{"id":4473,"date":"2025-03-18T08:09:00","date_gmt":"2025-03-18T08:09:00","guid":{"rendered":"https:\/\/medical-article.com\/?p=4473"},"modified":"2025-03-18T08:09:00","modified_gmt":"2025-03-18T08:09:00","slug":"at-little-known-health-agency-doge-ends-dream-to-make-a-difference","status":"publish","type":"post","link":"https:\/\/medical-article.com\/?p=4473","title":{"rendered":"At Little-Known Health Agency, DOGE Ends Dream \u2018To Make A Difference\u2019"},"content":{"rendered":"
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By MICHAEL MILLENSON<\/p>\n

Four days after emergency surgery and barely able to walk, Heather Sherman flew from Chicago to Washington for first-day-of-work onboarding at the Agency for Healthcare Research and Quality. Fourteen months later, Sherman suddenly became one of the thousands of federal employees summarily dismissed by a weekend email telling them they were \u201cnot fit for future employment.\u201d<\/p>\n

The trauma of that abrupt ending in mid-February \u2014 giving her just a few hours before all access was shut off \u2014 still lingers. \u201cThis was my dream job,\u201d Sherman told me.<\/p>\n

If Sherman were an air traffic controller or nuclear materials expert, her work keeping the public safe would be obvious. But as a mid-level employee with a technical role at a little-known agency in the mammoth Department of Health and Human Services, her curt dismissal and that of an undisclosed number of AHRQ colleagues prompted not even a ripple of news coverage.<\/p>\n

Yet what a\u00a0New York Times<\/em>\u00a0editorial<\/a>\u00a0decried as a \u201chaphazard demolition campaign\u201d by the Elon Musk-led Department of Government Efficiency, one that is undermining \u201cthe safety and welfare of the American people,\u201d applies to agencies like AHRQ and low-profile jobs like Sherman\u2019s just as much as to more high-profile positions.<\/p>\n

In complex systems, of which healthcare is surely one, carelessness has consequences.<\/p>\n

(Disclosure: I\u2019ve known Sherman for years, and while I serve on AHRQ\u2019s National Advisory Council, I have no inside information. All opinions are my own.)<\/p>\n

For Sherman, with two master\u2019s degrees and a Ph.D., the anodyne title of health scientist administrator masks a beyond-the-data devotion to patient safety.\u00a0A 2023 report<\/a>\u00a0by the President\u2019s Council of Advisors on Science and Technology declared patient safety \u201can urgent national public health issue.\u201d In truth, the urgency is embraced mostly by a small number of individuals determined to drastically reduce the estimated 160,000 Americans perishing each year from preventable medical errors in hospitals.<\/p>\n

That death toll is a conservative estimate by the Leapfrog Group. Food and Drug Administration administrator-designate Martin Makary\u00a0has called medical error<\/a>\u00a0\u201cthe third-leading cause of death\u201d and estimated a death toll of more than 250,000 Americans.<\/p>\n

Saving Lives and Money<\/h2>\n

Even if the focus is only fiscal \u2014 leaving aside the human impact \u2014 medical care that causes unintended harm is inefficient and costs money. The potential savings are large: an in-depth examination of medical records by the HHS Office of the Inspector General found that a shocking one-quarter of Medicare patients suffer some level of harm during a hospital stay.<\/p>\n

It\u2019s that \u201cinefficiency,\u201d human as well as financial, that Sherman wanted to attack at AHRQ. She proposed an initiative enabling hospitals nationwide to collaborate within a legal framework that promotes candor by protecting their interactions from being discoverable in a malpractice lawsuit. That structure is known as a \u201cpatient safety organization,\u201d established by Congress through bipartisan legislation in 2005. The process of ongoing collaboration is known as a \u201clearning health system.\u201d<\/p>\n

Sherman recalls reaching out to everyone she knew whose organization was affiliated with a PSO and asking what they needed to meet today\u2019s challenges. \u201cThe almost unanimous answer was, \u2018We want a place to find solutions, a place to share solutions,\u2019\u201d Sherman said. \u201c\u2018We want to know what to do.\u2019\u201d<\/p>\n

\u201cAny kind of systemic prevention of problems saves money,\u201d she added.<\/p>\n

To be effective, however, collaborative problem-solving on a large scale requires more than just setting up Zoom calls and sharing documents. It quickly gets technical; e.g., ensuring that all participants classify and report an adverse event in the same way.<\/p>\n

\u201cClassification is the key,\u201d Sherman said. \u201cIt\u2019s like a box of different-colored Lego pieces in different sizes. Each Lego is a data element. Everybody has to understand what it means in order to use it.\u201d<\/p>\n

Along with her technical expertise, Sherman also brought a determination to expand what information was collected and how it was used; for instance, by bringing in patient and family input. \u201cThe law was not meant to exclude reporting of problems by anyone who wasn\u2019t a clinician,\u201d Sherman said. She also planned to utilize qualitative data \u201cto tell a story. You learn a lot more about the nuances of error in the qualitative data.\u201d<\/p>\n

