Want the U.S. Department of Veterans Affairs to do a better job serving America’s 22 million veterans? Try shaming it. Big time.
That’s how it’s worked over the years. In general, the VA has jumped to fix long-festering issues only after they have blown up in the media, embarrassing the president.
On this Veterans Day, with new VA Secretary Robert McDonald trumpeting “the largest restructuring in the department’s history” in response to the scandal that brought down his predecessor, let’s stop to take stock: Have past and present efforts delivered real help to Americans who have worn the uniform?
Long wait times, cooked books and early death
For years, veterans have complained about how long it takes to see a VA doctor; for just about as long, government watchdogs have accused the VA of cooking the books to make things look better.
After the 2007 report, Sen. Patty Murray, D-Wash., then-chairwoman of the Senate Veterans Affairs’ Committee, held a hearing. In a news release, she declared: “It is past time for the VA to put an end to the pattern of dishonesty … the VA is not coming clean with the American people. And every time the VA tries to save political face it ends up costing our veterans.”
But the issue did not explode for seven more years, until The Arizona Republic spotlighted a whistleblower who claimed that 40 patients had died at the Phoenix VA while on a secret waiting list. CNN, which had been covering patient care delays at the VA since November 2013, rode the story hard and other TV networks joined in, trying to outdo one another by exposing cooked books and long delays. House lawmakers launched a series of hearings to examine malfeasance. Within weeks, VA Secretary Eric Shinseki was forced to resign.
Now Shinseki’s replacement, former Procter & Gamble CEO McDonald, is making the rounds. He told The New York Times that he will hire 28,000 new health care professionals and create a medical voucher program that will cut wait times by allowing veterans to turn to the private sector. On Sunday, he told “60 Minutes” that he is considering disciplinary actions against as many as 1,000 employees.
So far, the VA has dismissed four senior executives. Sharon Helman, director of the VA in Phoenix, which was at the center of the scandal, remains on the payroll while on administrative leave.
An echo of earlier scandals
This is the pattern at the VA: Severe shortcomings in service to America’s veterans endure for years before scandals prompt government action.
It’s what happened last fall when The Center for Investigative Reporting revealed that VA doctors were overmedicating patients as the agency struggled to keep up with their need for more complex treatment.
CIR found that VA prescriptions for four highly addictive opiates had increased by 270 percent since the 9/11 terrorist attacks. The agency charged with helping veterans recover from war was instead masking their pain with potent drugs, feeding addictions and contributing to a fatal overdose rate among VA patients that was nearly double the national average.
This was old news to insiders. VA officials long had been aware of the problem and in 2009 issued regulations requiring clinicians to follow an “integrated approach” to helping veterans in pain, including a stronger focus on treating the root causes of pain rather than using powerful narcotics.
But those regulations did little to change the VA’s prescription patterns. Although legally mandated, alternative therapies were not routinely available. Real change took media coverage, which provoked congressional scrutiny.
CIR’s story on opiates sparked three congressional hearings: two in the House and one in the Senate. At the first hearing in October 2013 by a subcommittee of the House Committee on Veterans’ Affairs, lawmakers were alarmed to learn that the agency had only 115 pain specialists on staff nationally, or about one for every 50,000 patients in pain.
Since then, integrated pain programs have been launched and certified at 13 hospitals. In March, six months after CIR’s story ran, the VA reported that 37,000 fewer veterans were being prescribed narcotics.
An ‘unacceptable’ backlog of disability claims
Perhaps no controversy more closely mirrors the current flap over long wait times than the one last year over the VA’s backlog of hundreds of thousands of disability claims.
On the campaign trail in 2008, then-candidate Barack Obama had promised to revamp the “broken VA bureaucracy” that caused returning veterans to wait for months, sometimes years, for compensation for conditions like post-traumatic stress disorder and traumatic brain injury.
In 2010, Obama’s first VA secretary, Eric Shinseki, promised to eliminate the backlog by 2015. Yet the backlog continued to grow.
Then, in March 2013, CIR published a story based on internal VA documents showing that the number of veterans waiting more than a year for benefits had increased by more than 2,000 percent under Obama.
Wait times for veterans filing their first claim – including those returning from Iraq and Afghanistan – were almost comically high: 642 days in New York, 619 days in Los Angeles, 542 days in Chicago.
Although the agency had spent more than half a billion dollars on a new computer system, 97 percent of claims remained on paper. The paper crisis was so bad, in fact, that the VA’s inspector general found the federal building in Winston-Salem, North Carolina, was literally sagging under the weight of all the paperwork.
Like the current scandal over wait times, the story on the backlog launched a national furor, forcing the administration to react.
Major newspapers weighed in with editorials demanding answers. Shinseki made the rounds in a series of televised interviews; 67 senators and 164 members of the House of Representatives wrote to Obama demanding leadership. On “The Daily Show with Jon Stewart,” the TV host launched a series called the “Red Tape Diaries.” Even Obama acknowledged the severity of the problem in his State of the Union address, which CIR’s media impact analyst cited as significant change in a report released today.
And so, the VA reacted. The long-delayed computer system was launched, and Shinseki ordered VA claims processors across the country to work overtime to bring down the backlog.
Six months later, on Veterans Day 2013, the agency reported major progress in fighting the backlog: The number of veterans waiting more than a year for benefits had declined nearly 90 percent.
Today, VA records tally 373,000 fewer veterans waiting for benefits than in March 2013.
Performing without scandal
Even though Shinseki was widely credited with fighting the backlog after it had been fully exposed, he also was criticized for being out of touch, waiting until it could not be ignored.
This perceived disconnect with reality contributed to Shinseki being forced to resign. He professed shock and outrage once the patient wait time stories gained momentum, but because the VA had been manipulating wait-time data for years, insiders may have found his shock implausible.
So, the question veterans and their supporters should be asking of the new VA secretary is not how he is handling the current scandal, but whether he will change the culture so it doesn’t take a scandal to get the agency to step up.
Clarification: This story has been updated with more information on CNN’s coverage of VA patient care.