TIME Veterans

It’s Time For Some Perspective on the VA

US-POLITICS-VETERANS-AFFAIRS-OBAMA
U.S. President Barack Obama delivers a statement after meeting with Veterans Affairs Secretary Eric Shinseki at the White House in Washington, DC, May 21, 2014. Veterans have had to wait months to see a doctor at some hospitals, and allegations have arisen that administrators at a VA hospital in Phoenix, Arizona, covered up the delays there. JIM WATSON—AFP/Getty Images

The high-profile investigation into wait-times at VA facilities masks the good job most of its 230,000 daily visitors believes the agency is doing

President Obama finally took to the White House podium Wednesday to denounce the VA wait-list delays that allegedly have led to dozens of veterans’ deaths around the country. “When I hear allegations of misconduct — any misconduct, whether it’s allegations of VA staff covering up long wait times or cooking the books — I will not stand for it,” he declared. “Not as Commander-in-Chief, but also not as an American.”

It was interesting that Department of Veterans Affairs Secretary Eric Shinseki was visible by his absence. Sure, the VA chief has an important job to do in his office right across Lafayette Square from the White House. But right now, Shinseki faces no more important task than fixing what ails the VA — and salvaging his own reputation to boot. His absence betrays an increasingly lukewarm attitude from the President and his team to the wounded Vietnam-era soldier who has run the agency for more than five years.

“People have died while waiting for basic services for their service-connected issues,” says ex-sergeant Rob Kumpf, who retired from the Army earlier this year after five years of service, including tours in Iraq and Afghanistan. “This is criminal neglect, and the fact that the government continues to fail our armed forces and our veterans is disheartening at best.”

Plainly, the White House is stalling for time. The problem existed well before Obama took over, and formal reports have detailed them for nearly a decade. The Administration has endorsed investigations into the problems in the hope that they’re not serious enough to imperil Shinseki’s continued service. But you can tell there are a lot of crossed fingers at 1600 Pennsylvania Avenue. The key to Shinseki’s fate is how systemic the “gaming” of scheduled appointments was; the more systemic it turns out to be, the higher the chance Shinseki will be sent packing. The VA inspector general said Tuesday that 26 VA facilities now are under investigation, more than double last week’s number.

“President Obama’s remarks didn’t introduce many actions we didn’t already know about, but it did put Shinseki on the clock,” says Alex Horton, who spent 15 months in Iraq during the 2006-07 surge as an infantryman before going to work for the VA for three years until 2013 as an online communications specialist. “Shinseki must take actions now to reform the VA’s scheduling system so it can resist manipulation.” He also must call in the Justice Department, Horton believes, to investigate possible criminal wrongdoing. “And the most important thing: he must swiftly repair the broken trust between the VA and veterans.”

Yet it’s interesting to get away from cable TV postmortems and Internet screeds to determine more of what — accountability, doctors, money, eager employees, jail time, respect? — is needed to fix the VA. Perspective is an important element in understanding any problem. “Over the past two weeks, the American Legion has received over 500 calls, emails, and online contacts from veterans struggling with the healthcare system nationwide,” Daniel Dellinger, the Legion’s national commander, told the Senate Veterans Affairs Committee on Thursday. Over that same period, the VA saw a total of about 3.2 million patients. That works out to a complaint rate of 0.015%. Including a wider date range drops that share even lower.

Carl Blake of the Paralyzed Veterans of America suggested the Senate panel go undercover. “If the committee wants to get the truth about the quality of VA health care, spend a day walking around in a major VA medical facility,” he said. “We can guarantee that you will likely hear complaints about how long it took to be seen, but rare is the complaint about the actual quality of care … It is no secret that wait times for appointments for specialty care in the private sector tend to be extremely long.” The public, he says, has gotten a distorted view of the quality of VA care at various field hearings where a handful of those with poor experiences have taken center stage.

