Underworked doctors, crooked contracting officers, criminals, perverts and cheats are all part of the broken culture that rewards failure and punishes honest employees at the Department of Veterans Affairs, according to a report released Tuesday by Sen. Tom Coburn.
"This investigation found the problems at the VA are far deeper than just scheduling. Over the past decade, more than 1,000 veterans may have died as a result of VA’s misconduct and the VA has paid out nearly $1 billion to veterans and their families for its medical malpractice," Coburn said in a statement about the report.
The Oklahoma Republican, himself a physician, did not spare his fellow senators, who he said are often more concerned with the good publicity that comes from a ribbon-cutting ceremony than they are about holding VA accountable.
“Congress has ignored its oversight role because it requires hard work — asking tough and often uncomfortable questions of government officials, examining budgets, listening to whistleblowers and constituents, and standing up against special interest groups,” Coburn said in his 154-page assessment of what’s wrong with the largest civilian agency in the federal government.
“Unlike breaking ground on a new VA health center, there is no ribbon-cutting ceremony for politicians if they stop a government boondoggle in their state, but sometimes this can do just as much good — or more,” he said.
Coburn's report -- the latest in a long succession he's released as a senator detailing waste, fraud and inefficiency throughout the federal government -- comes as VA is under withering fire due a crescendo of media and congressional reports of documented patient deaths, long backlogs for services and patient wait lists being falsified to hide lengthy delays in scheduling appointments.
Much of Coburn's report is based on a collection of investigations from the VA inspector general and Government Accountability Office. He also cites media reports, including dozens from the Washington Examiner, exposing a litany of failures across the agency.
Some of the problems are system-wide, such as the falsification of waiting lists used to hide long backlogs in care and “game” the system so top administrators will qualify for performance bonuses.
Other parts of Coburn's report highlight failures to hold individual employees accountable for criminal conduct, billing personal expenses to the government, chronically failing to show up for work or retaliating against whistleblowers.
More money is not the solution, Coburn said, noting that VA is expected to end the 2014 fiscal year with $5.9 billion in unspent funds.
Federal employees at VA must be held individually accountable, and patients should be provided more choices of where they obtain care, he said.
“The culture of the Department of Veterans Affairs has developed into one that favors bureaucracy over service and mismanagement over accountability,” Coburn said.
“Rather than putting the needs of veterans first, agency administrators used gimmicks to create the appearance of success in the midst of tragic failure.”
Doctors at the VA have it easy compared to their private-sector counterparts, according to Coburn.
The 10 highest-paid federal employees work at the VA, with more than 1,000 physicians making more than $300,000 per year.
In Phoenix, for example, 13 VA employees made more than $300,000 annually, including one orthopedic surgeon drawing more than $357,000. That is almost double the average income for doctors in Arizona, according to Coburn's report.
VA employs almost 19,000 full-time physicians nationwide.
Yet VA doctors see far fewer patients than their counterparts in the private sector, Coburn said. An average primary care physician in private practice has a caseload of about 2,300 patients. For VA doctors, it’s about 1,200.
VA officials have long resisted standards designed to measure doctors' productivity, even though such standards are commonplace in the private sector and for Medicare, Coburn said.
Real shortages of medical personnel are made worse by allowing so much “official time,” which allows union representatives to be released from their regular duties to perform union work while drawing full pay and benefits from the taxpayers, Coburn said.
VA had 277 employees on full-time release to work for the unions in February 2013, Coburn said. At one point, 85 VA nurses were on 100 percent official time while the department was attempting to recruit more nurses to fill vacant positions.
Earlier this year, the Examiner published "Too Big to Manage," a special investigative series on official time abuses throughout the federal government.
The report intersperses examples of abuse to illustrate the lax working environment and lack of accountability for VA workers.
VA employees caught shirking their duties or breaking the law typically faced no punishment or were placed on long periods of paid administrative leave rather than being fired immediately, according to Coburn.
Examples in the Coburn report included:
• A male neurologist in Kansas who spent two years on paid administrative leave after five female patients filed sexual misconduct charges, saying he conducted “inappropriate pelvic and breast examinations.”
The doctor was placed on leave in 2011 and finally fired in May 2013 after pleading no contest to criminal charges.
• A VA employee in Nashville who was put on paid administrative leave after being caught charging his “jet-setting” lifestyle to the taxpayers.
The employee worked only when he wanted, set his own hours and conducted personal business throughout the workday, according to Coburn’s report.
He was absent without leave 25 times and downloaded software onto his VA computer so he could send out sexually explicit photos and texts.
The employee’s antics cost the taxpayers more than $109,000, according to an inspector general’s investigation.
After getting in trouble in Nashville, he escaped punishment by convincing his supervisors to create a new and higher-paid job for him in Washington.
• A health coordinator in Cheyenne, Wyo., was put on paid leave after he sent an email to other employees detailing how to “game” patient wait time data.
Schedulers who refused to abide by his illegal instructions were warned they were on a “bad boy list.” While the VA claimed the employee was on administrative leave, a reporter tracked him down at his office.
“In these cases, paid administrative leave is the equivalent of disciplining a misbehaving child by suspending his chores while continuing to pay him an allowance,” Coburn said.
“Regrettably, there are numerous examples of the VA tolerating or even rewarding misconduct by paying delinquent employees rather than disciplining them,” he said.
When employees refuse to abide by improper orders or attempt to expose wrongdoing, they are routinely punished, Coburn said.
Among the cases cited in the Coburn report is that of Oliver Mitchell, an ex-Marine who told the Examiner in February that he faced retaliation from his VA bosses in Los Angeles after he tried to report a mass purge of patient appointments to the IG.
“The VA has shown a willingness to fire and punish employees it considers troublesome,” Coburn concluded in his report.
“For decades, the VA has silenced, harassed, and retaliated against whistleblowers who were merely trying to fulfill the commitment to veterans that is the mission of the VA,” he said.
Coburn's report also detailed wasteful spending on construction, call centers and curtains.
Four VA construction projects have combined cost overruns of $1.5 billion, and construction delays run between 14 and 74 months. The VA medical facilities are, on average, 35 months behind schedule and $360 million over budget.
VA spent almost $500 million in less than five years on “office makeovers,” including $6.8 million to build one conference room in Illinois, $1.8 million for office furniture in Puerto Rico and $10.7 million for curtains and draperies nationwide.
In July 2011, VA established two employment call centers to recruit veteran employees. An IG investigation found that while the center cost $2.2 million to operate in 2012, call center employees each handled an average of only 2.4 calls per day.
Congress, particularly the Senate, bears much of the responsibility for the out-of-control agency, Coburn said.
He singled out the Senate Veterans’ Affairs Committee, which has held 28 hearings since the beginning of the current two-year term in 2013.
Only two of those were deemed oversight hearings to examine allegations of impropriety within the agency, rather than such things as considering legislation, Coburn said.
The House Veterans' Affairs Committee has had more than 80 hearings this term, about half of which have been for agency oversight, according to Coburn.
“By any measure, the Senate Committee on Veterans’ Affairs has done little oversight on this or other areas where the VA has fallen short or demonstrated a need for stronger accountability,” Coburn said.