Tag: eric shinseki
Audit Reveals ‘Systemic’ Access To Care Woes For U.S. Veterans

Audit Reveals ‘Systemic’ Access To Care Woes For U.S. Veterans

Washington (AFP) – An audit on health care access for U.S. veterans released Monday confirmed the existence of fake waiting lists, prompting a top official to slam “systemic” problems for America’s wounded warriors seeking treatment.

The report is the latest revelation in a political scandal that last month led to the resignation of Eric Shinseki as Veterans Affairs secretary.

The audit showed that 13 percent of scheduling staff got instructions from supervisors or others “to enter a date different than what the veteran had requested in the appointment scheduling system” to conceal wait times in official statistics.

Eight percent of scheduling staff said they used “alternatives to the official Electronic Wait List.”

“In some cases, pressures were placed on schedulers to utilize unofficial lists or engage in inappropriate practices in order to make waiting times appear more favorable,” according to a fact sheet provided by the Department of Veterans Affairs.

Allegations last month that staff manipulated scheduling data and that veterans may have died waiting for treatment at a VA clinic in Phoenix, Arizona, put President Barack Obama’s administration on the defensive and ultimately cost Shinseki his job.

“There have been lapses of integrity, we’ve got systemic problems with scheduling practices,” Acting Veterans Affairs Secretary Sloan Gibson said Monday as he presented the report.

“We’re going to get veterans off the wait list, and we’re going to get them in the clinics where they can be seen and cared for. That’s our first priority.”

The audit found that, around the country, there were roughly 57,436 veterans waiting to be scheduled for an appointment according to May 15 data.

In addition, it cited another 63,869 veterans who have enrolled in the VA health care system over the past decade and have not been seen for an appointment.

In total, of the more than six million appointments scheduled across the Veterans Health Administration system on May 15, some 242,000 — or four percent — had a wait time of longer than 30 days.

Officially, a veteran is not supposed to wait longer than two weeks for medical appointments at VA facilities.

However, the audit showed that such a “target for new appointments was not only inconsistently deployed throughout the health care system but was not attainable given growing demand for services and lack of planning for resource requirements.”

“There have been lapses of integrity, we’ve got systemic problems with scheduling practices,” Acting Veterans Affairs Secretary Sloan Gibson said Monday as he presented the report.

“We’re going to get veterans off the wait list and we’re going to get them in the clinics where they can be seen and cared for. That’s our first priority.”

Based on the findings of the audit, the Department of Veterans Affairs has, among other things, decided to freeze bonus payments, acquire and put into place “long-term scheduling software solutions” and establish “access timeliness goals.”

The audit involved more than 3,772 interviews of clinical and administrative staff at 731 VA medical centers and clinics.

AFP Photo/Brendan Smialowski

Washington Promises To Fix VA But Overhaul Won’t Be Easy

Washington Promises To Fix VA But Overhaul Won’t Be Easy

By Lindsay Wise, McClatchy Washington Bureau

WASHINGTON — Eric Shinseki has been pushed out as the secretary of veterans affairs. The president vows changes. The Senate is moving with uncharacteristic speed toward a bipartisan response.

But fixing the sprawling agency with an entrenched bureaucracy won’t be easy.

It has a management culture marred by cronyism, intimidation and poor oversight from the Department of Veterans Affairs central office. It has a performance-based bonus system that rewards those who falsify records to meet unrealistic quotas. And it simultaneously penalizes supervisors who don’t push their employees to “cook the books.”

“If you weren’t going to crack people’s heads, if you didn’t put people’s feet to the fire, they didn’t want you around,” said Charleston Ausby, a Marine Corps veteran from Sugar Land, Texas, who worked as a VA service representative from 2002 to 2012.

Ausby said he and his co-workers routinely came under pressure to reduce the VA’s record disability-claims backlog by misfiling or mislabeling old claims that had been pending for years to make them appear in the computer system as though they were new claims.

Like “cooking the books” at VA hospitals to conceal delays in medical care, the practice of manipulating claims data made it seem as though veterans weren’t waiting as long for decisions on their benefits as they really were, Ausby said.

Most underlings are too demoralized to complain or don’t know how to do so without risking retribution, he said.

