Van Zandt employee calls for VA to reform investigation practice
The former head of long-term nursing care at Van Zandt VA Medical Center is alleging that an ex-hospital director abused his authority by launching an investigation against her that lasted
17 months, leading to her demotion and embarrassment — all without justification, as a subsequent director has dismissed her case.
Nicole Bukosky, who still works as a regular staff nurse in a different department after declining to resume her old job for fear of “being under the microscope” again, said the VA needs to get rid of the instrument then-director William Mills used against her — the “Administrative Investigation Board.”
“As nurse manager, I was held (responsible) for allegations that were not substantiated by any evidence,” Bukosky said. “Simply because the VA wants to be able to say they hold their employees accountable.”
The VA needs to begin communicating with front-line staff and middle managers to solve problems, rather than using the AIB as a management tool for targeting, then getting rid of “scapegoats,” she said.
AIBs — including two others in her department where all charges were dropped and two others in recent times in other departments — must end, because they ruin careers and erode trust between staff and management, Bukosky said.
“They destroy relationships,” Bukosky said.
The VA stands by the practice of AIBs, according to a statement from Van Zandt spokeswoman Andrea Young.
“VA conducts intensive, thorough reviews when needed to learn the truth about incidents or accusations,” Young wrote.
Recommendations from AIBs are submitted to facility leadership, and leadership evaluates the recommendations and determines what actions should be taken, Young wrote.
“(These internal reviews are) an important fact-finding process in determining accountability,” Young wrote.
It’s a sham, according to Bukosky.
Top management at Van Zandt — and perhaps at other VA hospitals — use AIBs to take the focus off themselves, so they can turn it onto middle managers and front-line staff, she said.
It allows them to make the “accountability” claim at no cost to themselves, she said.
It’s a practice that top management adopted after the nationwide VA scandal at Phoenix, she said.
It’s a “trickle-down” effect of the scandal, she said.
Bukosky’s problems began in March 2015, when the girlfriend of a resident of the Community Living Center complained about nurses’ treatment of the resident.
Those complaints implicated Bukosky, because she was head of the CLC.
One nurse had allegedly displayed impatience when asked for a suppository, suggesting the resident should have waited to ask a nurse on the succeeding shift.
Another nurse allegedly groused about the resident’s ringing a call bell while she was eating lunch.
And two nurses allegedly failed to answer the resident’s call bell for 20 minutes, while they talked with one another in the hall.
The girlfriend also complained about nurses being unwilling to tend to the resident’s basic daily needs, like shaving and making his bed, and about their being unwilling to install the resident’s sleep apnea device at night, and about slamming his door one time.
And she complained about staff not being fully trained on respiratory equipment the resident received on a visit to the Cleveland VA hospital, about staff not using one of those pieces of equipment immediately on the resident’s return and about nurses not changing the filters on another machine frequently enough.
The girlfriend also alleged that Bukosky didn’t respond adequately to allegations in April 2015 that the treatment of the resident amounted to abuse and neglect — an allegation that triggered a VA police investigation.
The girlfriend and the resident backed off the abuse and neglect claims when questioned by police, but Mills nevertheless instituted the AIB in May 2015.
He introduced the AIB with a “brief statement of issue and status:
“On 4/6/15, reports of contact were received regarding a resident on the CLC regarding allegations of intentional omissions of patient care, verbal abuse, rude and demeaning remarks to a resident and significant other, humiliation, retaliation and neglect towards the CLC resident.”
That led to charges: seven counts of “failure to provide appropriate managerial oversight,” and one count of “failure to follow the patient abuse/neglect policy.”
The charges led to Bukosky’s informal demotion on May 26, 2015, pending the outcome of her AIB — her reassignment to the “non-VA care” department, located in the Van Zandt annex on Cayuga Avenue.
“I was exiled from the medical center,” Bukosky said.
As part of the AIB, a four-person group interviewed Bukosky in September 2015 for seven hours, Bukosky said.
The chair of the group asked questions, one at a time, and another member of the group would rephrase those questions, then a third member would rephrase them yet again, Bukosky said.
Then the board would move on to other questions.
Then they would return to the earlier questions.
At one point, the chair of the group told her, “Well, we’ve grilled you pretty good,” Bukosky said.
Most questions concerned leadership — hers and that of others in the nursing chain of command at the hospital, she said.
There were few questions about the actual complaints that triggered the investigation, she said.
The board members seemed to be trying to determine whether what had happened reflected badly on Bukosky’s bosses, she said.
She answered all the questions honestly, she said.
“I guess that’s not what they wanted,” she said.
Rather, they seemed to want her to say that the nurse executive and the service chief for acute and long-term care weren’t doing their jobs, she said.
