WASHINGTON — Eric Shinseki resigned as secretary of the Department of Veterans Affairs on Friday, leaving behind a sprawling bureaucracy embroiled in scandal and burdened with a decades-old legacy of overwhelmed facilities and management failures that his successor must now confront.
President Barack Obama announced Shinseki’s departure after a 45-minute Oval Office meeting between the two men that ended a week of mounting demands from both parties for the secretary to step down. Obama, who appeared pained at the turn of events, hailed Shinseki as having an unquestioned commitment to the nation’s veterans.
He said, however, that the political storm had made Shinseki’s continuing leadership untenable.
“We don’t have time for distractions,” Obama said. “We need to fix the problem.”
Fixing the problem at the department now becomes an urgent political matter for the president. It once again raises questions about whether the candidate who pledged in 2008 and 2012 to make government work efficiently has lost grasp of the government he now leads.
The department’s troubles, however, remain a far more serious concern for the millions of veterans whose access to timely health care has been steadily eroding. This has occurred as waves of wounded soldiers from Iraq and Afghanistan have converged with those who returned from earlier wars.
Most of the veterans now seeking treatment at department facilities are aging Vietnam-era service members. Many have chronic illnesses such as diabetes that require long-term care. Veterans of Iraq and Afghanistan are further straining the system with mental health problems like post-traumatic stress disorder.
Soaring demand
The demand for veterans’ medical services is soaring. The number of outpatient visits to VA health care facilities has grown by 26 percent over the last five years, to 94.6 million in the current fiscal year, according to the department. Over the same period, the number of staff doctors and nurses has grown by 18 percent.
The effort to resolve the fundamental problems at the department will also play out in Congress. Republicans say the issue is not a lack of money — the department’s $154 billion annual budget has more than doubled since 2006 — but rather inefficiencies in the delivery of care. Democrats say the problem is a serious shortage of doctors and not enough hospitals.
“This is going to be a slow grind,” a senior administration official who asked for anonymity said of the need to overhaul the department. “A lot of the problems, they are not just systemic, but they are chronic. It’s like, roll up your sleeves, start digging into the culture and get rid of people who are impeding necessary change.”
One immediate question is whether the departure of Shinseki will have any real impact on the agency’s deep-seated problems.
Shinseki’s defenders
Shinseki apologized in a speech Friday morning, before Obama accepted his resignation, saying that he was “too trusting” of some people working for him. He criticized a “systemic, totally unacceptable lack of integrity” at some veterans health care centers that he said he could not explain.
Defenders of Shinseki point out that problems at the Veterans Affairs Department, the country’s largest health care system, were far worse during the Vietnam era. Despite the current problems, many veterans say that the quality of care delivered — once they are able to get into the system — is much better today.
But the problems described Friday in an internal audit are remarkably similar to those documented six years ago in a report to the department by Booz Allen Hamilton, the management consulting company. The Booz Allen report found “chronic delays in care” at veterans hospitals and clinics. Those resulted in part from “the current shortage of nurses, nurse practitioners, primary care providers and specialty physicians.”
Shinseki had been challenged by some of those problems during his five years at the department’s helm. A year ago, he and Obama had what aides described as a “come to Jesus” meeting in which the president demanded that Shinseki deal with a huge backlog of disability claims that were delaying benefits to veterans.
But the recent allegations that officials manipulated waiting lists for thousands of veterans across the country exposed even bigger issues. The department’s internal audit, which Shinseki presented to the president on Friday, attributed the scheduling scandal to the agency’s “overarching environment and culture which allowed this state of practice to take root.”
The audit said that the department’s culture “must be confronted head-on if it is to evolve to be more capable of adjusting systems, leadership and resources to meet the needs of veterans and families.”
The seeds of Shinseki’s departure may have been planted years ago, when he established standards that his supporters said were admirable but unrealistically high. He set 125 days as the goal for processing disability claims and was then blamed for the backlog that ensued. For new patients, he required that veterans be seen within two weeks.
In the audit, that 14-day standard was singled out as an “organizational leadership failure” and a major problem in providing timely care, second only to a shortage of doctors.
In announcing Shinseki’s departure, Obama said a number of department officials, including in Phoenix, the medical center that spawned the current scandal, would be fired. He also said that bonuses would not be paid to senior VA health care executives.
Finding replacement
The challenge for Obama now will be finding someone who has the ability not just to lead a department with nearly 300,000 employees, but also steer it in a new direction.
Obama said Friday that Sloan Gibson, Shinseki’s deputy and the president’s choice to be the acting secretary, will not lead the department over the long run.
“There is a need for a change in culture within the VHA,” Obama said, referring to the Veterans Health Administration, “and perhaps the VA as a whole that makes sure that bad news gets surfaced quickly so that things can be fixed.”
The president may also face a difficult time getting Congress to agree on legislation and financing to make the necessary changes. Democratic and Republican lawmakers have demonstrated vastly different visions for reforming the department.
Speaker John Boehner, R-Ohio, said Friday that “until the president outlines a vision and an effective plan for addressing the broad dysfunction at the VA, today’s announcement really changes nothing.”
Michael D. Shear and Richard A. Oppel Jr., The New York Times
VA care Q&A
The Department of Veterans Affairs’ aging network of hospitals and clinics — it opened its first new medical center in 17 years in 2012 — is one of the world’s largest integrated health care systems.
Where can veterans seek health care?
The Veterans Health Administration, by far the VA’s largest arm, operates about 1,700 health care sites, including medical centers, community clinics and counseling centers. There are 150 medical centers, with at least one in each state, Puerto Rico and the District of Columbia. In 2003, a nationwide Web-based portal was launched to help vets track their records and give them access to health information.
After the recent allegations about treatment delays and falsified records surfaced, Veterans Affairs Secretary Eric Shinseki announced more veterans will be able to get care at private hospitals and clinics.
Who provides care?
The VA health system has more than 275,000 full-time employees. Its specialists conduct research in such areas as PTSD, prosthetics, spinal-cord injury and exposure to Agent Orange.
Who is eligible?
Veterans of any military branch, unless they were dishonorably discharged, are eligible, as well as reservists and National Guard members in some cases. Dependents and children of veterans can also receive benefits. In most cases, veterans must apply for enrollment.
Nearly 9 million — up from just under 8 million in 2008 — are enrolled. The VA system saw 5.5 million patients in 2008; that grew to 6.5 million in 2012-13.
The VA says its commitment to providing better care increased a disability claims backlog but that it hopes to eliminate the backlog in 2015. It processed about 1 million claims a year from 2010 to 2013.
Is it free?
Health care is free for some veterans, including those whose incomes are low, former prisoners of war and those with severe disabilities as a result of their service. Veterans who served in a combat zone are eligible for free VA hospital care, outpatient services and nursing home care for two years after leaving active duty because of an illness or injury that may be linked to service. For others, co-pay charges are $15 for a basic visit and $50 to see a specialist such as a surgeon or optometrist or for certain tests. The co-pay for a stay at the hospital can be as low as $236 for the first 90 days.
What does it cost the U.S.?
The VA’s medical care budget was about $55.6 billion in fiscal year 2013 and is estimated at about $57.3 billion this year. The 2015 estimate is nearly $60 billion.
The Associated Press
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