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Leaving Manchester VA, Montoya Defends Handling of Flies in Operating Rooms

Peter Biello

Flies have once again forced the closure of now all three of the Manchester VA's operating rooms. This comes just as Medical Center Director Al Montoya is preparing to leave the Manchester VA for a job leading the Connecticut VA system.

Montoya took the helm as director in July 2017 when the past director was removed from her position after 11 whistleblowers came forward with allegations of mismanagement of a variety of things, including how to remove flies from the operating room. 

Friday is his last official day at the Manchester VA. Al Montoya spoke with NHPR's Peter Biello by phone.

Let's start with the news of the week first. When did this most recent appearance of flies in the operating room at the Manchester VA first occur?

I think as both of us know, this is an issue that the Manchester VA has looked at over the last several years. So what I am most proud about the Manchester VA is the fact that our staff felt that they could stop the line and speak up about any issues that they may have. And so over the last month or so, we've been working on a plan to really mitigate the issues in the OR.

So I'm gathering is so it's been about a month since they've most recently appeared. And you've, as the VA has done in the past, shut things down to clean the room and make sure that no veterans were were infected in any way.

Absolutely. I would say it's a little less than a month, Peter. And, you know, essentially what happens is it started out very small, so it started out in one room. And so it gave us an opportunity to continue procedures for our veterans to make sure that there was no impact on patient care. And then certainly there has been, and there continues to be, a zero percent infection rate as well.

This has been an issue at the VA in Manchester for years. And your predecessor was removed from a position in part. Not totally, but in part because of dissatisfaction about how the flies in the OR issue was handled. From your perspective. Why does this keep happening at the Manchester VA?

I want to put things in perspective a little bit. This just isn't something that just happens. You know, at the Manchester VA, this is something that happens nationally in private hospitals as well. And so, you know, anytime that there is some kind of an insect or something that comes into an operating room or a sterile field, you know, it's really important what happens after that.

But what is it about the Manchester VA that that makes this a problem that lingers for years? This is not something I've heard lingering for years in the private sector.

That's because I don't think that many organizations are as transparent as the VA is. So there is no requirement for private hospitals or institutions to do any kind of reporting like this. But I think, you know, it really speaks to the transparency here at the Manchester VA with respect to transparency.

I just want to point out that neither two years ago during the big scandal with the whistleblowers, nor during this time, has the VA come forward to the public and said, "This is what's happening. We're addressing it." This was something that that was discovered by whistleblowers coming forward and or reporting by journalists. So I just want to make that clear that when it comes to transparency, this is not something the VA comes out publicly and says. This is something that is left to discover.

I actually actually disagree with you on that point, Peter, because I think it is something that we have come out with.

I didn't get any press release about flies in the OR. This was something that was was told to me.

It's not something that's going to come out in a press release. It's something that we e-mailed out to our staff and let them know what was happening in the process that we were following.

You've been tasked as as the leader since the whistleblowers came forward two years ago with, among other things, helping to change the culture of the Manchester VA How, in your view, has the culture changed?

I think if you look at Manchester VA two years ago, we as you know, right after the Boston Globe article, we undertook our annual all employee survey. It's a pretty comprehensive survey, in fact, that asked a number of questions. How much do our staff trust the VA? How much do they trust their leadership team? Whether they think this is a best place to work in. A whole bunch of other questions.

So in that survey back in 2017, the Manchester VA was ranked number 127 out of 129 for best place to work. I'm very happy to report this year that if you look at our employee survey, we are ranked as one of the best places to work in VA. Overall for the all employee survey we're number 16 in the country.

What would you say are the Manchester VA's challenges going forward?

You know, I think the challenges are much what any organization faces.

And so just to to put a fine concrete point on it, like what are the specific things that the. The next leader of the Manchester VA gonna have to spend some time working on and thinking about and really overcoming.

What they are is really loving the organization. It's getting down on the front line and rounding. It's talking with your veterans, talking with the staff, talking with our community partners, you know, getting out there and really embracing the culture of the Manchester VA. And you know what's great about this, Peter, is that our employees, you know, the 940 dedicated employees have embraced this culture, too. So this is now their expectation.

You've taken steps to change the Manchester VA's urgent care. Ours used to be open 24 hours. And as of the end of August, it was reduced to just business hours Monday through Sunday. Some told me that this limits the VA's ability to respond in a timely manner to some urgent care cases. Does this not reduce the VA's capacity to treat veterans?

We did change the hours in urgent care. It is still a seven day a week operation. And I think that's important for our veterans to understand. It's still open on Saturday and Sunday and it's from the hours of 8 a.n. to 4:30 p.m. And so that's that's an important thing that, as we did change those hours, we actually brought on board the same services that every veteran would require when they would come into urgent care. So a veteran who presents now between 8 a.m. to 4:30 p.m. seven days a week, has access to radiology, to pharmacy, to the laboratory, to all of that those services that they need, which is something that's new.

A former employee of the Manchester VA wrote to me and told me this about the urgent care and the changes that were made at the end of August of this year. This person wrote: If a veteran presents after closing looking for mental health assistance, the administrative officer of the day will greet them at the door and call 9-1-1, even if it's not a true emergency. There's a good chance that a veteran will be stuck with that ambulance bill, even though the VA no longer offered 24-hour care and even though the VA calls the ambulance. If a case manager down at the Brady Sullivan building determines that it was not truly an emergency, the veteran will get stuck with that bill." Al Montoya, your thoughts on on this former VA employees comments on an urgent care?

Yes, I think, you know, it's certainly we need to put things into perspective here and, you know, for emergency care.  This is one of those things that it is dependent on eligibility. So it's going to be important for any veteran to know what priority level they are for eligibility and for their benefits.

But is that not a disincentive in some ways to use the VA if they are not sure that whatever illness they have is going to cause them to essentially have a huge ambulance bill that they may not be able to pay? Are they rolling the dice?

I actually don't think it's a disincentive. I think it's the other way around. I think it's an opportunity for them to be involved in their health care, much like millions of Americans across the country. Right? And so this allows them to be a partner in their health care. And, you know, certainly I encourage all veterans to choose the VA.

Peter Biello is the host of All Things Considered and Writers on a New England Stage at New Hampshire Public Radio. He has served as a producer/announcer/host of Weekend Edition Saturday at Vermont Public Radio and as a reporter/host of Morning Edition at WHQR in Wilmington, North Carolina.

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