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Northport VA Medical Center

Northport VA Medical Center. File photo

The Department of Veterans Affairs announced the appointment of Dr. Antonio Sanchez as the new director of the Northport VA Medical Center. He is taking over for interim director Dr. Cathy Cruise. Sanchez will oversee delivery of health care to more than 31,000
veterans.  

“We are excited to bring Dr. Sanchez on board as the new director of the Northport VA Medical Center,” said Dr. Joan E. McInerney, director of Veterans Integrated Service Network. “His sound leadership qualities and proven experience will be valuable assets for the facility, the employees and volunteers, and most importantly, for the veterans we are honored to serve. We anticipate he will arrive at the medical center within the next 45 to 60 days to begin his appointment.”

Sanchez joined the VA more than 18 years ago and has held positions at the VA Caribbean Healthcare System in San Juan, Puerto Rico. Most recently, he has been serving as the acting medical center director in Puerto Rico, operating 230 hospital beds, 30 psychiatric beds, a 122-bed Community Living Center, among others for a total of 382 operating beds. He has overall responsibility for 3,700 full-time equivalent employees and a $600 million budget.

Sanchez is a diplomate of the American Board of Psychiatry and Neurology and has a board certification as a fellow with the American College of Healthcare Executives. He received both his doctor of medicine degree and master’s in healthcare services administration from the University of Puerto Rico Medical Science Campus.  

The VA hospital has been without a full director since Scott Guermonprez left the position in July of last year after only one year at the helm.

The Northport VA has been plagued with staff shortages in recent years, including a federal investigation last year showing a chronic nursing shortage.

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Northport VA Medical Center. File photo

The Northport Veterans Affairs Medical Center’s homeless shelter closed their doors for repairs 18 months ago and never reopened.

Congressional leaders from all four Long Island districts want to know why and are demanding that the 50-bed facility, which they say is ready for inhabitants, welcome homeless veterans once again. 

“The closure of Northport’s on-site homeless shelter has forced veterans to find accommodations far from the medical services they need — the services that oftentimes help mitigate the root causes of homelessness,” said Rep. Lee Zeldin (R-Shirley), Rep. Tom Suozzi (D-Glen Cove), Rep. Kathleen Rice (D-Garden City) and Rep. Peter King (R-Seaford) in a prepared joint statement.

The veterans who stayed at the VA’s shelter suffered mainly from traumatic brain injury, post- traumatic stress disorder and substance abuse, according to Frank Amalfitano, president and CEO of Beacon House, the non-profit entity that managed the facility before it closed.

“It would be a tragedy if the place didn’t reopen, because so many people need the convenience of the services offered in one location,” he said. 

Northport’s  shelter closed in January 2018 for renovations to the heating system. Its closure was prolonged because the contractor hired by VA failed to update the building in accordance with current fire codes, according to information provided by Long Island’s congressional leaders. 

“As it has been presented to us, Building 11 has now been brought up to code and is ready to be inhabited,”  they said in a press release. “However, due to VA’s decision to terminate the on-site contract with Building 11’s vendor, with neither a communicated reason nor a viable replacement, we now find ourselves sixteen months later with a renovated building and no vendor in place to provide this vital service to our community’s veterans.”

Levi Spellman, press officer for the Northport VA Medical Center, said the contracting requirements are changing for the shelter, so that it can potentially be awarded to a for-profit, veteran-owned business. “We are actively expediting this process and anticipate resuming on-site services before the end of the year,” he said. Spellman also stated that Beacon has done a great job for the VA. “Although housing moved off-site, the same vendor is managing those shelters and the care we provide our veterans has not changed.”

Amalfitano said his contract for the Northport shelter was supposed to last until 2020. He’s been encouraged to reapply, but his organization may no longer qualify.

Beacon House manages 42 residential programs in Nassau and Suffolk counties for veterans. The mission of the 25-year-old, non-profit, which is funded by United Way, is to “help veterans regain their self-worth and empower them with the tools necessary to rejoin their communities as independent and productive citizens.”

Feds recommend trio of changes in staffing, hiring and overtime management to facility’s new leadership

Northport VA Medical Center. File photo

A federal investigation into Northport Veterans Affairs Medical Center’s four community living centers has shown a troubling trend of chronic nursing staff shortages and excessive overtime, issues that could have placed patients “at a higher risk for adverse events.”