“If one veteran is not receiving the care he or she needs, it is one too many,” Ryan Gallucci of the Veterans of Foreign Wars told the panel. That’s a worthy goal for any healthcare organization, but one impossible to achieve when that organization is treating 230,000 patients a day.

There have been success stories. “I have to say that until Senator Obama became President and Secretary Shinseki became the secretary, I couldn’t get adequate care,” says Alex Lemons, who was a Marine from 2002-09 and served as a scout sniper among other billets during three combat tours in Iraq. “PTSD claims under President Bush were as successful as expeditions to Everest. I got my claim within one year of Shinseki taking office,” he says. “Sadly, my claim had actually been sitting in the wrong pile, on the wrong floor of the VA in Portland, Oregon. I had to call someone there, track it down, they found it and then took it, literally, up to the next floor and I saw the acceptance letter about two weeks after that.”

Acting VA inspector general Richard Griffin told Senators his probe has found potentially 17 veterans who died while waiting for care in Phoenix, but said there was no evidence that the waiting caused those deaths. The original whistleblower, a recently-retired VA doctor, elaborated Wednesday. “In terms of the allegation that I originally made,” Sam Foote told CNN, “that was up to 40 people may have died while waiting for care at the Phoenix VA. We never made the comment that they all died because of the wait, just that they were dying while waiting for care.”

An unscientific poll released by VoteVets.org Wednesday among its members found that 60% of 3,300 veterans want Shinseki to stay on the job. Only 17% want him to leave; the rest are undecided. “The American Legion has called on Shinseki to resign,” VoteVets co-founder Jon Soltz wrote. “As of yet, I don’t believe they asked their members if they agreed. So, we decided to. Of those on our list who also are members of the American Legion, only 17% backed the Legion’s call for Shinseki to resign. Sixty-four percent said he should not resign, with 19% saying they weren’t yet sure.”

“The problem is the inability to fire terrible VA employees, not the faulty chain of command,” says William Treseder, who spent 10 years as a Marine before leaving as a sergeant in 2011 after tours in Afghanistan and Iraq. Congress is pushing to give Shinseki more authority to cashier ineffective VA workers; Shinseki, whose agency fired 3,000 of its 300,000 workers last year, says he doesn’t need such power. “If Secretary Shinseki can’t overcome these problems in six years at the head,” Treseder adds, “I’m not sure what we expect the President to do in the next week” — which is when Obama expects to receive “preliminary results” from the IG’s nationwide survey of access to VA care.

Like most Washington battles, the fight for the VA’s future boils down to money. Some believe the tripling of the VA budget since 9/11 is sufficient. “They have gotten more money, number one. And number two is there is no shift in priorities,” David McGinnis, a retired Army brigadier general and Obama supporter, said on the PBS NewsHour Wednesday. “The internal attitude is, ‘If you want me to do more, give me more money,’ instead of taking a look at, this is the new world order. We got Vietnam veterans now realizing, ‘Hey, we need the VA.’ We went 30 years without realizing that, or longer. Also, you have this whole new group of veterans coming in. And we haven’t adjusted the priorities inside VA to spend the money appropriately.”

Others believe there is no way to change the VA without boosting its budget. Despite the surplus of congressional outrage directed toward the VA in recent weeks, there’s been a congressional deficit when it comes to giving the VA the money it and its advocates say it needs — even as its budget has grown from $50 billion in 2001 to $150 billion today.

  • Joseph Violante of the Disabled American Veterans told the panel last week that the VA’s own capital investment plan requires between $5.6 billion and $6.9 billion annually over the next 10 years to keep pace with demand, but the Administration has sought no more than $1.5 billion yearly.
  • Congress is also short-changing the VA. Blake, of the Paralyzed Veterans of America, noted that veterans groups for years have told Congress more money is needed to fix the agency. “In recent years, our recommendations have been largely ignored by Congress,” he told the Senate committee. “The House just recently approved an appropriations bill for VA that we believe is nearly $2 billion short for VA health care in 2015.”

