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Fight over veterans benefits exposed

A doctor at Bay Pines VA Medical Center says he wasn't given enough time to evaluate patients. His superiors suspend him.

By PAUL DE LA GARZA
Published September 6, 2005
http://www.sptimes.com/2005/09/06/Tampabay/Fight_over_veterans_b.shtml

TAMPA - Every year the Department of Veterans Affairs determines the level of disability benefits for hundreds of thousands of veterans.

It's no small decision.

VA rulings can affect the livelihoods of veterans and their families for the rest of their lives, allocating them as much as $2,300 a month, tax-free, or nothing.

It raises a critical question: How much is enough time for VA doctors to spend with patients during mental health exams to help decide their benefits - 15 minutes, an hour, 90 minutes, more?

The debate over the correct answer is at the heart of a remarkable legal battle between Bay Pines VA Medical Center in St. Petersburg and staff psychologist Dr. Allan Fine.

The fight has spilled into the open, providing a rare look at how the VA decides the fate of veterans seeking financial relief.

Last fall, administrators at Bay Pines assigned Fine to conduct compensation and pension exams to help erase a backlog of benefits' claims.

Almost immediately, Fine fell behind. He conducted dozens of exams but did not file the paperwork to process the claims. He complained he wasn't given enough time to do "ethical, objective exams."

His supervisors countered he had plenty of time. They threatened to increase his workload, and proposed shortening the amount of time he could spend with patients - from 90 minutes to an hour.

With so much at stake, Fine said, that wasn't enough time. Sometimes files are incomplete. Sometimes they run three to four volumes. Sometimes veterans lie.

"You have to know the entire story in order to sort out what's what," Fine said. "Everybody's history is different. Everybody's experience is different. Everybody's personality is different."

In February, Fine's superior, Dr. Dominique Thuriere, moved to fire him. But hospital director Wallace Hopkins decided to levy a 30-day suspension, without pay, instead.

Fine has appealed his suspension with the U.S. Merit Systems Protection Board, the federal agency that settles labor disputes and which recently heard the case in Tampa.

A ruling is expected in a few weeks.

* * *

The battle between Fine and the VA began last October, after administrators at Bay Pines discovered that the hospital had the nation's second-worst backlog of compensation and pension claims.

The psychologist who conducted the exams at the hospital had quit in August, and the position had stayed vacant two months. The backlog totaled about 100 claims.

As recently as Aug. 22, the VA said the backlog of such claims nationwide totaled 349,841. Every year, the VA processes about 800,000 disability claims.

At Bay Pines, what management would later characterize as a crisis was no secret. But witnesses say that the interests of veterans can take a back seat to such factors as office politics, personal vendettas and budgets.

During a two-day hearing at the federal courthouse annex in Tampa last month, veterans' representative James Moulds said he repeatedly warned hospital officials about the backlog but that his pleas "fell on deaf ears."

The hospital eventually devised a plan to address the problem, but it wasn't without kinks.

Administrators rejected an offer of help from the VA in Miami. Two private doctors who were recruited to conduct exams backed out over pay.

Thuriere, director of Mental Health and Behavioral Sciences, suggested using residents, and allotting 30 minutes for the exams.

But Dr. Theophil "Tom" Sutton, supervisor of the compensation and pension exams at Bay Pines, worried about quality. He cautioned that the residents at James A. Haley VA Medical Center in Tampa had a terrible track record.

"I'm not sure I want any part of residents doing 30-minute psych exams," Sutton said.

Thuriere also proposed using three staff psychologists: Fine, Dr. Allan Smith and Dr. Daniel Penrod.

At the hearing, Thuriere testified she sidestepped union rules and did not seek volunteers or go by seniority to get people to conduct the exams because the hospital had an "operational emergency."

The mental health service at Bay Pines has 63 employees, including 14 psychologists and 18 psychiatrists. Fine, who has been at the hospital since 1991, said management retaliated against him because he has filed labor disputes before.

Sutton testified that from the start, Fine and his colleagues were unhappy they had been selected, "making me suspect in advance the quality of exams they will do."

The chief of staff at Bay Pines, Dr. George Van Buskirk, said he did not care.

"Their motivation comes every 2 weeks as a direct deposit in their bank accounts," Van Buskirk wrote in an e-mail that was cited by Fine as part of his appeal. "I'd like to see a little less whining and a little more action on this issue."

* * *

In a mental health evaluation, examiners review a patient's medical file, as well as military and family history. They also conduct a face-to-face exam.

At Bay Pines, which processed 3,600 compensation and pension claims last year, mental health examiners have 90 minutes to get everything done.

At the hearing, administrators pointed out that they cleared Fine's schedule repeatedly to allow him to complete his reports. His supervisors said he made little headway.

"He is adamant that he cannot complete the exams in less than three hours," Dr. Maria Crane, assistant chief of Mental Health and Behavioral Sciences, wrote in an e-mail Jan. 5.

"He stated that he would do the exams in less time if I wanted him to do the "veterans a disservice' and that I should put that in writing."

Witnesses testified the quality of Fine's exams were good.

As both sides punched and counterpunched, one thing remained clear: nobody really knows how much time doctors should devote to the exams.

Sutton testified that staff at Haley take as little as 15 minutes. (Haley did not respond to a message seeking comment.)

Van Buskirk, who previously worked at the VA clinic in Orlando, said exams there usually took 30 minutes. Thuriere said she had conducted 10 to 20 exams at Haley, completing each in an hour.

Dr. Penelope Bratton, who is under contract at Bay Pines to conduct the exams, said 90 minutes is plenty of time.

Hopkins, the hospital director, said "anybody with keyboarding skills" would be able to complete the exams. Smith and Penrod testified it took them three hours or longer, although they ended up doing only a handful.

J. Robert McCormack, Fine's attorney, introduced a "best practices" manual published by the Veterans Benefits Administration. According to the manual, initial post-traumatic stress disorder compensation and pension evaluations "typically require up to three hours to complete, but complex cases may demand additional time."

Of the 300-plus exams he has conducted, Fine estimated half were initial PTSD exams.

The VA argued the manual did not apply to Bay Pines, noting the agency's benefits section is separate from the medical section.

But Dave Autry, Washington-based spokesman for the Disabled American Veterans, said doctors should use the manual as a guideline. "You need to take the time to do the job right," Autry said. "The veteran is not served if you give them short shrift."

In the end, Bay Pines used residents, private doctors and Fine to eliminate the backlog, spokesman Oscar Seara said.

Since his suspension Fine is back conducting the exams, but his workload has been decreased. As of last week, he said he had one or two reports to finish.