The Hospital on the Hill

A mean-spirited VA medical center director has patient care playing distant second to the bottom line

The Blinded American Veterans Foundation has documented lengthy waits -- often more than a year to get an appointment scheduled -- at the hospital's blind-rehab center; it also found that employees at the rehab center have been subject to harsh discipline and retaliation, which is why the unit is now being investigated by the VA's Inspector General's Office.

The existence of a link between Seiler's management style and lapses in services is not a given, critics acknowledge. But it is safe to assume that content, well-managed employees will be more conscientious in their work, that all their energies will go into providing care for veterans, not protecting themselves.

"He [Seiler] is a holy terror," Liftman offers. "He's created a climate of fear, and I don't have a problem saying that based on all the staff I've talked to."

Director Edward Seiler has created a culture of fear at the West Palm Beach veterans hospital, some who work there say.
Director Edward Seiler has created a culture of fear at the West Palm Beach veterans hospital, some who work there say.
Mark Poutenis

The WPB VA Medical Center experienced rocky times from the day it opened in 1995. Designing the hospital began in the 1980s, before the notion of cost-cutting through managed care had found traction. The plans called for 450 medical/surgical beds and 120 nursing home beds. By the time it opened, however, managed care was king. Gone were the days when patients with torn ligaments or even a hernia were kept overnight. Those hundreds of rooms were simply wasted space. And access to outpatient services through a single front entry has simply led to a logjam. By 1998, the average number of inpatients a day, including nursing home patients, was 172. The most recent figures, for 2001, show 186 patients -- a usage rate of less than 50 percent.

But the anachronistic design wasn't the only problem, according to a 1999 analysis by the VA Inspector General's Office. The hospital "essentially created its own organizational structure, which was unique within the VA," the IG report stated. The man responsible for this freewheeling style was Richard Isaac, who had overseen construction and then stayed on as the hospital's first director. Like any top hospital administrator, Isaac was responsible for implementing medical care with the roughly $100 million annual budget. Hoping to circumvent the bureaucracy and foster innovation, Isaac -- who had never run a VA hospital before -- chose a cadre of physicians with no prior VA experience to manage the clinical departments. In 1996, Isaac hired a new chief of staff who had little experience in such a position.

In 1997, Isaac -- a schmoozer with a penchant for micromanaging, according to people who worked with him -- attempted to restructure the organization, but "the effort was not well received or understood by the clinical staff and was not successful," the IG report stated. Late that year, Isaac resigned.

The next director, Edward Seiler, looked like a good choice on paper. He began his career in 1968 as a personnel management specialist at the VA Medical Center in Baltimore. During the ensuing years, Seiler worked his way up the ladder and in 1987 became director of the VA Medical Center in Providence, Rhode Island, where he earned a reputation as a man who could cut costs. While at the helm of the Providence hospital, he was forced to deal with a $1.5 million budget shortfall in 1996. He saved money by cutting staff and restricting the number of patients accepted.

Then Seiler came and imposed his own reorganization in West Palm, a system of harsh disincentives designed to keep costs down no matter what the consequences, critics say.

"The clinicians felt that too many decisions were being made by administrators," a psychologist at the medical center recalls. "It was a very punitive environment. If they didn't do what they were told, they were chastised."

By the end of 1998, Liftman, who works out of an office in West Palm Beach, had been bombarded with complaints by employees of a hostile work environment. At Hastings' behest, the VA Inspector General's Office looked into the allegations, finding a dysfunctional medical center in which the director had surrounded himself with top managers who broached no input from doctors and other medical professionals. The chief of acute care medicine told investigators that Seiler's chief of staff "lacks leadership skills" and "runs a feudal system that does not promote teamwork." Another former chief asserted that the chief of staff "uses intimidation to get his way, creating an atmosphere of mistrust and vindictiveness."

At the same time, Seiler "does not appear to want to talk with staff directly," a former chief of psychology told investigators.

The director, however, had solid support from Robert Roswell, another career VA man with a stern, long face who had become director of a network of six VA hospitals in Florida and Puerto Rico in 1995. An Oklahoma native who previously served as chief of staff at VA hospitals in Birmingham and Oklahoma City, Roswell insisted that Seiler and company were, in fact, "on the right track." Seiler would receive solid backing in the years to come from Roswell, until his benefactor himself crashed and burned earlier this year under allegations of mismanagement.

Coddling shaky administrators in the VA has been well-documented by congressional committees that oversee the VA medical system. Terry Everett, a square-jawed Republican representative from Alabama who chaired hearings about VA management in 1999, told members that "there is without question a good-old-boy network within the VA" that tolerates "favoritism, cronyism, harassment, and reprisal." He decried numerous examples "of where higher-ups have been given no discipline whatsoever for the actions they have taken." Retaliation against whistle blowers was also common, he said.

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Seiler did the same thing at the Huntington VA. Total disregard of staff, veterans except those on his close pal list.