Typical Washington, if you believe those two. Apparently there’s enough blame, but not enough money, to go around.

TIME Veterans

VA Chief Eric Shinseki (Still) Must Go

Eric Shinseki
Veterans Affairs Secretary Eric Shinseki pauses while testifying before the Senate Veterans Affairs Committee hearing to examine the state of Veterans Affairs health care on Capitol Hill in Washington, May 15, 2014. Cliff Owen—AP

The VA is broken. It’s past time to fix this shameful bureaucratic tragedy

Back at the turn of the 21st century, when he left Washington to become president of the New School university in New York City, former Senator Bob Kerrey learned a little something about the ethos of Veterans Affairs. Kerrey, a Medal of Honor recipient who lost part of a leg in Vietnam, needed to get his home address changed. He had called his bank and settled the matter in 10 minutes. He called the VA and spoke to a hostile and not very helpful receptionist. He spoke to the receptionist’s supervisor, who told him, “You’re going to have to come in.” So Kerrey went to the VA office in New York. The receptionist again wasn’t very helpful. Kerrey pointed out that he was only talking about an address change. The receptionist said, “Talk to one of them,” pointing to customer “service” employees sitting at desks labeled A and B. Desk C was vacant. Kerrey went to Desk A, where he was told, “That’s handled by Desk C.” Kerrey asked when the occupant of Desk C was returning. “I don’t know,” said Desk A. Kerrey went over and sat at Desk C for a long while, and then a longer while. He spoke to the supervisor, who had no idea where Desk C was and told Kerrey, “Come back tomorrow.”

“You gotta be kidding,” Kerrey said, or perhaps yelled. It took 12 days to get his address changed.

I’ve heard far more serious VA horror stories ad nauseam in recent years. I know of at least one young Marine who committed suicide while waiting—months—for his medical records to be transferred from Los Angeles to Houston. I’ve also heard stories of heroic treatment performed by devoted VA doctors, nurses and counselors, but those often occurred after their patients endured a Kafka-esque struggle with the VA’s bureaucratic gate-keepers. You might expect that the system, which is staffed largely by older veterans, would have adapted with alacrity to the crisis posed by the wave of wounded Iraq and Afghanistan veterans over the past decade. But the VA’s response has been stagnation, and worse. It is now clear that there was a conscious, and perhaps criminal, effort to camouflage the time veterans had to wait for service in Phoenix and at other VA facilities. It is alleged that 40 veterans died waiting for service in Phoenix; whether or not that proves accurate, we’re facing a moral catastrophe.

The question is, How do we change this situation? The simple answer is leadership, which is why some have called (as I did last year) for VA Secretary Eric Shinseki to resign. By all accounts, Shinseki is a fine man who has spent nearly six years lost in the system. An effective leader would have gone to Phoenix as soon as the scandal broke, expressed his outrage, held a town meeting for local VA outpatients and their families—dealt with their fury face-to-face—and let it be known that he was taking charge and heads were going to roll. Instead, Shinseki intoned the words “mad as hell” at a congressional hearing. And White House chief of staff Denis McDonough said the President was “madder than hell” about the situation. Does anyone actually find this convincing?

The President cares deeply about the troops; he visits the wounded in the hospitals all the time; it’s just not his style to make a public deal of it. But he has been sadly ineffective on the veterans–health issue. The benefits system is still rigged against recent veterans, who go to the end of the line with their claims. Five years ago, Obama promised a unified electronic records system so that a soldier’s medical history would follow him or her seamlessly from active duty to the VA, but it still hasn’t been implemented because of trench warfare between the Pentagon and the VA. More than a billion dollars has been spent on the project. A senior Administration official told me a year ago that a solution was weeks away; now the Administration is promising a new system by 2016. The President could have solved this problem yesterday, by cracking heads—and selecting either the existing VA or Pentagon electronic records system. (Believe it or not, the VA system is pretty effective but not up-to-date.)

