by Robert Callobridge
In one of the largest scandals in its history, the Department of Veterans Affairs (VA) is now the focus of criminal and congressional investigations into its healthcare facilities after allegations arose that chronic mismanagement and possibly illegal scheduling practices led to the death of over fifty U.S. veterans. Originally branching from allegations of misconduct and scheduling irregularities at a VA healthcare system in Phoenix, Arizona, the scandal has since sent shockwaves throughout the political world and thrown into question the ability of the scandal-plagued agency to successfully address the needs of veterans.
A Tale of Two Lists
In early 2012, Sharon Helman took over as director of the sprawling Phoenix VA Health Care System. Within Helman’s first days, Dr. Katherine Mitchell, supervising physician for the Phoenix VA’s emergency room, warned her that the ER was overwhelmed and dangerous. Days later she was chastised by senior administrators and moved out of the ER, according to USA Today.
Mitchell’s complaint, later lodged with the Office of the Inspector General, alleged that the Phoenix VA kept two lists of patient appointments: one the publicly reported list that administrators were using to generate wait-time statistics and the other a secret list of appointments that hospital staff would use to house veteran appointment information until two weeks from the appointment, according to the New York Times. The secret list skewed the publicized statistics and made it look like the Phoenix VA was meeting two-week waiting targets set by Secretary Ed Shinseki.
At roughly the same time, Phoenix-based VA employees sent emails to staff lists questioning the integrity of statistics being cited as success stories by VA administrators. These emails, while not delving into the depth of Mitchell’s complaint, noted the discrepancy between the six-week wait times staff were encountering in the hospital to the two-week waits that the administrators were touting.
“I think it’s unfair to call any of this a success when veterans are waiting six weeks on an electronic waiting list before they’re called to schedule their first PCP (primary-care provider) appointment,” program analyst Damian Reese complained according to USA Today.
A month later, in October of 2013, Dr. Sam Foote, a doctor of internal medicine at the Phoenix VA, sent another complaint directly to the Inspector General. His complaint alleged that the Phoenix VA successes in meeting updated veteran waiting time goals were the result of data manipulation and that veterans were dying while awaiting appointments for medical care.
Foote retired two months later, meeting with Dennis Wagner of the Arizona Republic to publicize the allegations he had sent to the Inspector General.
In response to the mounting pressure from the Government Accountability Office and Foote’s publicized complaint, the VA Acting Inspector General initiated an investigation into appointment booking procedures at the Phoenix VA. As part of its investigation, it sent a notice to senior administration at the VA to immediately protect and preserve all documents associated with appointment booking for veterans. Jeff Miller, a Republican Congressman from Arizona and chairman of the House Committee on Veterans’ Affairs, also sent the Phoenix VA orders to preserve all document as his committee prepared for a congressional investigation.
Mitchell told Fox News in May that Phoenix VA administrators had told hospital staff to report on a Saturday in late April for mandatory overtime; the staffers were later ordered to create new appointments for all veterans on the list, destroying in the process the digital files that confirmed the allegations in Mitchell’s and Roote’s original Inspector General complaints. These records were to serve as the basis for the Inspector General’s audit, and their destruction would make it nearly impossible to prove the allegations Mitchell and Foote had made.
The Arizona Republic reports that a co-worker of Mitchell’s at the VA called her when he discovered that hospital administrators were destroying veteran appointment records. He had printed out a log of all the records the administrators were seeking to destroy and didn’t know how to proceed. The employee believed the documents would be destroyed within a matter of hours and recognized the need to preserve them, especially in light of the two legally binding demands for preservation from the Inspector General and Miller.
The two tried to get police to preserve the records, but when that effort failed, they locked them securely in an unused hospital office. Twelve hours later, Mitchell said, her co-worker delivered the evidence and a statement to an investigator from the Office of the Inspector General while Mitchell visited The Arizona Republic, asserting status as “a government whistle-blower.”
The story reported by the Arizona Republic created one of the largest firestorms for the beleaguered federal agency in years.
In April, the House Committee on Veterans Affairs, led by Miller, held a hearing on the long wait times suffered at VA medical centers, the first national spotlight for the brewing scandal at the Phoenix VA Health Care System. But the hearing also served as the impetus for the important jump from local concern over long wait times into a national outcry over corrupt booking practices that ended in the death of veterans.
After Mitchell corroborated the reports of Foote with the Arizona Republic, attention was drawn to more than two dozen VA hospitals and clinics that were added to the investigation list. On May 21, just three weeks after the Arizona Republic broke the story of the irregular booking practices at the Phoenix VA Health Care System, President Barack Obama summoned Veterans Affairs Secretary Eric Shinseki to the White House amid cries of a cover-up, according to the New York Times.
In the wake of that meeting, the President issued his first comments on the matter.
“If these allegations prove to be true, it is dishonorable, it is disgraceful, and I will not tolerate it, period,” said Obama from the Rose Garden. “When I came into office, I said we would systematically work to fix these problems and we have been working really hard to address them.”
But that narrative runs counter to the claims of Miller, the influential Republic Congressman who conducted the first hearing on the matter in April. “The president, for three weeks, has said nothing until today,” Miller said after Obama’s statements. “He still said nothing today. The secretary has not been involved,” he added, referencing the fact that Shinseki at that point still had not resigned, despite the mounting pressure for him to do so.
