conducting its investigation.
Throughout, Director Graninger has kept fairly quiet, speaking almost exclusively through a public information officer. Edwards requested an interview with the newspaper several days after Lee went public in February, to offer management's side - that the new building would improve patient care and that the union's claims only detracted from those efforts.
But Edwards' published comments appeared only to add fuel to an already raging fire.
Both Graninger and Edwards declined to be interviewed for this story, saying - through the public information officer - that media interviews would be inappropriate while the review team was in Salem. The team left Friday.
In a letter to the Roanoke Times & World-News earlier this month, Graninger accused Lee of disparaging "the reputation and excellent staff efforts of the Salem VA Medical Center" with her remarks.
Graninger's views have been bolstered by some employees who say that Lee's attack only serves to damage the center's reputation.
"We have had some problems because of change in management and budget constraints that dictated some changes," said Laura Mays, a registered nurse who works in an intensive care unit. "There's been stress placed on nurses who had to quickly" change duties to "take care of patients they may not have taken care of before.
"My major beef is I'm not being thoroughly represented by this individual," May said, referring to Lee.
Other employees agree, saying they are doing the best they can given cuts in the Department of Veterans Affairs budget.
Graninger charged Lee with advancing "her personal agenda of re-election in April and possible national union office at some future date."
Lee is first executive vice president of the national federation's VA Council and a fair practice coordinator for the union for the district covering Maryland, North Carolina, Virginia and West Virginia, in addition to being president of the local in Salem.
Salem local elections will be held next month. National office elections are held in November. The union tried to delay local elections until the fall to deflect attention from Graninger's claim, but the union's constitution would not permit it, Lee said.
Graninger also wrote that Lee's remarks were an attempt to camouflage the union's major concern with management - competency testing and assignment of the center's nursing staff.
The union in turn has accused Graninger of intentionally turning the focus to the competency tests and away from real problems at the Salem medical center.
The union has filed an unfair labor practices complaint to challenge the competency tests. The union has charged that testing allows management to dictate staff assignments rather than negotiate them with the union, as federal statutes require.
At a March 8 meeting with 50 representatives from veterans service organizations, Graninger said the union was "stepping into something they have no business in" by contesting the competency tests.
A tape recording of Graninger's comments at that March 8 meeting was furnished to the Times & World-News.
"They are stepping into something that is clearly management's rights," he said. "When the union person and I talk, we don't talk about what's going on in the medical center. The only thing she says to me is, `You'd better stop this testing. You've got to stop this testing.'
"The rest of it is a smoke screen. It doesn't mean we don't have problems, but what I do not understand is how can [Lee] get up and say something about the quality of care on the one hand and not allow us to check the competency of the nursing staff on the other?" he said.
The 1992 Joint Commission on Accreditation of Healthcare Organizations standards for nursing care require that an evaluation of each nursing staff member's competence be conducted. Standards do not dictate how that evaluation is to be conducted.
In a move initiated by Graninger and Edwards, the Salem VA center recently began administering formal tests to assess employees' competency.
Nursing staffers were given two to three days of classroom instruction, followed by a written test. Test results were to have helped management in making work assignments, Edwards has said.
Graninger has said the testing puts the Salem center at the forefront of the VA system's 172 medical centers - the nation's largest system of health-care facilities. He has said that the test has been administered at only one other VA medical center, in Augusta, Ga. But a spokeswoman at the VA center in Augusta said last week that she knew of no such test given to nursing personnel at her facility.
On March 20, Graninger informed Lee by memo that management was delaying testing beginning March 23 and had agreed to meet and negotiate with the union on testing. That memo came several days after Graninger and Edwards flew to Washington for a meeting with top VA officials.
"This was one positive step to one of our many problems," Lee said. The negotiation meeting has been scheduled for mid-April, she said.
Lee says she has never disputed the quality of care that veterans receive at the Salem center. What she fears is that staff changes, stress and low morale is hampering patient care.
"It's got to filter down," she said.
Typewritten minutes from labor-management meetings indicate that the concerns Lee raised in February were the same ones she raised nearly a year ago.
The complaints raised then, taken directly from minutes of meetings in June, July, September and October include:
"Morale is down. There is a scheduling problem due to staff shortages. The employees feel they are overworked and stressed out.
"The union indicated that nursing has been pulling staff from 9-2 [a psychiatric ward] to leave only one person on the unit. They do not feel that is a safe situation for the employees.
"AFGE expressed their concern about so many things moving so fast and that there is insufficient planning taking place. AFGE is not being notified about what is happening.
"Employee morale is very low especially in Nursing Service due, in AFGE's opinion, in large part to the moves and planned changes which were not well thought out."
Similar concerns were raised in 1990. An investigation of the center's nursing service was conducted by a review team as a result of numerous complaints by nursing staff about staff shortages, patient care quality and physician involvement in nursing-administration decisions.
In its report, that team found that staff "consistently" cited workload and excessive use of overtime as a problem.
"Staff members state that sick leave usage has increased because requests for annual leave are routinely denied," the team wrote in its report. "Head nurses admit to frequently denying annual leave and state that this is done because actual staffing is insufficient to cover on a 24-hour basis without use of overtime."
The union filed an unfair labor practice complaint in 1990 because portions of the version of the report it received had been blacked out. The union argued that it was entitled to an unedited version under the Freedom of Information Act. The union has not yet received the unedited copy it requested, Lee said.
"These are not new concerns, not concerns just issued," Lee said. "You go the right route, have your meetings, file your grievances, whatever. But meetings and paperwork just haven't worked.
"I'm sure they didn't think this would go this far," Lee said. "We've had some hard times.
"But this is bad."
by CNB