A whistleblower at the Billings Veterans Affairs clinic revealed practices in the statewide dental system that caused care delays and risked patients’ health, a 2016 internal investigation found.
The whistleblower, a staff dentist named Kelly Hale, has remained employed at the Billings VA clinic but hasn't seen patients.
It's unclear what Hale's current role is at the clinic since the VA closed the Billings dental office in January. The VA described it as an administrative position rather than a "patient-care" position.
The U.S. Office of Special Counsel is fighting the VA's recommendation that Hale be fired for professional misconduct, alleging that it was in retaliation to Hale's disclosures.
Hale’s allegations led to an investigation by the VA’s Office of the Medical Inspector in June 2016. It found that the Montana VA dental system had communication gaps in consultation requests that caused long delays and posed “a substantial and specific danger to public health and safety,” according to the VA’s report to the U.S. Office of Special Counsel.
In one case, a patient with a mouth lesion waited 11 weeks for a consultation form to be filed before a biopsy was requested.
It also found that the Montana VA dental system improperly denied consultation requests for dentists outside the VA system, causing patients to make long trips for dental care.
All this was under the direction of Dr. Robert Bourne, who was the Montana VA chief of Dental Services, according to the report. Bourne stepped down from that position but stayed on as a staff dentist.
A consistent pattern
The hiccups in the system, and the concerns raised by Hale, arose from the lack of access to an electronic filing system.
VA dentists use a program called the Computerized Patient Record System to log information, including consultation requests for doctors outside of the VA facilities.
According to the report, staff dentists didn’t have access to the electronic record system. Instead, Bourne required them to fill out paper forms and fax them to another facility for electronic entry.
Denied consultations never made it into the computer system, leaving no record of any request on behalf of the patient, the report said.
The VA found that this system caused consistent delays that potentially affected the health of patients.
After staff dentists faxed the paper consultation forms, it often took days — and sometimes weeks — for the information to be logged into the electronic system. Patients needing tooth extractions or implants were left to wait and, according to the report, suffered pain for “longer than necessary.”
“We noted a consistent pattern of patients presenting to the CBOC (Billings) dental clinic with severe pain being sent to the community,” the report said. “Some veteran patients were identified as having severe swelling or infection.”
Bourne was told by superiors to correct this as early as February 2016, after a review by the VA Administrative Investigation Board.
By the time the Office of the Medical Inspector arrived in June 2016, the dentists were still using the unapproved paper forms, according to the report.
The VA also found that within this system, Bourne denied some patients dental care outside of VA facilities when they should have been approved. Patients who lived 200 to 300 miles from the nearest VA clinic were automatically denied a voucher for care from a non-VA dentist.
As a result, the patients were required to make the trip to the nearest VA facility, even if it was hundreds of miles away.
Consultation delays weren't limited to dental services within the Montana VA system. A review by the VA's Office of Inspector General found delays for thousands of patients seeking medical care at Fort Harrison.
Forty-two percent of patients were delayed for in-house consults, and 56 percent were delayed for consults to facilities outside of the VA. Within the Veterans Choice program, 61 percent of patients saw delayed consultations.
The OMI report on the dental system was presented to the U.S. Office of Special Counsel in October 2016. A letter written by Acting Special Counsel Adam Miles in August 2017 said that the dentists no longer use the paper consultation forms and have access to the electronic system.
Though the paperwork problem appeared to be fixed, the Montana VA dental system still caused pain to patients.
In January, the Montana VA shut down the dental office at its Billings clinic. Patients needing routine dental work were referred to the next nearest VA clinic — either Fort Harrison near Helena (245 miles away) or in Sheridan, Wyoming (128 miles away). Provider agreement programs, such as the Veterans Choice Program, were suspended in the middle of the year for lack of funding.
The VA hasn't publicly explained the reason for the dental program's closure.
Montana VA spokesman Mike Garcia explained to The Gazette on Oct. 10 that the Billings dental position is "scheduled to be filled in January." On Wednesday Garcia declined to discuss Hale, citing personnel privacy.
In the background, the future of Hale's employment at the VA is in dispute.
In July, the Montana VA recommended Hale's removal based on an internal review that sustained four allegations of misconduct. The charges that served as the basis for removal were abuse of patients, disrespectful language or conduct and endangering the safety or causing injury at a VA facility.
But those findings are being challenged by the Office of Special Counsel on Hale's behalf. The dispute is taking place at the U.S. Merit Systems Protection Board, an agency that oversees federal employees.
According to documents filed with the Board, the Montana VA requested an investigation into Hale's conduct two weeks after he was identified as the whistleblower in late 2016.
The OSC believes the Montana VA may have taken personnel action against Hale because he was a whistleblower.
The OSC successfully obtained a stay of the proposed firing of Hale, which expires Nov. 19.
As a whistleblower, Hale may be subject to new protections. The VA Accountability and Whistleblowers Protection Act, co-sponsored by Sens. Steve Daines and Jon Tester, was signed into law by President Donald Trump in June. The law forbids retaliation against whistleblowers.
Hale has declined comment to The Gazette.
The VA's current position is that patients can seek dental work through provider care agreements, like Veterans Choice, or go to another VA facility, like the one more than a hundred miles away in Sheridan.
Department of Veterans Affairs Press Secretary Curt Cashour confirmed on Thursday that the stay order requires the VA to keep Hale on staff, though it's an "administrative position."
While the Merit Systems Protection Board postponed Hale's removal, Cashour said the VA wasn't obliged to have him see patients while the review is underway.
“Secretary Shulkin has been clear that judges who have never run a hospital and never cared for our nation’s veterans will not force VA to put employees back into patient care positions. This case is no different,” Cashour said, referring to VA Secretary David Shulkin.
Due to privacy restrictions, he said he couldn't comment further.