Falsifying data isn’t a new phenomenon at VA, said Gerald Manar, who worked as an adjudication manager at the VA for 30 years before becoming the national veterans service deputy director for Veterans of Foreign Wars.

VA managers are reluctant to ask for more money and the staff they need to meet quotas because they don’t think their requests will go over well with higher-ups in Washington or politicians in Congress, Manar said.

“The attitude among managers is, ‘Why even bother asking, because we’re not going to get it,'” Manar said. “When you have that kind of culture, you feel so beaten down, so restricted, so disheartened by what’s happened before that you don’t even ask for what you need.”

Some VA employees resort to hiding the problem. As a result, politicians, the public and officials at the VA central office don’t get an accurate picture of what’s wrong from people in the field.

“In a bureaucracy when people are given orders to do things that can’t possibly be done, they become cynical,” said Ronald Abrams, a former VA official who is the joint executive director of the National Veterans Legal Services Program.

“For example, years and years ago I read that the post office made a rule that all mail coming in on Monday had to get out on Monday, otherwise people would lose their jobs…so in Pennsylvania employees rented a trailer and simply threw the letters into a trailer,” Abrams said.

“When the VA said, ‘OK we have to get all these appointments scheduled within 14 days,’ the cynical employees said, ‘We can’t possibly do that.'”

A new test is whether the massive agency needs to grow even more to accommodate a booming veterans population or whether it’s an outmoded model that should be re-imagined to simplify veterans’ benefits applications and give them more access to private care.

A compromise bill crafted by Senators John McCain (R-AZ) and Bernard Sanders, a Vermont independent, aims to strike a balance between expansion and privatization.

It would allow veterans who live far from VA facilities or can’t get timely VA appointments to seek care from any doctor in the Medicare program, at federally qualified health centers, facilities funded by the Department of Defense or Indian health centers.

The bill would authorize the VA to lease 26 new health facilities and would allot $500 million in unobligated VA funds to hire more doctors and nurses.

Another provision in the bill would allow the VA secretary to demote or fire senior agency officials based on their performance. Unlike a similar bill that passed last month in the House of Representatives, this version doesn’t remove the right of poor-performing officials to appeal their terminations, but it expedites the process from 120 days to just three weeks, and withholds their pay until the appeal is resolved.

Among other legislative fixes offered by members of Congress in recent weeks are measures that would freeze bonuses to senior VA employees until changes are implemented, require the VA to identify officials accused of misconduct by name and publicly release Office of the Medical Inspector reports of investigations into wrongdoing at VA facilities.

Past efforts to overhaul the VA have met with a mixed record of success.

In the 1920s, for example, the government adopted strict civil service rules after the first director of the Veterans’ Bureau was caught selling surplus hospital supplies for personal profit.

The rules ended up stifling innovation and made it hard to recruit good doctors, said Colin Moore, an assistant professor of political science at the University of Hawaii who is working on a book about the history of the VA.

The consequences hit after World War II, when a series of articles exposed the abuse and neglect of returning veterans.

The VA responded to the crisis by establishing partnerships with medical schools that dramatically improved the quality of care for veterans.

But the downside of focusing VA resources on acute in-patient care in urban areas near medical schools became apparent after Vietnam, when returning veterans had trouble accessing local primary care. It wasn’t until Congress passed the 1996 Veterans Health Care Eligibility Reform Act that the VA became an integrated health system and expanded into hundreds of outpatient clinics in rural areas and across the South and Southwest.

The VA now has 152 hospitals and 800 clinics serving more than 6 million veterans across the country.

“It’s tragic for the veterans, but this pattern of scandals and reform is just more or less the entire history of the organization,” Moore said.

AFP Photo/Saul Loeb

Will Congress Be As Brave As Shinseki?

Will Congress Be As Brave As Shinseki?

WASHINGTON — If you want a prime example of what’s wrong with our politics, study the response to the veterans’ health care scandal. You would think from the coverage that the only issue that mattered to politicians was whether Gen. Eric Shinseki should be fired.

