VA Scandal Gets Worse

The VA scandal has fallen from the headlines recently, displaced by new scandals like the implosion of the Obama foreign policy, especially in Iraq, and the “lost” e-mails at the IRS where Democrats are accused of targeting conservative groups. But new information just released by Senator Tom Coburn (R –OK) reveals far more trouble 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 is 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.

Dr. Coburn explains: “The Administration and Congress have failed to ensure our nation is living up to the promises we have made to our veterans. As a physician who has personally cared for hundreds of Oklahoma veterans, this is intolerable. As a senator, I’m determined to address the structural challenges of the Department of Veterans Affairs so we can end this national disgrace and improve quality and access to health care for our veterans.”

Findings of the Report

The key findings in the report include:

  • The cover up of waiting lists for doctors’ 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.

 

Tragic Consequences

The tragic consequences of this scandal of mismanagement are highlighted in the report:

  • The report identifies $20 Billion in waste and mismanagement that could have been better spent providing health care to veterans.
  • More than 1,000 veterans may have died as a result of VA misconduct over the past decade.
  • The federal government has paid out $845 million for VA medical malpractice since 2001.
  • Most VA construction projects are over budget and behind schedule, inflating costs by billions of dollars.

Who is responsible? There is plenty of blame to spread around for a problem that has existed for more than a decade under administrations of both parties. Yet the problems were well known when President Obama took office and he pledged to solve them. Unfortunately, there is little or no evidence that he did anything to provide the solution other than increasing the VA budget.

Senator Coburn’s report identifies the following failures:

  • The Senate Veterans Affairs Committee largely ignored the warnings about delays and dysfunction at the VA for decades, abdicating its oversight responsibilities and choosing to make new promises to veterans rather than making sure those promises already made were being kept.
  • This report details how Congress was repeatedly alerted and warned of the problems plaguing the VA over decades.
  • The Senate Veterans Affairs Committee has only held two oversight hearings the last four years, and was even profiled in Wastebook 2012 for being among the committees in Congress holding the fewest number of hearings.

The Real Problem

What is the real problem behind these VA scandals? Mark Hemingway, writing in The Weekly Standard believes it is the inability of the government to hold incompetent VA employees accountable. He reports the VA has fired a grand total of three senior executives for performance failures in the last five years – one-fourth the federal average for terminations.

The Office of Personnel Management disclosed in 2013, only 0.47 percent of the federal workforce was terminated for cause, considerably below the 3.0 percent fired in the private sector. In 2011, USA Today reported that in at least 15 federal agencies, employees were more likely to die of natural causes than be terminated in any given year. Yet, the average federal employee made  $126,141 in pay and benefits in 2012, more than double the private sector average.

Unions also contribute to the problem. Public employees’ union dues flow into the unions’ political contributions – which flow into Democratic coffers to maintain the status quo. Stopping this will require eliminating unions in government jobs. But even before this is achieved, we must stop union workers from being compensated by the taxpayer for union activities. In 2012, the IRS alone spent $21.6 million compensating employees who were working on union activities, not on public jobs. The Coburn report details how this same problem is widespread in the VA as well.

Solutions Proposed

The House of Representatives overwhelmingly passed bipartisan legislation, by a vote of 390-33, which would give the VA greater authority to fire or demote senior executives for performance. This additional firing flexibility would apply only to the top 360 supervisors out of more than 340,000 employees at the VA. Yet the bill was blocked in the Senate by Vermont’s Bernie Sanders.

Instead, Sanders joined forces with Senator John McCain (R – AZ) to pass a different bill that would increase VA funding by $500 million to expedite hiring for new doctors, nurses and other staff. The Wall Street Journal reports this is on top of this year’s $57.3 Billion VA budget, which is 106 % more than in 2003 though patients have increased by only 30 percent. The bill also gives the VA $236.9 million to lease or build 27 new major medical facilities in 18 states and Puerto Rico. And the Phoenix VA, first identified in this scandal for its dissembling and dysfunction resulting in preventable deaths, will be rewarded with a new $20.7 million “community-based outpatient clinic.”

In typical Washington fashion, the solution proposed is to throw more money at the problem and hope something good happens. But increasing the VA budget, as President Obama already did, has done nothing to solve the problem, because the problems are entrenched within the system. Building more buildings and hiring more staff will never solve these problems.

The Senate legislation does make one good suggestion; issuing veterans a “choice card” to allow them to seek care outside the VA if the wait is longer than the two-week maximum. This partial privatization trial is scheduled to expire in two years.   I would recommend this be made permanent so that veterans can be sure they will receive their care in a timely manner. Furthermore, this will hold VA executives accountable when they fail to meet their benchmarks.

Perhaps the most credible opinion on improving the VA situation comes from Kenneth W. Kizer, former Undersecretary of Veterans Affairs in charge of the VA health system under President Clinton from 1994 to 1999. Kizer modernized the VA’s computer systems, fired poor-performing doctors, and established private-sector-style metrics to measure the VA’s performance on patient wait times, according to Avik Roy, health care journalist for Forbes. The VA enjoyed a period of prosperity and improved performance under his leadership.

Writing in The New England Journal of Medicine, Kizer and coauthor Ashish K. Jha propose three steps to solving the current VA crisis:

  • First – after ensuring all veterans on wait lists are screened and triaged for care, the VA should refocus its performance-management system on fewer measures that directly address what is most important to veteran patients and clinicians – outcome measures.
  • Second – conceptualizing access to care in terms of a “continuous healing relationship”, the agency should design a new access strategy that draws on modern information and advanced communications technologies.
  • Third – engage more with private-sector health care organizations and the general public and make performance data broadly available. Transparency may expose vulnerabilities, but it is easier to improve when weaknesses are publicly acknowledged.

 

It is clear from the assessment of Kizer and Jha that just throwing more money at the problem is not the solution. The Wall Street Journal applauds their work and recommendations but offers a warning:

“After the Senate deal, look for the politicians in both parties to drop this issue and move on. The Kizer-Jha diagnosis is merely one among many showing that the VA’s problems run far deeper than a new hospital building or more spending can solve, which means that the Senate’s non-reform reform betrays veterans one more time.”

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