The problem of bureaucratic stagnation at the VA (and throughout the rest of the government) could be addressed as well. Think about the lazy clerks Bob Kerrey faced. Why were they so callous? Because under the existing, antiquated civil-service system, they face practically zero threat of being fired. The President could ask for a temporary waiver of civil-service rules to clean up the mess at the VA, but that seems politically impossible. Government accountability is a popular mantra—but you can’t have accountability unless everyone, including Desk C, is held to account.

TIME Veterans

Obama: ‘I Will Not Tolerate’ Veterans Affairs Misconduct

President Barack Obama speaks at the White House following his meeting with Veterans Affairs Secretary Eric Shinseki in Washington on May 21, 2014.
President Barack Obama speaks at the White House following his meeting with Veterans Affairs Secretary Eric Shinseki in Washington on May 21, 2014. Susan Walsh—AP

"If there is misconduct it will be punished," said Obama, who defended embattled Veterans Affairs Secretary Eric Shinseki but stopped short of fully backing him

President Barack Obama got angry Wednesday after weeks of allegations of misconduct at Veterans Affairs facilities, but defended his embattled Secretary of Veterans Affairs Eric Shinseki — for now, at least.

Speaking to reporters from the White House in his first public remarks on the subject in nearly a month, Obama said he has ordered Shinseki to conduct a review alongside a independent inspector general review, adding if the allegations prove to be true, “It is dishonorable, it is disgraceful, and I will not tolerate it. Period.” Last month CNN reported that the VA health facility in Phoenix had been cooking the books to cover up long wait times, potentially leading to the deaths of 40 veterans, allegations that have now been made about other facilities around the country.

“Once we know the facts, I assure you that if there is misconduct it will be punished,” Obama said, acknowledging he doesn’t yet know how widespread the problem is. “I don’t yet know are there a lot of other facilities that have been cooking the books or is this just an episodic problem,” he said.

Obama said Shinseki will present him with the preliminary results of his review, which has expanded to all VA facilities, next week. Obama also tasked Deputy Chief of Staff Rob Nabors to lead a review of the entire Veterans Health Administration, which has long been plagued by backlogs and delays. Nabors will travel to Phoenix later Wednesday after meeting with veterans’ groups in Washington.

Obama sought to highlight the progress his administration has made in bringing down the disability claims backlog and the veterans unemployment rate, crediting Shinseki with much of the progress, but witholding his full backing until the completion of the investigations.

“Ric Shinseki I think serves this country because he cares deeply about veterans and he cares deeply about the mission,” Obama said. “And I know that Ric’s attitude is if he does not think he can do a good job on this, and if he thinks he’s let our veterans down, then I’m sure that he is not going to be interested in continuing to serve.”

The allegations have become the latest political headache for the president, with Republican lawmakers alleging the White House should have known about efforts to misreport wait times sooner.

Obama called on Congress to put partisanship aside as the investigation continues. “It is important that our veterans don’t become another political football, especially when so many of them are receiving care right now,” he said.

TIME Veterans

Veteran Affairs Probe Widens to 26 Medical Facilities

The Office of the Inspector General at the Veterans Affairs Department says more health facilities are being probed after explosive testimony in front of a Senate committee spotlighted the alleged mistreatment of America's veterans

The probe into the U.S. Department of Veteran Affairs (VA) has been dramatically widened, according to the department’s Office of Inspector General.

Federal officials are now examining at least 26 of the VA’s medical facilities in accordance with an ongoing investigation into possible malfeasance.

The inquest into the agency follows testimony before the Senate Veterans Affairs Committee last week after a doctor claimed that as many as 40 veterans might have died while waiting for care at a VA clinic in Phoenix. Wait-time records were also allegedly falsified.

