MANCHESTER, N.H. — This is what the US Department of Veterans Affairs says a four-star hospital looks like:

One operating room has been abandoned since last October because exterminators couldn’t get rid of the flies. Doctors had to cancel surgeries in another OR last month after they discovered what appeared to be rust or blood on two sets of surgical instruments that were supposedly sterile.

Thousands of patients, including some with life-threatening conditions, struggle to get any care at all because the program for setting up appointments with outside specialists has broken down. One man still hadn’t gotten an appointment to see an oncologist this spring, more than four weeks after a diagnosis of lung cancer, according to a hospital document obtained by the Globe.

And when patients from the Manchester Veterans Affairs Medical Center are referred to outside specialists, those physicians are sometimes dismayed by their condition and medical history. A Boston neurosurgeon lamented that several Manchester patients sent to him had suffered needless spinal damage, including paralysis, because the hospital had not provided proper care for a treatable spine condition called cervical myelopathy.

“Only in 3rd World countries is it common to see patients end up as disabled from myelopathy as the ones who have been showing up after referral from you,” wrote Dr. Chima Ohaegbulam , of New England Baptist Hospital, to a doctor at the Manchester VA in 2014.

But this hospital, the only one for military veterans in New Hampshire, is just 50 miles from Boston. And it’s supposedly one of the better VA hospitals in the country. Late last year, in fact, the veterans affairs department raised Manchester’s quality rating from three stars to four, putting it in the top third of the entire VA system.

Ratings can deceive. Inside the unassuming red-brick walls of the Manchester medical center is ground zero for an extraordinary rebellion led by doctors who say they have almost no say in how the hospital is run, lack tools to do their jobs, and witness chronic shortcomings in patient care. They say the four top administrators, only one of them a doctor, seem more concerned with performance ratings than in properly treating the roughly 25,000 veterans who go to Manchester for outpatient care and day surgery each year.

So far, 11 physicians and medical employees — including the hospital’s retiring chief of medicine, former chief of surgery, and former chief of radiology — have contacted a federal whistle-blower agency and the Globe Spotlight Team to say the Manchester VA is endangering patients. The US Office of the Special Counsel, the whistle-blower agency, has already found a “substantial likelihood” of legal violations, gross mismanagement, abuse of authority, and a danger to public health, according to a January letter to one of the doctors who alleged wrongdoing.

“I have never seen a hospital run this poorly — every day it gets worse and worse,” said Dr. Stewart Levenson, chief of medicine, an 18-year veteran of the hospital who is among the whistle-blowers. “I never thought I would be exposing the system like this. But I went through the system and got nowhere.”

On Thursday night, a spokesman for Veterans Affairs Secretary David J. Shulkin expressed concerns about the problems relayed by the Spotlight Team.

“These are serious allegations, and while we cannot comment on the specifics due to patient privacy issues, rest assured that we will look into them right away,” said the VA press secretary in Washington, D.C., Curt Cashour.

[Globe]The Veterans Affairs administration failed to seriously investigate multiple complaints of poor patient care at the Manchester VA Medical Center in New Hampshire until media reports last year made the issues public, according to a sharply critical letter a whistle-blower agency sent to President Trump.

Doctors at New Hampshire’s only hospital for veterans had long complained that an extraordinary number of veterans being treated in Manchester were suffering from a rare spinal condition that can lead to paralysis if not treated. They said it was a sign hospital officials were not paying attention to patients’ declining conditions until it was too late.

But for months, VA investigators rebuffed criticisms of the hospital’s care for spinal patients as well as other shortcomings — including chronic flies in one operating room — until the Globe published its story in July, according to a letter from the federal Office of Special Counsel, which investigates whistle-blower complaints.

“This sends an unacceptable message to VA whistle-blowers that only the glaring spotlight of public scrutiny will move the agency to action,” wrote the head of the whistle-blower agency, Henry Kerner, in the Jan. 25 letter to Trump.

