Rima Nelson disappeared from public view after the St. Louis Department of Veterans Affairs (VA) hospital she managed potentially exposed 1,800 patients to HIV, was closed twice for serious medical safety issues and ranked dead last in patient satisfaction.
But Nelson wasn’t fired. Her VA superiors hid her literally on the other side of the Earth in 2013 at the department’s only foreign facility, a seldom-used clinic inside the palatial U.S. Embassy in the Philippines capital city of Manila.
She resides in a government-provided condo and gets the same $160,000 salary she made in St. Louis, which allows her to live like royalty in a country where the average person makes only $2,500 a year.
The Manila VA office provides outpatient care and disability checks to the few surviving Filipino World War II veterans who fought alongside Americans against the Japanese. The occasional American veteran who happens to be in the country can also get outpatient care in the Manila VA facility.
The Government Accountability Office questioned in 2011 whether the office was still needed since the last members of the WWII generation of vets were rapidly dying.
On Monday, The Daily Caller News Foundation published a story and database documenting VA’s “bad bosses merry-go-round,” in which the department attempts to solve problems at one facility by bringing in a director who is often fleeing problems at another facility. The merry-go-round exists because civil service rules make it costly and time-consuming to fire top government managers.
Nelson — one of nearly 100 top VA managers TheDCNF found were transferred between three or more states within eight years — became director of the St. Louis facility in February 2009. In mid-2010, its dental unit shut down for a time after the hospital notified 1,800 vets that issues with sterilizing dental equipment could have exposed them to HIV and hepatitis.
Earlene Johnson, a medical device tech, told Congress she tried to warn management starting in March 2009, but no one listened. Johnson was then fired by the VA in retaliation, Johnson testified.
“If people were taking their jobs seriously, not passing the buck and pointing the finger, none of this would have happened,” she said. A VA undersecretary acknowledged that “we did not respond quickly enough.”
An inspection had found that dental equipment was “visibly dirty post-sterilization … Staff was not familiar with relevant VHA guidance.” A re-inspection found that some of the same issues “still existed 6 months later.”
Then in February, 2011, the hospital stopped performing surgeries for more than a month after surgical trays were found to be rusted. Nelson said the department had no clear explanation for how it happened.
Another follow-up “determined that routine environment of care (EOC) inspections did not adequately identify and resolve outstanding deficiencies.”
“The EMS cleaning log reflected missed cleanings of the area, and our inspectors’ surgical booties were dirty when they left the area,” inspectors wrote.
“This is one of the issues that has made me madder than anything I’ve ever seen,” Carnahan said, adding that mediocrity “thrives” at the hospital.
Capping it all off in 2011, a survey ranked the St. Louis facility last in patient satisfaction among VA’s 126 hospitals.
A 2012 review of 27 nurses’ personnel files found only half had the required documentation of their competency. Auditors found “a lack of effective nursing leadership.” A nurse committed “egregious acts resulting in death or near-death of patients” in 2010.
Nurses said they were retaliated against when they reported problems, and that they were saddled with staff-wide rules intended to fix problems that should have been solved by disciplining or firing individual nurses. Employees told a local TV station that veterans were left sitting in feces for days.
In 2013, a judge awarded $8.3 million to a veteran who became paralyzed after what his lawsuit argued was negligence and delays related to heart surgery at the hospital. Another sued, saying he went through radiation needlessly after a false cancer diagnosis.
“If [the St. Louis VA facility] were a ship or a military unit, the commander would have already been relieved,” then-Rep. Todd Akin wrote to then-Secretary of Veterans Affairs Eric Shinseki in 2011, noting that he wouldn’t support more money for the VA unless there were reforms and accountability for top staff.
Nelson was transferred to Manila in July 2013, even though as a nurse and hospital administrator she had little relevant experience to manage a facility whose main job is processing benefit checks.
Nelson said VA didn’t pressure her to leave St. Louis, and that her superiors wanted her to stay.
“The only reason I’m doing this is personal… other than that, why would I move to do something completely different and move to the benefit side when I’m a clinical person?” she told TheDCNF.
She’s been gone from St. Louis for nearly three years and VA has yet to replace her with a permanent successor.
Nelson said she applied for the job because her parents were spending half of each year in the Philippines during their retirement, and she wanted to be with them, especially because of health problems.
She said she left the St. Louis hospital better than she found it, and emphasized that closing it down twice was far better than the alternative.
She acknowledged that her new job managing 100 people, mainly Filipino, is less complex than managing a major city’s hospital with thousands of workers. The Manila office is responsible for 16,000 monthly checks being sent out, but “the money is automatically deposited from the Department of Treasury into the vet’s direct deposit account,” she said.
As for the benefits of making $160,000 salary and living rent-free in an extremely low-cost location, Nelson claimed “I don’t know, I hadn’t even thought that far, or thought of it that way. It’s a nice quality of life.”
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