President Obama is to meet with Secretary of Veterans Affairs Eric Shinseki and White House Deputy Chief of Staff Rob Nabors on Wednesday, to be updated on the situation at the department. Last week, President Obama assigned Nabors to work with the VA as conduct and procedures at its hospitals are reviewed.

Nabors was due to meet with officials from the Phoenix Veterans Affairs Medical Center later this week.

[AP]

TIME Veterans

VA’s Chinese Water Torture Continues

Veterans Affairs Secretary Eric Shinseki Testifies Before Senate  Committee
VA Secretary Eric Shinseki and VA health chief Robert Petzel appear before the Senate veterans committee last Thursday. The next day, Shinseki accepted Petzel's early retirement, effective immediately Andrew Harrer / Bloomberg via Getty Images

Calls mount for Secretary Eric Shinseki to leave

The classic Washington political drama—will he go or will he stay?—is now swirling around Eric Shinseki, the secretary of the Department of Veterans Affairs. It could be weeks or months before we know the answer.

Good, his critics might retort. He may end up waiting as long to learn his fate as some of those veterans have waited for appointments with one of his 300,000 employees.

The critics have a point. Despite the high grades the VA gets for tending to the ailments of the nation’s vets, it has always had problems seeing them quickly enough when they need help—or when they are seeking disability benefits. Such wait-list problems have persisted for years, even as the VA’s budget has tripled, to $150 billion annually, since 9/11.

The VA debate over fudged appointment waiting times—possibly leading to vet deaths—reached a critical point over the weekend. There was a call from the Washington Post‘s Dana Milbank on Sunday for Shinseki to go (“His maddeningly passive response to the scandal suggests that the best way Shinseki can serve now is to step aside.”) That was echoed by the independent Army Times, which said in an editorial that “allowing the status quo at VA to remain intact is unacceptable.”

Even Duffel Blog, a military version of the Onion, got into the act. “VA: Please Hold,” it headlined a post. “You Should Hang Up And Just Watch Cat Videos Instead.” Once a political predicament has curdled into farce, the sharks begin circling. The scent of blood in the water spiked Friday when Shinseki accepted the premature retirement of Robert Petzel, the VA’s undersecretary for health care.

But Shinseki has his defenders. “The President is madder than hell” over the mess at the VA, White House chief of staff Dennis McDonough said Sunday on CBS’s Face the Nation. Shinseki, he added, “will continue to work these issues until they’re fixed.” Defense Secretary Chuck Hagel and Army General Martin Dempsey, chairman of the Joint Chiefs of Staff, have endorsed Shinseki’s continuing tenure. So has Max Cleland, a triple amputee from the Vietnam war, who ran the VA under Jimmy Carter.

Dr. Sam Foote, a key VA whistleblower, said Sunday that Shinseki should remain on the job. “I think our best bet at this point is to keep the secretary onboard,” he told Fox News, “but I think the President needs to keep him on a pretty short leash.”

Following two of the nation’s longest wars, the VA has become a political tool, because veterans are a potent political force. Like politicians embracing the status quo on Social Security, there is scant downside to nodding in agreement with whatever veterans say. There was a lot of heat at last week’s Senate Veterans Affairs Committee hearing where Shinseki and Petzel testified, but little illumination, from them or anyone else. It’s worth noting that beyond the American Legion, which has called for Shinseki’s replacement, most veterans groups support, or haven’t take a position on, Shinseki’s future.

But the anger among some veterans is palpable. Shinseki, in his low monotone, seems unperturbed by the problems happening on his watch. Such stoicism—probably a side effect of his 38 years in uniform—doesn’t play well in today’s political arena. It seems as if you’re not breathing fire, you don’t care.

Army Times, in its editorial calling for Shinseki’s ouster, noted that he’s not a chest-thumping, bellowing commander. “Going back to his four-star days as Army chief of staff, Shinseki has long been recognized as a behind-the-scenes leader, one who uses his influence outside the public eye,” its editorial said. “Unfortunately, that’s simply the wrong style for what VA needs now.”

