VA secretary demands leaders 'redouble' efforts to improve culture at Detroit VA

Washington ― Secretary of Veterans Affairs Denis McDonough is demanding leaders "redouble" efforts to improve the workplace culture and flow of information at the John D. Dingell VA Medical Center in Detroit after an internal agency watchdog found "siloed" communication and staff afraid to speak up about problems.

"Those findings are particularly troubling to me. ... I will be personally working with Veterans Health Administration and with our leaders including our network directors to ensure that they are redoubling our efforts to ensure that we are dedicated to and are implementing the fundamental tenets at the heart of a (High Reliability Organization)," McDonough said during a news conference Wednesday.

"Among those are the ability for us to have clear, candid and professional conversation and communication that goes two ways in our facilities, from our leadership down and from our care providers closest to the point of providing care to veterans back."

The agency's Inspector General Michael Missal said last week that past leadership failures at the Midtown hospital had resulted in a culture that did not prioritize patient safety or the delivery of high-quality health care, saying staff felt "psychologically unsafe to bring anything up."

Missal and McDonough traveled to Detroit on Friday for meetings with staff and veterans as the hospital strives to rebound from revelations of mismanagement and a lack of oversight that officials said led to patient harm.

VA official: Detroit hospital staff felt 'psychologically unsafe' to speak up

The visit followed Missal's release of an independent review showing slow progress on some of the recommended improvements at the facility and pointed out instability in leadership there, finding the hospital had suffered from recurring turnover in senior leadership positions, contributing to "a sense of irresponsiveness and a lack of psychological safety."

McDonough noted Wednesday that the VA is working to finalize Acting Director Chris Cauley's appointment as the medical center's permanent leader. Cauley has been at the facility in an interim capacity since March and previously led the Aleda E. Lutz VA Medical Center in Saginaw.

"I was very happy to have been in a position where we could reassure veterans and a veteran town hall and reassure our workforce in the workforce town hall, that the acting director Chris Colley would no longer be acting," he said.

The OIG report also revealed that facility leaders had delayed fully revoking clinical privileges last year for the hospital's former chief of surgery and reporting him to outside entities that track alleged physician misconduct, despite findings of substandard care and a potential "imminent threat to patient safety."

The OIG said facility leaders in Detroit had missed opportunities for reporting the former chief of surgery, Dr. Gamal Mostafa, to licensing boards in states where he's licensed, saying two clinical reviews in 2021 and 2022 had identified 16 episodes of substandard care by Mostafa that met the requirements to initiate reporting to the state entities.

Asked Wednesday why Mostafa had been allowed to retire in April with full benefits and pension, McDonough noted that, "It's been a very tumultuous period at the Detroit VA Medical Center."

"The ongoing review required many of our personnel to go through very difficult conversations, distressing conversations, and the leadership therefore made the decision to proceed as you've suggested," McDonough said.

The VA said it ultimately revoked Mostafa's clinical privileges and reported him to a national database that tracks cases of physician incompetence, misconduct and discipline, including malpractice payments and the restriction of physician privileges. 

McDonough also emphasized Wednesday that the VA had shared the "troublesome" data with 12 separate medical licensing boards in states where Mostafa was licensed. He also revealed for the first time that VA officials had stopped Mostafa's proposed transfer to one of their facilities in Chicago.

"They made the entire thing contingent on that provider never again even applying to work at VA, so we've made very clear our concerns in this regard," McDonough said.

Mostafa's attorneys have said the OIG report contained inaccuracies, and that "no harm came to any patients and no complaints or tort claims were ever filed by any of these patients."

Mostafa retired from the VA as of April 5, though he had performed no surgeries at the facility since August 2021. 

Wayne State University confirmed Friday that Mostafa remains a member of the WSU School of Medicine faculty.

mburke@detroitnews.com