The service chief was Bukosky’s superior, and the nurse executive was the service chief’s superior.
Her service chief and the nurse executive were interviewed in similar fashion, Bukosky said.
One session with the nurse executive lasted eight hours, Bukosky said.
Bukosky was interviewed about a month later by the same group for three hours, she said.
The AIB was still unresolved when Mills was “detailed” to take over the Memphis VA hospital in February.
In March, after the AIB completed its investigation, the acting nurse executive — who had been one of those questioned by the AIB — proposed a formal demotion to staff nurse for Bukosky, who had already been functioning as a staff nurse for 10 months, as a result of the complaints.
Bukosky responded in her own defense with a long, detailed letter to Interim Director Joe Sharon.
She worked on the response every night after work and every weekend, sometimes sitting at her dining room table for eight to 10 hours on weekend days, she said.
She finished at 3 a.m. the morning before presenting it to Sharon one day in May.
“I was trying to save my job,” she said.
Before Sharon had a chance to rule, however, the packet of papers comprising Bukosky’s response blew off the interim director’s windowsill, and she had to reorder it.
“Are you flippin’ kidding me?” she said, recalling her reaction when told it had happened. “You can’t make this up,” she said.
It took her four hours to put the packet back together.
Sharon never decided her case, as he was detailed out of the interim director’s job in July, she said.
Sharon’s successor was Charles Becker, who was not permitted to decide her case, she said.
Her ordeal didn’t end until October, when Acting Director Judy Hayman ruled there wasn’t enough evidence to justify any of the charges.
In her exoneration letter to Bukosky, Hayman reviews each of the eight counts in detail, then draws “conclusions” for each count, also in detail.
She ends each of those by repeating, “Accordingly, I find that this specification of misconduct was not supported …”
In explaining why Bukosky shouldn’t be faulted, Hayman cites her timely responses and extenuating circumstances — including her being away from work during alleged incidents, other officials taking appropriate actions before Bukosky had an opportunity to do so and situations in which Bukosky, as one who was accused, had to recuse herself.
Hayman also apologized for what had happened, Bukosky said.
In declining to retake her job, she forfeited two steps in pay, worth about $4,000 a year, which left her earning about $73,000, Bukosky said.
She doesn’t feel welcome at the main hospital now, anyway, because of the “stigma” of the AIB, she said.
In response to the AIB, Bukosky filed a complaint with the Office of Inspector General and with the VA’s Office of Special Counsel.
The OIG did nothing, she said.
The OSC stated that what had happened to her was not a “prohibited personnel practice,” she said.
Spokesmen for both of those agencies declined comment.
Bukosky also sent a letter to the secretary of the VA and to a representative in Congress, but got no response, she said.
“The leadership style at the Altoona VA is very much shoot from the hip, and employees are always guilty until proven innocent,” she wrote to VA Secretary Bob McDonald. “The Altoona VA leadership team is very good at sacrificing employees — especially frontline nurses and middle managers — to facilitate hidden agendas that promote the status quo.”
She brought her story to the newspaper as a “last resort,” she said.
Rather than launch an AIB against her, Mills should have talked with her and other nurse managers about the issues raised by the girlfriend of the resident, according to Bukosky.
“All he had to do was come to the table with us,” she said. “We could have developed a plan and avoided all of this.”
Instead, Mills launched an antagonistic process that led to employees informing on other employees, according to Bukosky.
His ultimate goal was to remove a chunk of the nursing leadership team — the nurse executive, who was in charge of all nurses; the service chief for acute and long-term care and the nurse manager of long-term care — whose collective management style he didn’t like, Bukosky said.
He succeeded in dislodging all three from their jobs, Bukosky said.
The resulting “turmoil” has contributed to the hospital’s slide from a five-star to a three-star facility in the VA rating system, she said.
Prior to the AIBs, she had worked on the CLC for 13 years and never had an action brought against her, she said.
Prior to that, she had served in the Air Force for 20 years, where she never had a disciplinary action proposed against her, she said.
In her case, “they tried to make something out of nothing,” she said.
“Guess what?” she said. “It didn’t work, because I didn’t just roll over.”
AIBs have made it a bit like high school, where you need to worry what you can safely say to whom, Bukosky said.
The VA contests Bukosky’s image.
“(The organization) is committed to thorough and comprehensive reviews to examine every aspect of critical situations to identify errors and ensure they are not repeated,” VA spokeswoman Young said. “We owe that to veterans, taxpayers and to the vast majority of VA employees who do the right thing for our patients.”
“We’re supposed to be working in this culture of trust and transparency,” Bukosky said. “(Instead), it’s a very punitive culture.”
Mirror Staff Writer William Kibler is at 949-7038.