VA Social Workers Pressured to Discharge Vulnerable Patients from Community Living to Private Care

April 24, 2020

OSC has alerted the President to investigative findings showing that management at a VA medical center pressured social workers to inappropriately discharge patients from VA Community Living Centers.

The U.S. Office of Special Counsel (OSC) has alerted the President and Congress to investigative findings showing that management at a U.S. Department of Veterans Affairs (VA) medical center in Coatesville, Pennsylvania (Coatesville VAMC) pressured social workers to inappropriately discharge patients from VA Community Living Centers (CLC) into private nursing facilities. The findings demonstrated that discharged patients were not advised of their right to appeal these removals, and that patients with skilled nursing care needs were discharged when it was medically improper.

“I commend the whistleblower for alerting OSC to these serious allegations," said Special Counsel Henry J. Kerner. “The investigation found social workers were pressured to make discharge decisions that were not in the best interest of the patients. Moreover, discharged patients were not advised of appeal rights afforded to them under agency policy. I was disappointed by the VA's failure to hold management officials accountable for their actions. That is a disservice to the vulnerable veterans they were charged with helping."

The investigation confirmed that in December 2017, Coatesville VAMC initiated a “Difficult to Discharge" (DTD) process at the CLC and established a list of designated patients at the direction of management. Social workers repeatedly objected, noting that patients included on the DTD list were still eligible for CLC admission and were not clinically appropriate for discharge.

During interviews, numerous social workers expressed concerns that due to leadership pressure, patients had been discharged from the CLC inappropriately. The investigation found several examples. In one case, a patient was told he needed to pick a medical foster home for discharge, over his objections and in violation of three different VA policies. In another case, managers requested repeated examinations of a patient by different doctors in an apparent effort to obtain an evaluation that could justify the patient's discharge.

In his letter to the President, Special Counsel Kerner found that the VA's investigation did not appear reasonable and urged the VA to revisit accountability actions for senior leadership who endorsed and facilitated this conduct. He did, however, commend corrective actions taken by the agency and statements by the whistleblower that discharges are now being handled more appropriately at the facility.