Shinseki is a true patriot, and his resignation as Veterans Affairs secretary on Friday calls Congress’ bluff. He played his part in a Washington sacrificial ritual. Will the politicians now be honorable enough to account for their own mistakes?

Thanks to Shinseki’s latest selfless act for his country, you can at least hope that we will move on to the underlying questions here, to wit: Why was the shortage of primary care doctors in the VA system not highlighted much earlier? Why did it take a scandal to make us face up to the vast increase in the number of veterans who need medical attention? And why don’t we think enough about how abstract budget numbers connect to the missions we’re asking government agencies to carry out?

It’s an election year, so it’s not surprising that the Republicans are using the vets scandal against President Obama and the Democrats, though there is a certain shamelessness about the ads they’ve been running, given the failures of the previous administration.

Shinseki and Obama might have averted this by pushing Congress much harder, much earlier to give the agency the tools it needed to do right by vets. And as a general matter, I wish Obama spent more time than he has on fixing government and improving administration. Progressives rightly assert that active, competent government can make things better — which means they need to place a high priority on making it work better. This would include, as The Washington Post editorialized, a serious engagement with civil service reform.

It’s also fair to ask why Shinseki did not move faster elsewhere, notably on what the Iraq and Afghanistan Veterans of America (IAVA) called the department’s “egregious failure to process the claims of our veterans” in a timely and effective way. (For what it’s worth, I raised this concern in a column in November 2012.)

But this is where the story gets more complicated. Shinseki eventually made real progress on the claims issue and other inherited messes. He got little public credit, though many friends of veterans saw him as a reformer and refused to join the resignation chorus. Both House Speaker John Boehner and Minority Leader Nancy Pelosi deserve praise for insisting to the end that Shinseki’s departure wouldn’t solve the system’s problems.

The most important of these is not that VA employees falsified data about the excessive waiting times for veterans seeking appointments with doctors, as outrageous as this was. It is, as The New York Times reported last week, “an acute shortage of doctors, particularly primary care ones, to handle a patient population swelled both by aging veterans from the Vietnam War and younger ones who served in Iraq and Afghanistan.” Dealing with this isn’t sexy, just essential.

Sen. Bernie Sanders, (I-VT), the chairman of the Senate Veterans’ Affairs Committee who wanted Shinseki to stay, is trying to push the discussion in the right direction. A Sanders bill to expand VA funding across a wide range of areas went down in a Republican filibuster last February. The new bill he hopes will come up for a vote this week focuses specifically on the health system.

It would authorize private care for veterans facing emergencies, which is similar to a House Republican idea. But Sanders would also broaden access for veterans to other forms of government health care, fund 27 new VA facilities, and use scholarships or loan forgiveness to entice medical students to serve in the VA program.

Shinseki himself proposed other reforms in a speech he gave just before he quit, among them an end to incentives that have encouraged agency supervisors to produce fake information on waiting times.

If there is any cause that should be bipartisan, it’s care for our veterans. But too often, what passes for bipartisanship is the cheap and easy stuff. It tells you how political this process has been so far that so many of the Democrats who joined Republicans in asking for Shinseki to go are in tough election races this fall.

Now that Shinseki is gone, there are no excuses for avoiding the administrative challenges that Obama needs to confront and the policy errors for which Congress must also take responsibility.

AFP Photo/Saul Loeb

VA Secretary Eric Shinseki Resigns

VA Secretary Eric Shinseki Resigns

By Richard Simon, Tribune Washington Bureau

WASHINGTON — President Obama announced Friday that Veterans Affairs Secretary Eric K. Shinseki has resigned amid a health-care scandal that had engulfed the agency.

Shinseki has been under fire over allegations that VA facilities manipulated records to hide long waits for medical care.

The retired four-star general, whom President Obama appointed to lead the VA in 2009, had asked for patience while the charges were investigated. But a scathing interim report by the VA inspector general found a “systemic” problem at VA facilities nationwide, leading to bipartisan congressional calls for his resignation.

Obama made the announcement in a statement from the White House after meeting with Shinseki. He said he had accepted Shinseki’s resignation “with regret” but agreed with him that it was time for new leadership at the VA.

“We don’t have time for distractions,” Obama said.

AFP Photo/Saul Loeb