It is nearly two years since the news broke of veterans dying while waiting to receive appointments to see the doctor at VA Hospitals. Sadly, not much has changed in the last two years.
The Scandal Breaks Out
For those of you unfamiliar with this story, let me briefly review the known facts. According to the Inspector General report, the reports of fraudulent documentation of waiting times for veterans to receive medical treatment at the Phoenix VA Hospital were worse than initial claims. The IG report found primary-care waiting times averaged 115 days, nearly five times what the hospital reported and eight times the VA’s 14 day target. About 3100 veterans were actually waiting in line and more than half of them weren’t on the official waiting list. Whistleblowers at the hospital allege that forty or more veterans died while waiting to receive treatment.
This problem was not unique to the Phoenix VA Hospital alone. At that time 42 VA medical centers were under investigation for similar problems. This is not actually a new problem. According to an editorial in The Wall Street Journal, this is the 19th IG report since 2005 to document excessive wait times at VA Hospitals.
Dr. Sam Foote is an internist who worked for the VA system in Phoenix for 23 years. In recent years he became concerned when he saw that too many veterans were not receiving the care they needed. He wrote letters to the VA Office of the Inspector General charging that Phoenix-area veterans had died waiting months for care, hidden on secret waiting lists. Then he reached out to the media. Soon, other whistleblowers acknowledged the same problems at other VA hospitals.
The subsequent investigation revealed 57,000 veterans had been waiting more than three months for an initial appointment and another 64,000 veterans had requested an appointment over the past decade but weren’t even on the waiting list. These people had either fallen through the cracks of the system or had been kept on secret lists designed to make the facilities appear more efficient than they were.
What provoked this situation? In the 1990s, with the population of WW II veterans shrinking, the VA opened eligibility for health care to more veterans. Between 1997 and 2001, the number of veterans using VA health care services jumped 40 percent, to 3.7 million. The wars in Afghanistan and Iraq only added to those numbers.
Then the economy declined in 2008. This increased the stress on VA resources since many veterans lost their private health insurance and began using the VA as a backup system. “Whenever the economy tanks, more people come to the VA,” Foote says. “People would come in and say, ‘This is the first time I’ve used my benefits because I was on my wife’s insurance’ or ‘I had my own insurance and I lost my job.’ ”
Between 2002 and 2012, the number of VA health care enrollees increased nationwide by a third to 9 million. Outpatient visits to VA facilities nearly doubled to 83 million per year. In the last three years alone, primary care visits increased 50 percent, but the number of primary care providers grew only by 9 percent. Naturally, the result was even longer waiting times.
Foote tells of a meeting in 2012 to discuss strategies for handling the crisis of increasing demand for services. He recalls the only answer discussed: “But they came up with one: Fake the numbers. Simple. That was the solution.”
The Inspector General Report
The problem of long waiting times was nothing new to the Inspector General. He had issued 18 reports since 2005 documenting delays in care nationwide. In 2011 the VA had set a goal that patients should be seen within 14 days of requesting an appointment. Knowing they could not meet this expectation, Phoenix VA, and many other facilities, found ways to fudge the numbers.
For instance, if a veteran requested an appointment but the first available slot was five months away, the system handled the situation as Foote explains: If the veteran agreed to that time – even though he wanted care much sooner – a VA scheduler could mark the wait time as zero days. Since there were financial rewards for meeting the goal, employees had good incentives to cook the books.
Foote first began calling the situation to the attention of the inspector general in June 2013. It took six months for an investigation to begin but in December 2013, the IG sent a team to Phoenix. Foote heard little and wrote another letter of concern to the IG in March. When the results of their investigation were finally released, the news was worse than even Foote suspected. The IG team found 1,400 veterans had waited at least three months for a first appointment. Forty or more veterans had died awaiting care.
The Scandal Gets Worse
Just when the scandal seemed too bad to believe, it only got worse. A Senate investigation led by Senator Tom Coburn (R –OK) revealed far more dirt has been uncovered about the VA that shows the problems there go much deeper than falsified waiting times.
Senator Coburn released his new oversight report, “Friendly Fire: Death, Delay, and Dismay at the VA.” This report was based on a year-long investigation of VA hospitals across the nation that documents inappropriate conduct and incompetence at the VA that led to well-documented deaths and delays. Furthermore, it reveals inept congressional and agency oversight that allowed these problems to grow unchecked.
Findings of the Report
The key findings in the report include:
- The cover up of waiting lists for doctor’s appointments at the VA is just the tip of the iceberg, reflecting a perverse culture within the department where veterans are not always the priority and data and employees are manipulated to maintain the appearance that all is well.
- Bad employees are rewarded with bonuses and paid leave while whistleblowers, healthcare providers, and even veterans and their families are subjected to bullying, sexual harassment, abuse, and neglect. For example, female patients received unnecessary pelvic and breast exams from a sex offender, a noose was left on the desk of a minority employee by a co-worker, and a nurse who murdered a veteran harassed the family of the deceased to get them to admit guilt for the death.
- The care at more centers is getting worse and some VA health care providers have lost their medical licenses, and the VA is hiding this information from patients.
- Delays exist for more than just doctors’ appointments – disability claims, construction, urgent care, and registries are also slow or behind schedule.
- Despite a nursing shortage, many VA nurses spend their days conducting union activities to advocate for better conditions for themselves rather than veterans.
Not Much Change
Robert McDonald was appointed Secretary of Veterans Affairs in July 2014 and was tasked with solving this problem. Unfortunately, according to two legislators on committees responsible for oversight of the situation, not much has changed.
Senator Jerry Moran (R-KS) and Congressman Jeff Miller (R-Fl) report their findings in The Wall Street Journal. Moran is a member of the Senate Committee on Veterans’ Affairs and Miller is chairman of the House Committee on Veterans’ Affairs. They say the VA’s culture of indifference persists and the climate of accountability Mr. McDonald promised is nowhere in sight. They write:
“It is now clear that the VA’s most serious problems are rooted in its leaders’ routine and pervasive refusal to seriously discipline those who have engaged in proven incompetence, corruption and malfeasance.”
As evidence they site:
- Only three low-level VA employees have been fired for wait-time manipulation. Not one senior-level executive has been fired.
- In September the VA’s Office of Inspector General revealed that two VA senior executives inappropriately used their authority to game the agency’s hiring system, allowing them to benefit from more than $400,000 in taxpayer-funded relocation expenses. Instead of recovering the money and firing the two individuals, the VA is planning to give them assistant-director jobs paying more than $100,000 and ignoring calls from Congress and veterans service organizations to recoup the funds on behalf of veterans and taxpayers.
- In December the public learned of two internal VA investigations that found whistleblowers at the Phoenix VA Hospital were retaliated against by two senior managers for reporting dangers to patient care and financial mismanagement. More than a year after investigators recommended to Secretary McDonald that the managers be disciplined, the VA has refused to hold them accountable.
Furthermore, McDonald and President Obama are interfering in efforts by Congress to fix the problems. The VA Accountability Act (H.R. 1994) was passed by the House to give the VA secretary the authority to swiftly fire or demote any employee for poor performance or misconduct while protecting whistleblowers and limiting the agency’s ability to place misbehaving employees on paid leave. Yet McDonald refuses to support this legislation and the president has threatened to veto it.
There is no known reason for refusal to stand with veterans to improve their healthcare. This legislation is supported by every major veterans service organization, including Veterans of Foreign Wars, the American Legion, Vietnam Veterans of America and Iraq and Afghanistan Veterans of America. It’s time the president and the VA secretary do what’s best for our veterans and stop playing politics with their healthcare.