The U.S. Veterans Affairs Department’s medical system is hobbled by management with little accountability and a “corrosive culture,” according to an interim White House report.
The medical system, beset by a scandal over extended waits for appointments and allegations of falsified records to cover up those delays, often ignores directives from its central office and rejects criticism, according to a summary of the report by White House Deputy Chief of Staff Rob Nabors.
The report, released yesterday, validates months of reports of delayed medical care for veterans that led U.S. lawmakers to criticize the Obama administration and prompted the departure of the department’s secretary, Eric Shinseki. The health-care system, with more than 1,700 facilities serving 8.76 million veterans annually, needs wide-ranging changes, the report said.
The department must address “significant and chronic systemic failures,” and restructure the Veterans Health Administration, it said.
One of the medical system’s performance goals -- to see new patients within 14 days of seeking an appointment, and existing patients within two weeks of their desired day -- is “arbitrary, ill-defined and misunderstood” and may have motivated personnel at VA facilities to falsify records, according to the report.
More Doctors
The department needs to hire more doctors and other health-care professionals, adapt to serve women and younger veterans, and respond to a “surge” in demand for mental health-care services, the report said.
The White House released the report’s summary after Nabors presented it to President Barack Obama yesterday at an Oval Office meeting that included acting VA Secretary Sloan Gibson. Obama asked Nabors to remain in his temporary role assisting the VA, according to the White House.
An internal VA audit of 731 veterans’ medical facilities released June 9 found more than 120,000 veterans were either waiting for care longer than 90 days or hadn’t received an appointment. The Federal Bureau of Investigation’s Phoenix office is conducting a criminal investigation of the delays.
An earlier review, before Shinseki resigned, found scheduling staff were told to manipulate appointments to cover up wait times at 64 percent of VA facilities.
Speeding Care
As part of the effort to speed care to veterans, Nabors’ report suggests convening a panel of health-care experts and industry leaders to develop a set of best practices. It also cautions against using performance measures, such as wait-time data, as a gauge of the quality of care.
Joe Davis, a spokesman for the Veterans of Foreign Wars, a Kansas City, Missouri-based advocacy group, said in an e-mail: “You have to dig deep to first identify and then fix what’s broken, to hold people appropriately accountable to the fullest extent if the law, and to restore the faith of veterans in their VA.”
House Veterans Affairs Committee Chairman Jeff Miller, a Florida Republican, said the report shows “the White House has finally come to terms with the serious and systemic VA health-care problems.”
While faulting Obama for failing to more quickly “heed our warnings about the very real and very deadly problems,” Miller said he’s willing to work with the White House on changes to the VA.
Congress is crafting legislation that would authorize billions of dollars to shorten long wait times for veterans seeking medical care at Veterans Affairs facilities and to make it easier to fire agency employees.
According to the Congressional Budget Office, the Senate version of a bill would cost as much as $35 billion over 10 years while the House’s legislation would double VA health spending and cost as much as $44 billion over five years. A House-Senate conference committee will resume talks on crafting a final measure next month when Congress returns to Washington after its break for the July 4th national holiday.
The VA has experienced an influx of patients as about half of the 1.9 million troops discharged after serving in Afghanistan or Iraq return to the U.S. in need of medical care, according to VA data. The department operates the U.S.’s largest integrated health system.
To contact the reporter on this story: Angela Greiling Keane in Washington at agreilingkea@bloomberg.net
To contact the editors responsible for this story: Don Frederick at dfrederick1@bloomberg.net; Steven Komarow at skomarow1@bloomberg.net Justin Blum
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