In one case, federal investigators found a nurse’s assistant worked double shifts for six straight days — more than 96 hours in a single week – while expected to diligently oversee a patient requiring one-on-one care.

As the Northport facility is the only VA Medical Center on Long Island it serves more than 31,000 patients per year and oversees several outpatient clinical sites. Its four nursing homes are located in two buildings, with an approximate capacity of 170 beds.

The Office of Inspector General, a division of U.S. Department of Health & Human Services, charged with independent oversight of Department of Veterans Affairs programs, received several anonymous complaints about the quality of care received at Northport VAMC in 2017 following the deaths of two patients.

In September 2017, the OIG launched a year-long investigation into staffing shortages after receiving two further emails: the first from an employee at Northport VAMC, the second from a liaison to the House Committee on Veterans’ Affairs. The investigation produced a Sept. 18 report (click here to read the full report) that found Northport VAMC’s leadership knew about the staff shortages, forced administrative level nurses to care for patients, and yet still continued to accept new patients despite knowing they wouldn’t have the staff needed to provide the expected level of care.

Federal investigators recognized in August 2017 there was significant turnover in the leadership at the Northport VAMC, affecting key positions such as its director, acting chief of staff and acting nurse executive, who were cited “as catalysts for this change.” Staff members’ remarks indicated it’s given them hope for a better future.

The agency recommended a series of changes for the Northport VAMC pertaining to the nursing staff currently being enacted, and the facility says is bringing immediate tangible results.

Two patient deaths

Anonymous complaints about two patient deaths at the Northport VAMC in 2017 started the series of federal investigations into the facility.

The first death was a male patient in his late 60s who died as a result of choking on his food. Federal inspectors found insufficient evidence the man’s death was due to a lack of nurse oversight, as alleged in the complaints, but did conclude Northport VAMC had ongoing challenges in maintaining basic necessary staffing levels.

“Conditions such as staffing shortages could create an environment where the increased workload assigned to each staff member was such that it became more difficult to remain vigilant,” the report reads.

A forum was held for the Northport VA nursing homes staff to voice their concerns with the facility and its operation while an investigation of the first patient’s death was ongoing.

“Many [staff members] shared a concern about staffing levels being too low,” the report reads.

A second death raised claims of poor quality of care in the Northport vets nursing homes, after a patient in his mid-60s slipped, fell and fractured his hip. He underwent surgery and six days later stopped breathing. Allegations included the VA staff failed to protect the patient from falling and failed to properly provide
one-on-one observation post surgery, neither of which was substantiated by federal investigators.

The investigation into the second death showed the nurse’s assistant caring for him was on her sixth consecutive day of double shifts — 16 hours at a stretch. Investigators again cited “concern that working extra hours with double shifts could lead to staff becoming tired and less vigilant.”

A staff member working double shifts was not common practice, according to Northport VAMC spokesman Levi Spellman, who said union workers are contractually required to have 10 to 12 hours off between nursing shifts.

Closer look at staffing numbers

Records pulled by the federal investigators showed Northport VAMC has been chronically short of nursing staff dating back to at least 2016. Allegations were made that understaffing could lead to a higher rate of “nurse-sensitive outcomes,” such as surgical wounds getting infected, urinary tract infections, ulcers and pneumonia.

Northport’s four nursing homes were found to be short approximately 6.3 full-time employees in 2016 needed to meet VA’s recommended number of nursing hours spent with patients per day. By 2017, the facility’s staffing shortage had more than doubled, with 15.3 additional full-time employees needed. Northport VAMC’s nursing homes were only staffed at 60 to 80 percent of recommended levels over the two years, according to federal investigators.

Northport VAMC’s leadership attempted to tackle the short staffing issue by using “floating” shifts and overtime — sometimes mandatory, according to the federal report. Floating shifts meant staff from other areas of the VAMC were brought in to assist with patients in the nursing homes.

In 2016, Northport VAMC’s nursing home employees put in a  total of 19,991 hours of overtime. It nearly doubled by the end of 2017 as only 107.9 of the facility’s authorized 128 full-time positions were filled, according to Spellman, causing the facility’s overtime costs to skyrocket to nearly $1.5 million.

“Nurse managers had no mechanism to alert them if one of their unit nursing personnel worked excessive OT,” the report reads.