Apparently style-over-substance is now a job requirement at the VA. It’s worth recalling that it was more than a decade ago that Shinseki, then the Army chief, told another Senate panel—the armed services committee—that it would likely take “several hundred thousand soldiers” to pacify Iraq post-invasion. His best military assessment angered Defense Secretary Donald Rumsfeld and his deputy, Paul Wolfowitz, who thought far fewer troops would be needed. Shinseki’s public pronouncement left him a lame-duck member of the Joint Chiefs as the nation waged two wars, even as history ended up siding with him.

Yet Shinseki’s estimate delighted the commentariat. It seems his low-key, just-the-facts, style worked better pre-war than post-war.

TIME White House

Adviser: Obama ‘Madder Than Hell’ About VA Scandal

President Obama is urging Veterans Affairs Secretary Eric Shinseki to fix issues in the VA's hospital system after his testimony last week before the Senate Veterans Affairs Committee about reports that at least 40 veterans died while waiting for care at a Phoenix hospital

President Barack Obama is “madder than hell” about reports of long wait times that led to preventable deaths at veterans’ hospitals, according to a top adviser.

White House Chief of Staff Denis McDonough said on Sunday on CBS’s Face the Nation that Obama is urging Veterans Affairs Secretary Eric Shinseki to “continue to fix these things until they’re functioning the way that our veterans believe they should.”

Shinseki himself used similar language last week when he testified in front of the Senate Veterans Affairs Committee about reports that at least 40 veterans died while waiting for care at a Phoenix VA hospital.

“Any allegation about any adverse incident like this makes me mad as hell. I could use stronger language here, Mr. Chairman, but in deference to the committee, I won’t,” Shinseki said on Thursday.

Dr. Robert Petzel, the VA’s top health official, resigned on Friday. House Republicans have also scheduled for Wednesday a vote on legislation that would expand Shinseki’s firing power.

TIME Veterans

Top Veterans Affairs Official Resigns

VA Secretary Shinseki Testifies Before Senate On State Of VA Health Care
U.S. Veterans Affairs Secretary Eric Shinseki and Veterans Affairs Undersecretary for Health Robert Petzel testify before the Senate Veterans' Affairs Committee about wait times veterans face to get medical care May 15, 2014 in Washington, DC. Chip Somodevilla—Getty Images

The Department's Undersecretary for Health Robert Petzel steps down amid scandal involving an alleged cover up of long wait times for patients

Amid a scandal over delays in care for veterans and forged records at veterans’ hospitals, the top official for veterans’ health care resigned on Friday.

Veterans Affairs Secretary Eric Shinseki accepted the resignation of Robert Petzel, the department’s undersecretary for health care. Shinseki asked for the resignation, the Associated Press reports, quoting an anonymous source. Petzel was already set to retire this year. The resignation comes one day after Shinseki and Petzel came under fire during a four-hour hearing of the Senate Committee on Veterans’ Affairs, in which senators said they were enraged by the problems plaguing the department, including long waits for appointments, a backlog of benefit applications and reports of unnecessary deaths.

“As the President has said, America has a sacred trust with the men and women who have served our country in uniform, and he is committed to doing all we can to ensure our veterans have access to timely, quality health care,” the White House said in a statement provided to TIME. “He has asked Secretary Shinseki to conduct a review of Veterans Health Administration practices and procedures at its facilities nationwide to ensure better access to care, and that review is ongoing.”

“If these allegations are true people should be going to jail, not just resigning their positions,” Senator John McCain said on Fox News Thursday Night. He added that the Justice Department will likely conduct a criminal investigation.