Although Shinseki remained as Secretary, Obama had extracted the resignation of other top officials in the VA. The day before his meeting with Shinseki, Dr. Robert Petzel, VA undersecretary for health, resigned, though he had already announced his intent to retire later this year. Petzel was the bureaucrat charged with overseeing the health needs of veterans under VA’s care, according to NPR News.
United by Outrage – and Blame
Despite the political jockeying between Congressional Republicans and President Obama, politicians are generally united in their disgust and outrage at the VA scandal. But that bipartisan outrage has done little to quell the political theatre driving a contentious election year.
At the end of May, according to NPR News, the Republic National Committee had already begun a robocall campaign targeting ten Democratic incumbents. This despite the fact that more than a dozen Congressional Democrats had joined Republican calls for Shinseki’s resignation.
From Mara Liasson, of NPR News: “Of course, like most real Washington scandals, the origins of the VA problem are bipartisan, with very deep roots. For years, both parties have been competing to see who could promise greater benefits to veterans, and that has put new burdens on Veterans Affairs. The VA has also been slow to modernize its systems, a failing that predates President Obama.”
Over the last twenty years, leaders in the Democratic Party have attempted to distinguish their anti-war messaging from the implication that they are also somehow anti-military. For years, this anti-military undercurrent hurt the party in elections, and so, beginning with President Bill Clinton in the early 1990s, the party began to up its messaging on the military. From better pay for active military service members to increased benefits for veterans, Democrats joined Republicans in saddling the VA with an ever-increasing list of responsibilities while at the same time slashing or failing to increase the budget of the agency in the name of fiscal responsibility.
Over those twenty years of continued engagement with service members and veterans, Democrats believed they had made significant progress in courting the veteran vote – something poll numbers also seemed to indicate. But this new tie to veterans made Democratic politicians across the spectrum all the more hasty to draw lines in the sand over the waiting list scandal and demand swift action and accountability from the top levels of the VA.
Democrats are taking the task of showing they’re taking this issue seriously as a critical election-year, voter bloc-driving scandal, and Republicans are leaping at the opportunity to make the President and vulnerable Congressional Democrats as weak on protecting veterans.
This combination is what helped to ultimately drive the President, who stood outspokenly by Secretary Shinseki, to demand his resignation, and what fuelled the Democratic caucus to agree to important VA reforms in the wake of the scandal.
Reforming the VA
In late May, Bernie Sanders, an independent Senator from Vermont and Chairman of the Senate Veterans Affairs Committee, and Miller, who chairs the House Committee on Veterans Affairs, announced that they were in talks to introduce bicameral legislation to reform the scandal-prone agency.
After nearly two months of negotiations over the bills proposed by each leader (and later passed by their respective chambers), the conference committee was able to report a VA reform bill to the House and Senate. On July 31, the Senate sent that legislation on to President Obama with overwhelming support, in a vote of 91-3. It previously passed the House with only five Republicans voting against it.
The legislation includes $10 billion in emergency funds to pay private doctors to treat veterans who are not able to secure an appointment with the VA within 14 days, according to the LA Times. The remaining $6.3 billion of funds included in the measure are intended to allow the VA to build up the healthcare system’s clinical staff and to establish or lease new clinics in areas of the country that currently require veterans to travel in order to receive healthcare.
The bill also establishes an oversight committee to review the VA operations and to liaise between the VA and Congress and gives the VA Secretary broad authority to fire or demote senior executives if they underperform or mismanage the complicated bureaucracies of the sprawling agency.
The legislation, which President Obama supported, is a drastic change from the $44 billion proposal first unveiled in the House. That bill, and its $35 billion Senate counterpart, included sweeping provisions that reformed the provision of healthcare to veterans much more comprehensively, but Senate and House negotiators were forced to scrap most of those because they failed to agree on costs and how to pay for them.
Cincinnati Native to Right the Ship
On June 30, right as negotiators in Congress were deadlocking over budget worries, President Obama named former Procter & Gamble chairman and CEO Bob McDonald as his pick to head the VA. McDonald, a West Point graduate who served five years in the Army, is a stark contrast to the military generals and political class that have led the Agency for decades.
Instead, McDonald’s background is a 33-year trek through every level of the Cincinnati-based conglomerate. Starting at an entry-level position after leaving the Army, McDonald was brought in as CEO at a time when P&G, as the company is known, struggled to navigate in the wake of the financial crisis. McDonald’s tenure was marked by struggling sales, stagnant market share, and activist investors clamouring for changes at the top. After four years, he was replaced by the very man he himself had replaced, former P&G CEO Alan Lafley.
McDonald, who maintains strong relations with West Point and hosts a biennial cadet leadership conference there, is quick to admit that the problems facing the agency will not be easy to right. But the focus on processes and internal efficiencies that hurt his leadership at P&G could help to cure what the Inspector General of the VA called the agency’s “corrosive culture”.
As the reform effort begins to take hold, he will face the problems of introducing demoralizing changes to an agency that already suffers from among the lowest morale of all government agencies. He will also have to deal with the expected fallout of an Inspector General that is anticipated to link the deaths of up to 54 veterans to the scheduling practices of VA hospitals across the country and the results of a criminal investigation from the FBI.
But while the agency is undergoing to most intense scrutiny and criticisms it’s endured in years, the prospects for meaningful reform – of leadership and of the laws and regulations governing it – are better than ever.
The Senate confirmed McDonald as the new Secretary on July 30.