Federal investigators found part of the nursing homes’ staffing issues were due to an inability to hire and retain the members of its nursing staff. Northport VAMC got approval to hire 10 additional registered nurses and 10 nurse assistants as intermittent staff in November 2016, though the team wasn’t assembled until August 2017.

Often the process of hiring new nursing staff was delayed. In one instance, Northport’s leadership said two applicants interviewed and hired in January 2017 were told they would not start working until July.

“This delay in hiring often resulted in the loss of selected applicants who took other jobs,” the report reads.

The leadership of Northport VAMC said the high cost of living on Long Island has also made finding and maintaining a full-time staff difficult.

“Not only does this affect our ability to retain talent, but to recruit it as well,” spokesman Spellman said.

Steps to improvement

The federal investigators made three recommendations to Northport VAMC in order to  ensure it has adequate nursing care for its patients and improve quality of care for residents.

First, that the VAMC’s acting director, Dr. Cathy Cruise, completes a review of the nursing homes to ensure staffing levels align with the needs of its current residents. More staff should be recruited and hired to fill the current vacancies “until optimal staffing is attained,” reads the report.

Spellman said leadership of Northport VAMC, including Cruise, have already started taking action, implementing changes to improve the quality of care and working conditions.

A registered nurse clinical coordination position has been added in order to streamline nursing staff’s efficiency, according to Spellman. At the beginning of 2018, the facility was given approval to hire 2.6 more full-time employees and another 10 staff members were recently approved to bring the total nursing staff to the equivalent 140.6 positions.

“A staffing methodology is in the process of being completed, with additional staff expected,” Spellman said.

The Northport VA has received approval to directly hire its nursing staff and is giving new employees immediate start dates, according to him. It also had plans to expand its nursing floating pool, and to cross train other VAMC nurses in long-term care to continue to grow the available number of staff who can provide residents with care.

Third, Northport’s leadership was also told to improve its management of staff’s overtime hours and make sure of future responsible use of financial resources, citing the $1.5 million in 2017 overtime.

“Federal employees are expected to be good stewards of government funds,” the report reads. “The OIG found a lack of accountability for managing OT expenditures.

Spellman said the nursing homes staff had a total weekly average of 437.3 hours of overtime for the 2018 fiscal year, which ended Sept. 30. This indicates a significant drop from last year, where the total weekly average of overtime exceeded 750 hours.

“All of this is to say that, while the OIG has helped Northport identify areas in which we can improve, we have implemented measures to make those improvements — and we are already seeing results,” Spellman said.

Northport VA Medical Center. File photo

The director of Northport Veterans Affairs Medical Center has submitted his resignation, leaving the facility after a year at the helm.

Scott Guermonprez’s last day leading the Northport VA will be July 14 as he intends to retire after more than 30 years of military and federal service.

“Having the opportunity to come back to Long Island and my home, Northport, as a capstone assignment is a wonderful and awesome way to finalize my career,” Guermonprez said.

Having the opportunity to come back to Long Island and my home, Northport, as a capstone assignment is a wonderful and awesome way to finalize my career.”
– Scott Guermonprez

The director said this is effectively his second retirement from service. Guermonprez said he built his career in the military health  care system serving as an administrator there for 24 years, before initially filing for retirement. At the last minute, he transferred to the U.S. Department of Veterans Affairs to begin serving other veterans. Guermonprez worked for three years at Albany VA Medical Center before coming to Long Island.

“We’ve had a great time with health care professionally in Albany and Northport leading change, positive change we needed to make happen,” he said. “I am excitedly looking forward to future opportunities with family.”

Guermonprez said he believes he is leaving Northport’s facilities in better condition than when he arrived, claiming he’s improved the timely access to health care for veterans by making same-day appointments available for primary care and adding an increased capacity for telehealth, where elderly veterans can now use technology to talk and consult with their physicians from the comfort of their home. 

Dr. Cathy Cruise, recently promoted to permanent chief of staff at Northport VA, will step up to serve as the acting director while a national search is conducted to find Guermonprez’s successor.

“I can say I’m very happy to serve in the acting director position for as long as it takes; it’s an honor,” said Cruise, a Huntington native. “I’ve grew up here and developed my love of medicine here.”