[AP]

TIME Veterans

Top Veterans Affairs Health Care Official Resigns

Veterans Affairs Secretary Eric Shinseki Testifies Before Senate Robert Petzal
Eric Shinseki, U.S. secretary of Veterans Affairs (VA), left, and Robert Petzel, U.S. VA undersecretary for health, swear in to a Senate Veterans' Affairs Committee hearing in Washington, May 15, 2014. Andrew Harrer—Bloomberg/Getty Images

Undersecretary for Health Dr. Robert Petzel has stepped down a day after being grilled in Congress amid uproar over alleged malfeasance and cover-ups at the Department of Veterans Affairs. Petzel said in September that he planned to retire this year

Updated 7:18 p.m. ET

Secretary for Veterans Affairs Eric Shinseki announced Friday he accepted the resignation of the official in charge of the VA’s healthcare services.

Undersecretary for Health Dr. Robert Petzel offered his resignation a day after sitting aside Shinseki while both men were grilled on Capitol Hill. Shinseki and Petzel faced questions Thursday about long-standing inefficiencies in the VA’s healthcare system, as well as allegations that VA officials covered up evidence of delays at a Phoenix, Arizona, clinic that may have led to the deaths of 40 veterans.

“As we know from the Veteran community, most Veterans are satisfied with the quality of their VA health care, but we must do more to improve timely access to that care,” Shinseki said in a Friday statement. “I thank Dr. Petzel for his four decades of service to Veterans.”

Petzel said in September that he planned to retire this year, according to the Associated Press.

“As the President has said, America has a sacred trust with the men and women who have served our country in uniform, and he is committed to doing all we can to ensure our veterans have access to timely, quality health care,” the White House said in a statement. “He has asked Secretary Shinseki to conduct a review of Veterans Health Administration practices and procedures at its facilities nationwide to ensure better access to care, and that review is ongoing.”

This post was updated with a statement from the White House.

TIME Veterans

VA Day of Reckoning: Head Could Roll Over ‘Secret Lists’

Obama Welcomes Wounded Warrior Project's Soldier Ride To White House
VA Secretary Eric Shinseki and President Obama at a veterans' event last year. Win McNamee / Getty Images

Secretary Eric Shinseki faces Congress, and trouble, if woes are widespread

There’s a sword of Damocles hanging by a hair over Veterans Administration chief Eric Shinseki as he heads to Capitol Hill on Thursday to testify on the VA’s expanding secret wait-list mess. It’s an apt place for the retired four-star Army general, himself a veteran wounded in Vietnam. He finds himself in the tightest spot in his five years as secretary of the Department of Veterans Affairs, dealing with the downstream costs of two of the nation’s longest wars.

Charges—and confirmations—about VA double bookkeeping when measuring how long veterans have to wait for appointments are nothing new. But what has given the latest stories more impact are the deaths allegedly linked to the delays, the secret lists designed to hide them, and charges that the secret lists were a way for VA executives to mask shortcomings and thereby maximize their cash bonuses.

Those bonuses come from an annual $150 billion VA budget, triple 2001’s spending.

Congressional Research Service

Whether the sword falls won’t depend so much on what Shinseki tells the Senate Veterans Affairs Committee. He has already said he won’t resign. What’s critical is how Congress and veterans react to what he says, and what a VA-wide inspector general’s probe into the problem turns up. Shinseki will survive if he convinces them he was ignorant of such wrongdoing—he has denounced it as “absolutely unacceptable”—and shouldn’t have been expected to detect it on his own.

But anyone who has paid attention to VA data is aware that there have been persistent efforts inside the agency to make vets’ wait times seem shorter than they actually are. One 14-day limit for getting an appointment was ripe for abuse, and critics say such abuse should have been anticipated and eliminated. Shinseki’s defense becomes weaker with every corroborated story of his subordinates gaming the system. If there’s evidence that the problems are systemic, Shinseki’s days are numbered.

“This is an accountability moment for the VA,” says Phil Carter, who served as an Army officer in Iraq and now champions veterans issues at the nonprofit Center for a New American Security. “The key question is where within the organization to fix accountability: at the secretarial level, the regional level, the hospital level, or some other place.” Only after the IG’s inquiry, Carter says, can the government “decide who should be held accountable for these issues.”

