Director of Veterans Hospital Accused of Manipulating Ratings Is Replaced

The Department of Veterans Affairs announced Thursday it would replace the director of its medical center in Roseburg, Oregon, Douglas Paxton. He had come under fire in recent weeks for limiting the number of patients the center admitted in an effort to improve its dismal performance rating, according to doctors at the hospital.

“There are times that facility leadership needs to change in order to usher in a new approach that will demonstrate we are committed to delivering results for veterans,” Dr. Carolyn Clancy, executive in charge of the Veterans Health Administration, said in a statement.

The Roseburg Veterans Administration Medical Center, a rural hospital that for years had ranked near the bottom of the veteran health care system, saw its rating rapidly improve under Paxton. But doctors said that improvement — in a rating system measured on a scale of 1-5 stars — was driven largely by strategic tweaks to health care practices to boost performance measures, even when they left veterans worse off.

One approach, which was reported by The New York Times last month, was to turn away more veterans against doctors’ wishes. Fewer patients meant fewer bad outcomes.

The Veterans Affairs Department said it was not rethinking its performance metrics, despite their apparent vulnerability to manipulation. But it also announced Thursday what it called “an aggressive new approach” to take over management of low-performing hospitals like Roseburg in an attempt to head off similar problems.

“If low performance persists, we will make swift changes — including replacing facility leaders, until we achieve the rapid improvements that veterans and taxpayers expect from VA,” Dr. David J. Shulkin, Veterans Affairs secretary, said in a statement.

Roseburg’s chief of surgery, Dr. Dinesh Ranjan, who helped oversee hospital admissions, was also removed this week.

At Roseburg, doctors told The Times, staff members had complained for more than a year about practices intended to improve the hospital’s scores. They said Paxton and his leadership team ignored their complaints and in some cases retaliated against them.

The department initially denied the reports of manipulation at the hospital. Paxton called the allegations “fake news” in an interview on Oregon Public Broadcasting shortly after the Times report was published.

But a steady stream of medical center employees came forward with more complaints during an investigation last month, according to Rep. Peter A. DeFazio, a Democrat whose district includes Roseburg.

He said he welcomed Paxton’s removal, adding: “There is a perverse problem. You have to be able to measure performance, but it’s a tricky thing.”

Paxton did not immediately respond to a request for comment.

Similar manipulation of performance metrics had gone on at other hospitals, DeFazio said, and officials were working to overhaul how the department uses the data. A department spokesman did not respond to requests for more information.

In Washington, Shulkin has pushed to make data a bigger part of the veterans health care system. This fall he set up a command center where a wall of screens tracks key metrics at hospitals across the country, such as infection rates and nurse staffing, in real time.

Though Roseburg showed how those metrics could be gamed, DeFazio said he had faith that Shulkin, a longtime physician and hospital administrator, was capable of making improvements.

“He has my confidence,” DeFazio said. “He has an expertise in health care we have not seen in former secretaries.”

Paxton will be reassigned as assistant director of the veterans hospital in Huntington, West Virginia. DeFazio said the former director and others could lose their jobs if a pending investigation finds them culpable.

He said he was concerned that the department was shifting people to new jobs rather than holding them accountable, and said he would continue to watch developments at Roseburg.

In an attempt to avoid similar problems in the future, the department announced that the lowest-scoring hospitals in its star rating system would automatically receive strict oversight from Washington, including monitoring of performance measures and improvement plans devised by top officials.

“If the facilities fail to make rapid substantial progress in their improvement plan,” the department said in a release, “leadership will take prompt action, including changing the leadership of the medical center.”