Cruise has worked at the Northport center for approximately two years but has spent more than 23 years serving with the VA. She will take the reins of the $15 million in capital projects currently underway at the facility and, possibly, the long-awaited demolition of two buildings Guermonprez has focused on, for which permits were received and authorized July 5.

“I wish I could be here for it, but I’ve asked Dr. Cruise to save a brick for me,” he said.

Plan calls for the hiring of 40 additional engineers and police department staff

A temporary heating and air conditioning unit installed at the homeless shelter of Northport VA medical center. Photo by Sara-Megan Walsh

The new leadership at the reigns of the 90-year-old Northport VA Medical Center has unveiled a three-year plan aimed at making $21 million in repairs to address critical infrastructural and staffing concerns.

Director Scott Guermonprez said since taking up the position in June 2017, he has drafted together a plan that looks to address the out-of-date utilities systems and crumbling buildings that led to the closure of its homeless veterans housing in January, and a brief shutdown of its operating rooms in February.

““We have to figure out how we focus on the resources we have and use them as quickly and prudently as possible.”
– Scott Guermonprez

“There was a facility condition assessment done last year that came out that said if we were to try to fully rehabilitate the entire campus it would cost more than $450 million, or to try to build a new one would cost more than $1 billion,” Guermonprez said. “We have to figure out how we focus on the resources we have and use them as quickly and prudently as possible.”

There are approximately $7 million in projects getting underway this year, according to the director, which includes replacing four of the heating, ventilation and air conditioning units of the main medical center as well as a new roof.

The VA director said they had also received approximately $1.1 million to renovate the homeless veterans shelter, run by the nonprofit Beacon House, with new ductwork and an electronically controlled heating and cooling system. The work is expected to be completed by the end of the summer, according to Guermonprez.

The director said the three-year plan also calls for hiring 40 additional engineering and trade staff to oversee maintenance and upkeep of the 71-building campus under its new Chief Engineer Oscar Prue.

“[Prue] has been very successful in overseeing a large number of projects over multiple years and multiple locations,” Guermonprez said, noting he’s worked on VA medical centers in Albany and Syracuse.

“While this VA has plenty of work ahead of them, I am confident that they have a plan and are moving in the right direction…”
– Tom Suozzi

The first major project Prue is expected to tackle is the demolition of long-abandoned Buildings 1 and 2 which housed the facility’s original hospital, standing opposite the current medical center.

“It’s an eyesore,” the director said. “One of the biggest complaints we’ve had with Northport is insufficient parking. When it was built nearly 40 years ago, the intent was to demolish those buildings. It never happened.”

He anticipates the Department of Veterans Affairs will give him clearance to move forward shortly, with demolition tentatively scheduled to start in the late fall. These two of the 428 buildings nationwide the Veterans Administration has plans to demolish or repurpose. The space cleared will be converted to additional parking space for the medical center, allowing a few hundred spaces to be added.

“We want to add valet parking,” Guermonprez said. “We have the largest number of veterans over 80 years old in the New York-New Jersey health care system. We want to make it easier for them.”

Adding more parking and upgrading the heating and cooling systems will allow Northport VA to consolidate its medical treatment services into the medical center. Currently some programs like the outpatient mental health services and opthamology are in outlying buildings.

“[W]e are expanding police services given the unfortunate incidents occurring across the nation with shootings as we want to keep our veterans safe.
– Colleen Luckner

“While this VA has plenty of work ahead of them, I am confident that they have a plan and are moving in the right direction to ultimately upgrade and restore these facilities so that they can properly serve and honor our veterans here and in the community,” Congressman Tom Suozzi (D-Glen Cove) said after touring the VA facility with the director in late April.

Other key components of the VA’s three-year plan include replacing the campus’s steam vents and expanding its security force to deal with modern threats, said Colleen Luckner, associate director of Northport VA.

“In addition to the construction projects, we are expanding police services given the unfortunate incidents occurring across the nation with shootings as we want to keep our veterans safe,” Luckner said.

The Northport VA will be hiring on additional staff for its police department as well as implementing new systems such as additional cameras, panic alarms and other such measures.
Later this year, the Northport VA expects to celebrate the grand opening of expansion of its Riverhead outpatient clinic to include more physical therapy space and hearing services in July, before adding physical therapy, occupational therapy and more services to its Patchogue location.