VA Secretary David Shulkin’s office released a statement on Thursday saying that it disagreed with the report’s claim it was slow to address the concerns.

Within hours of the story’s publication in July, Shulkin removed the top two leaders in Manchester and announced a “top to bottom review.” He has also promised an additional $30 million in funding.

“As soon as the allegations highlighted by the [Office of Special Counsel] reached Secretary Shulkin, VA took a number of immediate actions to respond rapidly to the issues raised,” said spokesman Curtis Cashour.

Kerner said the VA’s failure to correct problems in Manchester reflect a broader failure to ensure quality care for the 9 million veterans treated at VA facilities each year.

“These cases are representative of VA’s ongoing difficulties in providing appropriate and expeditious patient care and appear to demonstrate issues with VA’s efforts to ensure allegations are appropriately reviewed,” Kerner wrote. He complained that the VA officials who review patient care complaints were “frequently evasive in their reluctance to acknowledge wrongdoing.”

[Stars & Stripes]WASHINGTON — The Office of Special Counsel criticized the Department of Veterans Affairs on Thursday for ignoring whistleblower complaints about its medical center in Manchester, New Hampshire, and said the agency only reacted once the problems were thrust into the public spotlight.

Eleven physicians and other medical workers at the Manchester hospital spoke out about dangerous and substandard care at the facility, including unsterilized equipment, an operating room infested with flies and patients developing spinal cord disease, allegedly because of clinical neglect.

The Boston Globe published a report about the complaints July 15 and VA Secretary David Shulkin responded the following day by removing the medical center director, Danielle Ocker, and its chief of staff, James Schlosser. Shulkin visited the hospital, removed another top hospital employee, Carol Williams, and announced the VA would spend $30 million to improve care at the facility.

But VA leadership already knew of the problems six months earlier, in January 2017, when the Office of Special Counsel – an independent federal investigative agency -- alerted VA officials that they had received whistleblower complaints from four physicians at Manchester. The VA’s response was “sluggish” and “evasive,” and the agency was reluctant to acknowledge any wrongdoing, the Office of Special Counsel concluded.

Special Counsel Henry Kerner sent a letter to President Donald Trump on Thursday detailing his concerns about the VA’s lack of action when confronted with whistleblower complaints. He wrote the situation could signal a larger problem at the VA – that information from whistleblowers isn’t taken seriously.

“This sends an unacceptable message to VA whistleblowers that only the glaring spotlight of public scrutiny will move the agency to action, not disclosures made through statutorily established channels,” Kerner wrote. “It is critical that whistleblowers be able to have confidence that the VA will address public health and safety issues immediately, regardless of what news coverage an issue receives.”

The VA disputes that it didn’t take seriously the issues uncovered by whistleblowers in Manchester.

“We disagree with [the Office of Special Counsel’s] contention that we were slow to address these concerns,” VA spokesman Curt Cashour said in a written statement.

Rep. Joe Kennedy III, D-Mass., has invited a transgender Army staff sergeant, Patricia King, to be his guest at the State of the Union address on Tuesday night, his office confirmed Monday.

“Staff Sergeant Patricia King represents the best and bravest our nation has to offer," Kennedy said in a statement. "For nearly two decades, she has valiantly served our country and defended not only our safety, but our values at home and abroad."

He added, "Although I won’t be able to join her Tuesday night, I know that she will make our Commonwealth and our country proud at the State of the Union."

Kennedy, who serves as chairman of the Congressional Transgender Equality Task Force, will be delivering the Democratic response following the president's speech, so he will not be in the chamber during the address. However, he said he hopes King's presence in the chamber will send a message to Trump, who has pushed for a ban on transgender people serving in the military.

"I want her to be there as a real person, and the face of an inhumane policy,” Kennedy told The Boston Globe.

King, a Massachusetts native, entered the Army in 1999 when she was 18, and said she was honored to receive Kennedy's invitation.

"The State of the Union is part of our political process, an accountability system to make sure our government is being transparent," she said. "I'm honored and glad to bear witness to it."