State of the VA

Earlier this week, President Obama gave his last State of the Union Address. Although this usually is a speech giving the President the opportunity of flaunt his accomplishments, no mention was made of the VA (1). Given the troubles at the VA, there seems little to tout.

Over 70% of the VA medical centers were discovered to have falsified wait times (2). Because of the wait scandal, VA Secretary Eric Shinseki resigned and VA undersecretary, Robert Petzel MD, retired under pressure. Ironically, Shinseki, a retired Army general and member of the Joint Chiefs of Staff, was viewed in a favorable light by the current administration because of a spat with the Bush administration's Secretary of Defense, Donald Rumsfeld, over the number of troops needed to secure Iran and Afghanistan (3). However, during Shinseki's tenure the number of VA "medical troops", doctors and nurses, was insufficient to care for the number of veterans. It is unclear if the new secretary, Bob McDonald, has done much to correct the problem.

Locally, the director of the Phoenix VA regional office, Susan Bowers, retired under pressure and former Phoenix VA Director Sharon Helman was fired (4). However, Helman was allowed to keep her bonus for the falsely reported shorter wait times and is appealing her firing. Her deputies, Lance Robinson and Brad Curry, were placed on administrative leave, but after over a year and a half have recently returned to work in the Phoenix VA regional office. Darren Deering DO, the Phoenix chief of staff, underwent a VA internal investigation because of retaliating against one of the Phoenix VA whistleblowers, Katherine Mitchell MD. Disciplinary action was recommended but no action was taken. In October 2015, the IG released a new report citing critical staffing shortages at the Phoenix VA.

Earlier this week the Senate Veterans Affairs Committee approved the nomination of Washington lawyer Michael Missal as the new permanent Department of Veterans Affairs inspector general (VAIG) (5). Lawmakers from both parties have sought a permanent VAIG for over 2 years. The chairman of the Senate veterans panel, Republican Sen. Johnny Isakson of Georgia, says the top priority of the inspector general must be to "hold bad actors at the VA accountable" for chronic delays for veterans seeking medical care and other problems at the agency.

If confirmed by the full Senate which is expected, Missal might be busy. Whether Isakson is serious or this is more political posturing is unclear. Rather than a few “bad actors” the wait scandal suggests that fraud, waste and abuse are common, perhaps even rampant, within the VA. Rather than being held “accountable”, the bad actors are more often protected and even rewarded by VA Central Office. Although Veterans and the public might be optimistic, it is likely that they will be disappointed by Missal, as they have by VAIGs and others charged with VA oversight in the past.

Richard A. Robbins, MD*

Editor, SWJPCC

References

1. Graf N. Veterans' affairs left out of State of the Union; Phoenix VA whistleblower disappointed in speech. ABC15 Arizona. January 13, 2016. Available at: http://www.abc15.com/news/region-phoenix-metro/central-phoenix/veterans-affairs-left-out-of-state-of-the-union-phoenix-va-whistleblower-disappointed-in-speech (accessed 1/15/16).
2. Klimas J. Huge backlog: 70 percent of VA facilities used alternative waitlists. Washington Times. June 9, 2014. Available at: http://www.washingtontimes.com/news/2014/jun/9/audit-more-57000-await-initial-va-visits/?page=all (accessed 1/15/16).
3. DeFrank T. How Donald Rumsfeld complicated Eric Shinseki’s last administration exit. National Journal. May 31, 2014. Available at: http://www.nationaljournal.com/white-house/2014/05/31/how-donald-rumsfeld-complicated-eric-shinsekis-last-administration-exit (accessed 1/15/16).
4. Arizona Republic. VA in crisis: the Republic investigation. Available at: http://www.azcentral.com/investigations/vahealthsystem/ (accessed 1/15/16).
5. Daly M. Senate panel backs lawyer Missal as VA watchdog. Washington Post. January 12, 2016. Available at: https://www.washingtonpost.com/politics/whitehouse/senate-panel-backs-lawyer-missal-as-va-watchdog/2016/01/12/d13db550-b96d-11e5-85cd-5ad59bc19432_story.html (accessed 1/15/16).

*The opinions expressed are those of the author and not necessarily the opinions of the Arizona, New Mexico, Colorado or California Thoracic Socities or the Mayo Clinic.

Cite as: Robbins RA. State of the VA. Southwest J Pulm Crit Care. 2016;12(1):28-9. doi: http://dx.doi.org/10.13175/swjpcc008-16 PDF