The Troubling VHA Scandal of 2014

The Veterans Health Administration (VHA) is embattled and is in a desperate need of reform. On July 31st, 2014, the bipartisan compromise bill to reform the scandal-plagued Veterans Affairs (VA) Department cleared the Senate after clearing the House earlier. It now awaits President Obama’s signature after lawmakers scrambled to wrap up this bill before their 5-week 2014 summer recess.

The VHA is a division of the U.S. Department of Veterans Affairs (VA) and is amongst the largest healthcare operations in the United States. It provides health care to U.S. military veterans in dozens of hospitals and medical facilities across the nation. However, it has a long and troubled history and is shaken by this year’s revelations that hundreds of veterans died while waiting for treatment plus allegations that workers falsified records to cover up the delays.

The revelations began on April 30, 2014 when CNN reported that at least 40 United States Armed Forces veterans died while waiting for care at the Phoenix, Arizona, VHA facilities. Ensuing thereafter were several investigations conducted by the VA’s Office of the Inspector General regarding delays in treatment throughout the VHA system. The House passed legislation to fund a $1 million criminal investigation by the Justice Department. On May 16, 2014, at the request of Secretary of Veterans Affairs Eric Shinseki, the VHA’s top health official, Dr. Robert Petzel retired early. But then on May 30, 2014, amid the fallout from the controversy, Secretary Shinseki resigned from office!

As the investigations by the VA Inspector General, the Congress and others widened, the Phoenix facility situation became just a case study because several other VA medical centers were identified with problems similar to Phoenix facility. Indeed, “an internal VA audit released June 9, 2014 found that more than 120,000 veterans were left waiting or never got care and that pressures were placed on schedulers to use unofficial lists or engage in inappropriate practices to make waiting times appear more favorable.”

On June 11, 2014, the Federal Bureau of Investigation opened a criminal investigation of the VA, while President Barack Obama ordered a White House investigation. On June 27, 2014, Obama’s Deputy Chief of Staff, Rob Nabors, identified “significant and chronic system failures” and a “corrosive culture” inside the VHA.

While in Denver this August and while speaking to a convention of wounded veterans Deputy VA Secretary, Sloan Gibson said that failed leadership is one reason “some veterans’ hospitals are falling short even while others are excelling.”  Gibson indicated that more VA Department employees will be disciplined. Meanwhile, the agency will continue to root out the causes of the scandal over the long waits for health care and falsified data.

VA/VHA problems remain unfinished. Even the provision of $17 billion by Congress for fixing the Department of Veteran’s Affairs problems, it does not address appropriate VA/VHA reforms. According to the Wall Street Journal, “what this bill doesn’t do is provide meaningful reform past the immediate waiting lists. Veterans deserve more choice, including access to better and closer private facilities.” Also, while the VHA official goal regarding the timeliness of care stipulates that “no more than 14 days would pass between a patient’s desired date for an appointment and the first actual appointment date”, that is yet to be achieved. Also, case load presents fundamental problems at VHA because of inadequate staffing especially for the aging Vietnam veterans and the more recent veterans from Iraq and Afghanistan who may have complex health challenges such as traumatic brain injury, multiple limb amputations and prosthetics, diabetes and post-traumatic stress disorder. Finally, while the punishing of the miscreants is welcomed, no one welcomes not helping the people who need help. So, we revisit a potent question posed in October/December 2003 Journal of Ambulatory Care Management,

“Can the Veterans Affairs Health Care System Continue to Care for the Poor and Vulnerable?”

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