New leader of St. Louis VA tries to stabilize embattled health care agency

Dec. 19--ST. LOUIS -- An old newspaper perched on the office shelf of the new director of the Veterans Affairs St. Louis Health Care System seemed like an odd display.

It was from 2014, when eager members of Congress celebrated a $17 billion plan to fix the national network of VA hospitals after a scandal that covered up poor medical service for military veterans.

Part of the plan included powers to immediately fire bad senior executives to hold them more accountable.

Keith Repko, now three months into his new post as top executive at the VA here, said he kept the newspaper for a different reason.

"We are getting past the rhetoric," he said of politics.

Repko flipped the newspaper open to a comment, circled deep in the story, from Navy veteran Ray Fogg. He had been treated for skin cancer at John Cochran VA Hospital on North Grand Boulevard.

"They saved my life," said Fogg, 79, of St. Charles. "I'm grateful to the great young surgeons that worked on me and put me back together. I don't know if I'm the exception, but I doubt it."

Repko holds onto Fogg's perspective for encouragement amid the distractions and problems he's now responsible to fix. He oversees a $440 million budget and 3,000 employees.

The search for the new director took more than three years, which drew scrutiny from Missouri's congressional delegation.

Sen. Claire McCaskill, D-Mo., a senior member of the Armed Services Committee, said in an email that the installation of a director was long overdue and she expected it would ensure better care for vets: "I've got high hopes that Mr. Repko will put his institutional knowledge to work in providing the highest quality of veterans' care, and in fixing personnel challenges, workforce shortages, and the red tape that's too often prevented reform -- and I look forward to working closely with him to meet those challenges."

While 34 out of 168 VA medical centers recently had vacancies at the top, St. Louis had one of the longest openings. Meanwhile, system wide, there have been more than 40,000 job vacancies. St. Louis is on the hunt for 400 employees, including 150 doctors and nurses, as well as a chief of staff.

"My hope, come the end of January, we will be a permanently filled executive team for the first time in three and half years," Repko said. "Hopefully, we will keep it that way for a while."

Two stars

Repko, 52, started working for the VA in the 1980s in North Dakota, when he was a biomedical engineering student. He transferred to St. Louis in 1991, rose to chief engineer, eventually deputy director a few years ago. He was last in a string of eight interim directors before being hired for the position starting Oct. 1.

"It's a big responsibility that I take to heart -- that there are 57,000 veterans who count on us as an organization for their care and my job is to lead that team," Repko said. "I am not personally responsible, but ultimately the buck stops here. It is my responsibility to lead that team to make sure we are firing on all cylinders, to make sure we are going after the areas that need improvement."

According to internal analysis of the national VA system in the third quarter of 2016, St. Louis ranked in the bottom half in several areas of service, including: efficiency, length of stay, employee satisfaction, in-hospital complications and acute care standard mortality ratio. St. Louis ranked among the bottom 10 percent for the likes of catheter associated urinary tract infection and in-patient satisfaction.

Overall, St. Louis has a two-star rating on a five-star scale.

"We believe the next quarter we will probably become a three-star system," Repko said. "Obviously, we aren't happy with being a three star, so we have multiple teams diligently continuing to work toward our next step of becoming a four star."

He pointed out that the St. Louis VA improved on several tiers evaluated for the rating system in the past year and became a standout for treating Hepatitis C.

But the VA's image has been the biggest obstacle to overcome in St. Louis since a report surfaced in 2010 over improper sterilization of dental equipment.

"Eight years ago, we went through some hard times here and we lost the trust of veterans. We did," Repko said. "We have worked hard -- and that's in our rear view mirror. Every day we want to regain more and more trust of the veterans."

A 2014 audit found that the VA St. Louis system, which includes Cochran and Jefferson Barracks hospitals and several clinics in a 17-county area, ranked among the worst in the country for average wait times for new patients to get specialty appointments.

Repko said more than 500 new positions were added in St. Louis to tackle wait times, which now rank in the best 20 percent of the VA hospital system.

Still, more obstacles surface. Last week, a man pleaded guilty to being part of a conspiracy to steal government funds through a kickback scheme involving contracting at Cochran. And a report from the VA Office of the Inspector General found that St. Louis VA officials insufficiently investigated the 2014 suicide of a mental health patient.

Fixing red tape

A spokeswoman for St. Louis VA said Repko signaled a sense of normalcy. He was promoted from within the ranks of employees who are familiar with him.

"I have a very direct passion for making and wanting to see St. Louis succeed," Repko said. "Having lived here now for 25 years, I've seen a lot of good things and a lot of trials and tribulations. I plan to stay here for a long time."

He and his wife, an administrative assistant at Washington University School of Medicine, raised two daughters in Fenton.

Though there's a push to hire more veterans at the VA, Repko is not one. His background is in equipment and facilities, such as the $366 million upgrade of the Jefferson Barracks hospital campus that is supposed to be completed in 2018.

He said he tried to see his father, a World War II vet, in the patients served by the VA. One time Repko's father, who is 90 and still delivers Meals on Wheels in North Dakota, gave him an earful about the VA's misplacing some of his medical records.

"You know what, I will admit, being part of a bureaucracy of the government, the amount of red tape and paperwork that we have is at times mind-boggling," Repko said. "We have worked hard, and continue to work hard, to try and streamline and get rid of some of that. We have a long way to go."

He said a recent example is that VA patients no longer need a referral from their primary care physician to get their eyes or hearing tested.

It's a small step toward pleasing more military veterans, their families and circling politicians.

Jesse Bogan --314-340-8255

@jessebogan on Twitter

jbogan@post-dispatch.com

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