The Department of Veterans Affairs Secretary Eric Shinseki said he is angry and saddened over reports that delayed medical care may have contributed to the deaths of dozens of veterans, but he told Congress Thursday he has no plans to resign his post until and unless the President tells him it’s time to go.
Shinseki’s testimony before the Senate Veterans Affairs Committee Thursday was his first public remarks on Capitol Hill since the publication of news reports alleging that as many as 40 veterans enrolled at the Phoenix VA medical center died while they were waiting to get doctor’s appointments and that hospital staff maintained an off-the-books appointment list designed to obscure long wait times at the facility.
In his remarks, Shinseki revealed little new information about the veteran deaths in Phoenix and elsewhere, other than to say investigations are ongoing.
“Any adverse incident like this makes me mad as hell, but at the same time it also saddens me,” Shinseki said. “I understand that out of these adverse events, a veteran’s family is dealing with the aftermath. I’m committed to taking all actions necessary to identify what the issues are to fix them and to strengthen veterans’ trust in VA health care.”
An ongoing internal audit
The department’s inspector general deployed a team of 185 people to Phoenix to investigate the case, which originated from whistleblower complaints from several current and former VA employees there. Because of the complexity of the investigation, the OIG estimates it will take until August before it issues a final report.
At the same time, Shinseki said VA is conducting an internal review of all its medical facilities to determine how widespread the practice of manipulating wait time statistics is.
“We need to ensure full compliance with our scheduling policies, and as we’ve begun that, we’ve already received reports where compliance is under question. We’ve asked the IG to also take a look at a number of those cases,” he said.
Shinseki said VA’s internal audit is examining the health care system’s largest facilities this week, and he told senators he expects to be able to provide them with the preliminary results within three weeks. He also pledged accountability for any VA staff who are found to have cooked the books on wait times, but not until the IG review is finished.
“If any of this is substantiated, we will act,” he said. “It is important, however, to allow the inspector general to complete his duty, which is to conduct an objective review and provide us the results.”
Allegations of a secret waiting list
Acting VA Inspector General Richard Griffin also testified Thursday. At his request, the director of the Phoenix VA hospital and two other Arizona VA officials are on administrative leave.
“This was done because of the gravity of the allegations and to ensure the cooperation of the Phoenix staff, some of whom expressed concern about talking to the OIG team,” Griffin said.
Griffin did not reveal any explicit details about the Phoenix investigation, but he cautioned that none of the evidence thus far has drawn a direct connection between delayed care and the deaths of the veterans who were awaiting medical appointments.
“It’s one thing to be on a waiting list, and it’s another thing to conclude that as a result of being on the waiting list that’s the cause of death, depending on what your illness might have been at the beginning,” he said.
Griffin, however, suggested that the alleged existence of a secret waiting list which operated outside of VA policies may extend beyond an administrative matter. His office, he said, is looking into possible criminal violations.
“Our own criminal investigators, including IT forensic experts, are assisting the team,” he said. “We are working with federal prosecutors from the United States Attorney’s Office for the District of Arizona and the public integrity section of the Department of Justice here in Washington so that we can determine any conduct that we discover that merits criminal prosecution.”
Griffin said in the weeks since the Phoenix case was publicized in national media, the IG’s office has received additional reports of manipulated waiting times at other VA facilities across the country via its own hotline service, members of Congress and media reports. The office has launched separate investigations at several other VA hospitals, though Griffin did not specify how many probes are currently underway, nor their locations.
But Debra Draper, the director for health care issues at the Government Accountability Office, pointed out that the practice of gaming the system in order to make a given VA health care facility’s statistics appear better on paper than they are in reality isn’t exactly a new development. GAO last reported on the problem in a 2012 report that also examined long wait times at VA facilities.
“During our site visits to four medical centers, we found that more than half of the schedulers we observed did not record veterans’ desired appointment dates correctly, which may have resulted in reported wait times shorter than what veterans actually experience,” she said. “Some staff also told us they changed veterans’ desired dates in the system so that the wait times aligned with VA’s performance goals. We also identified other problems with how the scheduling policy was implemented. For example, we found follow-up appointments being scheduled without ever talking to the veteran, who would then receive notification of their appointment through the mail. In addition, we found that the scheduling system’s electronic wait list was not always used to track new patients, putting these patients at risk for delayed care or not receiving care at all.”
Care that’s ‘somewhere between good and excellent’
The universal opinion among the nation’s veterans service organizations is that the care veterans receive within VA hospitals is somewhere between good and excellent and that VA provides many specialized health care services that don’t exist anywhere else.
The biggest problem veterans face, they say, is getting in the door in the first place because of a shortage of clinicians.
“At its core, this is an access problem, not a quality-of-care problem, and these are not the same thing,” said Carl Blake, the legislative affairs director for Paralyzed Veterans of America. “Sending veterans outside of the VA to get private care is not the solution to this problem, particularly for veterans who rely on the VA’s specialized services. There are not comparable services to the VA’s spinal cord injury service, blinded care, amputee care and the wide variety of specialized care that the VA provides in the private sector. But staffing shortages in those areas severely limit access to the system while also placing health care delivery for veterans at risk. Insufficient staffing and insufficient capacity is ultimately a reflection of insufficient resources that this administration and previous administrations have requested for health care and insufficient resources that Congress has ultimately provided.”
PVA and most of the other large veterans associations believe Shinseki needs to act more forcefully than he has thus far to address the issue of wait times and veteran deaths.
“Today’s testimony from Secretary Shinseki did not restore confidence that VA senior leadership is responding with action and not just concern,” said Tom Tarantino, the chief policy director for Iraq and Afghanistan Veterans of America. “Our members are outraged, and we need to see a bold plan to address these allegations. The secretary did not detail exactly how the VA holds its employees accountable when these concerns are raised. Today we heard plans to investigate, but few plans on how the VA will actually solve the problem in the coming critical days and weeks. The evidence provided so far demands immediate action. The VA cannot simply wait for the conclusion of the Inspector General’s review to overhaul its system of accountability.”
Rep. Jeff Miller (R-Fla.), the chairman of the Veterans Affairs Committee, also was unimpressed by Shinseki’s testimony Thursday. His committee issued a subpoena last week demanding a huge trove of documents related to the Phoenix matter in a unanimous bipartisan vote, a step the committee said was necessary because VA had refused to answer questions in a less-formal venue.
“I have no confidence whatsoever that an internal VA review will yield results that are either accurate or useful,” Miller said in a statement Thursday afternoon. “VA officials in Washington have known about problems with medical care access for at least six years and have failed to fix them. That’s why the only way we can begin to fix VA’s problem with delays in care is via an independent bipartisan commission. Anything less is unacceptable.”
Miller has stopped short of calling for Shinseki’s resignation so far, and most of the veterans service organizations have decided to stand by the secretary in the belief that he is the best possible leader to fix the problems they see in VA.
The most notable exception is the American Legion, the biggest veterans’ association, which called for Shinseki’s resignation in the wake of the news from Phoenix.
But Shinseki made it clear Thursday he has no intention of stepping down.
“I came here to make things better for veterans,” he said. “Every day, I start out with the intent to provide as much care and benefits for the people I went to war with and the people that I spent a good portion of my life with. This is not a job. I’m here to accomplish a mission that I think they critically deserve and need. Over the past five years we’ve done a lot to make things better. We’re not done yet, and I intend to continue this mission until I’ve satisfied that goal or I’m told by the commander in chief that my time has been served.”