To accomplish those ambitious goals, Sherman began seeking buy-in from AHRQ leadership while also planning a national kick-off conference for May. Then, awakening on Saturday morning, Feb. 15, and turning on the TV news, she heard a White House correspondent report that government departments were firing \u201cprobationary employees.\u201d Soon afterwards, the dreaded email popped up in her inbox from the HHS personnel office.<\/p>\n

\u201cWe all knew it was coming,\u201d Sherman said. \u201cWe just didn\u2019t know when.\u201d<\/p>\n

A Legal Loophole<\/h2>\n

\u201cProbationary employee\u201d has a different meaning for federal employees than for private-sector ones. In the private sector a probationary period might last a few months, but an employee can typically still be fired \u201cat will\u201d any time afterwards, barring protections related to union membership or illegal discrimination. In federal employment, in contrast, the probationary period before civil service job protections kick in can last one, two or even three years, depending on various factors, and the probationary period can start over even for long-time employees if they\u2019re promoted or switch agencies. Sherman was hired on a two-year probationary period.<\/p>\n

Even probationary employees, however, can be fired only for certain reasons. Hence the careful language of the DOGE-driven form letter signed by HHS Chief Human Capital Officer (Acting) Jeffery Anoka that informed Sherman she\u2019d not met \u201cthe burden to demonstrate why it is in the public interest\u201d for the government to finalize her appointment. It continued, \u201cyour ability, knowledge and skills do not fit the Agency\u2019s current needs, and your performance has not been adequate.\u201d<\/p>\n

Excerpt from letter sent to probationary federal employees<\/p>\n

\u201cI was very calm that day,\u201d remembered Sherman. \u201cThe next day I was a mess.\u201d Questions of what would happen to her work, as well as compensation for unused sick leave and time off, remain unresolved; senior AHRQ managers are also in the dark. \u201cNobody knows anything, and there\u2019s no guidance,\u201d she said. \u201cI am disheartened and disappointed.\u201d<\/p>\n

At the Centers for Medicare & Medicaid Services, a senior manager named Jeff Grant pushed back hard in\u00a0a letter<\/a>\u00a0to Anoka posted on LinkedIn after 82 employees in his group were told they were \u201cnot fit for continued employment.\u201d Grant began by announcing he was immediately retiring after 41 years of federal service, emphasizing later that he had served with equal dedication both Republican and Democratic administrations. Grant went on to refute accusations of incompetence by saying the fired workers had not only passed a series of formal reviews with high marks, but the interview process, one in which he was personally involved, allowed CMS to select \u201ctruly the best of the best\u201d out of hundreds of resumes.<\/p>\n

Moreover, Grant pointedly noted, many of those fired at his Center for Consumer Information and Insurance Oversight were set to work on writing and implementing a new rule announced as a Trump administration priority. That rule, \u201cis projected to save billions in program dollars,\u201d he wrote, \u201cwhich is the ultimate in government efficiency.\u201d<\/p>\n

A Plea For Public Service<\/h2>\n

On an even more personal note, an \u201copen letter to America<\/a>\u00a0from career federal civil servants,\u201d written anonymously to avoid retaliation, poignantly reminded the public, \u201cWe are your neighbors, friends and family. \u2026 Most of us heeded a call to serve because we love this country and what it represents as much as you and wanted to give back. The hard work we do, we do on your behalf.\u201d<\/p>\n

That declaration resonates with Sherman, who said she\u2019s long yearned to work for AHRQ, a small-budget agency with the\u00a0big-mission task<\/a>\u00a0of helping make U.S. medical care better and safer.<\/p>\n

\u201cI never wanted to leave AHRQ,\u201d Sherman said. \u201cI wanted to be in this department, in this job, for the rest of my life. I didn\u2019t go into this profession to be rich. I went into this profession to make a difference in people\u2019s lives.\u201d<\/p>\n

The \u201cchainsaw\u201d approach favored by Musk continues: the administration has ordered every federal agency to turn in a plan for even more drastic cuts by March 13. The impact of two federal juges\u2019 orders reversing some probationary employee layoffs remains to be seen, particularly since they are being appealed. For Sherman, meanwhile, there are two poignant codas to her career situation. DOGE, the force behind her firing, has been criticized for acting with both joyful cruelty and\u00a0dubious legal authority<\/a>. As it happens, Sherman\u2019s undergraduate major was in judicial morality and constitutional democracy.<\/p>\n

Meanwhile, although Sherman almost immediately lost all job-related access, her last official day on the AHRQ payroll was March 14. This year, that\u2019s the next-to-last day of Patient Safety Awareness Week.<\/p>\n

Michael L. Millenson is president of Health Quality Advisors & a regular THCB Contributor<\/em>.\u00a0This piece was previously\u00a0in Forbes<\/a><\/em><\/p>","protected":false},"excerpt":{"rendered":"

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