Friday, December 15, 2017
Mr. Dave Philipps,
U.S. House Representative Peter DeFazio contacted our group of emergency medicine
physicians, Emerald Valley Emergency Physicians, and requested we speak with you
about concerns regarding patient care at the RVAMC. Therefore, at his request, we
write you this summary of matters that are of longstanding concern to our group of
emergency medicine physicians. We are all partners and owners of a physician group
that has a contract to supply physician coverage to the emergency department at the
Roseburg VA Medical Center. The five partners are all Board Certified in Emergency
Medicine and continue to additionally work in a busy tertiary care medical center that is
a certified stroke, cardiac and trauma center. We also have 12 additional Emergency
Medicine Board Certified physicians with vast clinical experience working with us to
supply physician services. Five of us have worked at the RVAMC for 7 years.
Over the course of time, worsening over the past 2-3 years, we have seen a very
concerning trend of patient care being seriously compromised by the decision making of
senior administrative personnel at the RVAMC. The limitations imposed on us and our
ability to care for patients is very concerning. As experienced emergency medicine
physicians, we understand the complexity of patient needs and have devoted our
professional lives to providing the best possible care to our patients. The current
processes are being forced onto us by administrative non-practicing physicians, nonphysician positions including nurses and non-clinically trained positions which includes
the medical center Director. There has never been any effort to work with us to use our
knowledge of emergency medicine patient care to improve care of the veterans. They
make patient care decisions without speaking to the patient, without seeing the patient
in the ED and without speaking with the physician caring for the patient. The processes
are unethical, unsafe and driven by a constant discussion about needing to comply with
their misguided efforts to make the “SAIL” report better. Many times, we have been told
that the Director demands these artificial processes be used so that certain metrics are
met in order to try to increase the “star” rating of the facility. This has gone to such an
extreme that there has been an “Exclusion List” created by all these leadership
positions that is used to direct how we care for patients in the department. The
exclusion list is not one created by nor agreed to by the Board-certified physicians
working in the facility.
We have tried every manner possible within the VA system to address these concerns.
We have personally met with these people in leadership roles to discuss our concerns.
We have made it clear that we hope to be included in any processes that might discuss
clinical care within the medical center so we could offer our experience to assist the VA.
We are available at all times to meet with and discuss any clinical concerns. We have
participated in formal investigative processes conducted by the VA. We have attempted
to develop processes to collaborate with leadership. Despite our efforts, we are not
involved with nor consulted about clinical decision making. Often when we voice
concern that a process is dangerous and not good for patient care, we are met with the
response that “this is what the Director wants”. For many months the Chief of Staff, the
Chief of Surgery, the medical center Director, the previous Chief of Medicine and a

 Friday, December 15, 2017
previously employed physician who is part of the “Bed Control Team” who all direct how
we should be caring for patients in the ED have been unwilling to discuss these items
with us. Of importance is that the RVAMC is a small facility and our group of emergency
medicine physicians is by far the largest physician component there. Yet, we are
completely excluded from all patient care discussions and our concerns are continually
ignored.
Nowhere in a non-VA facility have we ever heard of this type of admission/care process
being discussed, suggested as a standard of care, nor forced upon physicians.
Physicians within our group hold many high level medical staff positions in a large
tertiary care private hospital system and trained at highly respected training programs
around the country giving us years of experience and context for our comments. We
cannot express strongly enough how detrimental this process has been for patient care
and how unacceptable it would be anywhere else. It is in our opinion a gross misuse of
positions of power in a complex government hierarchy to allow those people to
misrepresent the quality of care being provided to the veterans. Reasons for this
process being so adamantly defended by these few in power seem to be desire for
promotion, financial compensation and protecting their current salaries and positions.
It has become evident that a driving force behind restrictive processes and
compromised care in the RVAMC is an effort to meet a variety of metric measurements,
one of which is the SAIL report. The manner in which these metrics are discussed and
change is approached differs from any experience we have previously had in non-VA
medical centers. Although the metrics are purportedly to be used as a measurement of
quality, unfortunately the all-consuming drive to make spreadsheets look better by
senior leaders such as the Director Mr. Paxton , the Chief of Staff Dr. Ratnabali Ranjan,
the Chief of Surgery Dr. Dinesh Ranjan, other physicians Dr. William Stellar and Dr. Bilal
Chaudhry as well as RN staff Mr. Cowan and non-clinical staff Mr. Beiring has created a
nepotistic cartel of power that completely prohibits sound clinical decision making by the
emergency department staff and hospitalist physicians. Veterans are suffering.
Unethical practices are being promoted. We have no recourse within the VA system to
try to address these safety issues because every senior position above us refuses to
consider perspectives other than their own. It has become clear that the senior positions
starting at the Director level do not value the knowledge and experience of the
committed, educated, experienced staff physicians and nurses.
Our group has never before spoken with anyone outside of the VA system about our
concerns because we had tried to maintain faith that given time, the process for
improvement within the organization would correct these dangerous patient care
problems. It has become evident that there is no functioning process within the VA
system to improve care for these veterans and subsequently the health and safety of
the veterans is compromised. At this point we maintain some hope that speaking out
publicly might be the last hope for veterans to get the quality and compassionate care
they deserve. We feel we are placing our contract at risk by speaking to you at the
request of Mr. DeFazio but at this point it is simply not possible for us to find any other
means to address the malfeasance of the senior administrative positions in the RVAMC.

 Friday, December 15, 2017
We would have liked to work collegially with the staff and administrators to correct the
many issues of concern but there is unfortunately a very antagonistic, unprofessional,
unethical and deceitful relationship fostered at the RVAMC.
We hope that by speaking with the New York Times some of these issues might finally
be addressed to allow our group of dedicated physicians to provide the quality care that
the United States Veterans deserve and were promised for their service to our country.
Thank you for your professional consideration of the information we present to you. To
demonstrate how seriously we consider these issues, we are willing to allow these
statements to be used by you “on the record” if necessary as well as any other
comments in any possible follow up discussion with you that we explicitly discuss in that
context.
Sincerely,
Dr. Christoffer Poulsen, President, Emerald Valley Emergency Physicians
Dr. Charlotte Ransom, Secretary/Treasurer, Emerald Valley Emergency Physicians
Dr. Bradley Anderson, Partner, Emerald Valley Emergency Physicians
Dr. Michael Day, Partner, Emerald Valley Emergency Physicians
Dr. Ann Cooley, Partner, Emerald Valley Emergency Physicians