“This is not a new problem,” Paul Rieckhoff, head of the Iraq and Afghanistan Veterans of America, conceded last week. “Veterans have been dying in line for care for decades.” IAVA, like most veterans’ groups, has not called for Shinseki’s ouster.

But others have already made up their minds. “General Eric Shinseki has served his country well,” Daniel Dellinger, the commander of the American Legion, said May 5, when he and his 2.4-million-member organization called on Shinseki to step down. “However, his record as the head of the Department of Veterans Affairs tells a different story. The existing leadership has exhibited a pattern of bureaucratic incompetence and failed leadership that has been amplified in recent weeks.”

There is a baby-bathwater issue, too. “Surveys suggest that patient satisfaction is high among the 6.5 million veterans who get care each year from the VA,” Senator Bernie Sanders, I-Vt., who chairs the veterans committee, said Wednesday. “And while the American Customer Satisfaction Index said VA patients rank their care among the best in the nation, it is clear to me that there are problems within the VA and that the VA has got to do better.”

The VA is the country’s single largest health-care system, with its 300,000 employees spread among 151 medical centers, 820 clinics, and other sites tending to the needs of 230,000 vets a day. “While of course Shinseki is responsible for everything that happens at VA, he’s been fixing serious problems and overall the system is improving,” says Ron Capps, an Army veteran who has sought help from the VA. “So we should give him some more time and space to continue with his plan.”

Whether or not the fudged wait lists are widespread, warning lights highlighting them have been flashing for years:

  • The VA’s “method of calculating the waiting times of new patients understates the actual waiting times,” the agency’s inspector general said in a 2007 report on outpatient visits. “Because of past problems associated with schedulers not entering the correct desired date when creating appointments, [the VA] uses the appointment creation date as the starting point for measuring the waiting times for new appointments.”
  • In 2012, the IG said that when it came to getting a mental-health appointment within the VA goal of 14 days, the agency claimed it met that target 95% of the time. But after drilling deeper into VA data, the IG concluded only 49% got their appointments within two weeks.
  • That same year, the IG reported that patients at a VA facility in Temple, Texas, had “prolonged wait times for GI [gastroenterology] care [that] lead to delays in diagnosis of colorectal and other cancers…staff indicated that appointments were routinely made incorrectly by using the next available appointment date instead of the patient’s desired date.”
  • Not surprisingly, the longer the wait for care, the worse the result. “Long-term outcomes, such as death and preventable hospitalizations, are more common for veterans who seek care at facilities that have longer wait times than for veterans at facilities that have shorter wait times,” the federal Institute of Medicine said last year.

 

 

TIME U.K.

British Charity Sees Rise in Afghanistan Vets Seeking Mental Health Help

A U.K. veterans mental health charity reported a 57% increase over one year in Afghanistan veterans seeking support

The number of British veterans of the war in Afghanistan seeking help for mental health issues increased sharply from 2012 to 2013, a charity group said Monday, warning that need would continue to rise as the country ends its involvement in the war.

Combat Stress, a U.K. veterans mental health charity, said the number of veterans seeking its help went up 57% in the course of a year. The group received referrals for 358 veterans last year, compared to 228 in 2012. Its caseload now includes more than 660 veterans. The increase is linked to the withdrawal of British troops in Afghanistan from all but two bases in Helmand province.

The charity said it found that veterans wait an average of 13 years after serving before seeking help, but the average time has now fallen to 18 months for Afghanistan veterans. Combat Stress also reported that their total caseload of 5,400 veterans across the country was the highest number in its 95-year history.

“We have had great support from the Government and the public over recent years and we simply could not operate without the generosity we have experienced, ” said Commodore Andrew Cameron, chief executive of Combat Stress. “We cannot allow the ex-Service men and women who suffer from the invisible injuries of war to go unnoticed and untreated.”

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