A White House review of the Veteran Affairs Department uncovered layers of problems that led to extended wait times for veterans to get medical care, including a “corrosive culture,” little transparency or accountability and a system that encouraged the manipulation of wait times.
Written by White House deputy chief of staff Rob Nabors, the review also calls for a complete overhaul of the Veterans Health Administration, the section of the agency that administers more than 1,700 medical facilities serving veterans across the country.
The report recommended that the VHA be restructured and reformed after finding that the leadership structure is “marked by a lack of responsiveness and an inability to manage or communicate to employees or veterans.”
Although Nabors described the vast majority of the VA employees as "dedicated, hardworking and committed to the veterans they serve," he also found that a “corrosive culture” led to personnel problems across the department that are “seriously impacting morale and, by extension, the timeliness of health care.”
“The problems inherent within an agency with an extensive field structure are exacerbated by poor management and communications structures, distrust between some VA employees and managements, a history of retaliation toward employees raising issues, and a lack of accountability across all grade levels,” the report found.
The report also focused on the VA's 14-day scheduling standard, which previous internal government watchdog reviews found had been systematically manipulated and had little bearing in certain facilities on actual wait times veterans faced.
The White House review called the standard “arbitrary, ill-defined and misunderstood” and said it should be scrapped entirely.
“The manner in which the unrealistic goal was developed and deployed has caused confusion in reporting and, in some cases, may have incentivized inappropriate actions,” the report concluded.
The technology the VA uses to schedule doctor's appointments is “cumbersome and outdated” but those software problems are secondary to the need for more personnel, physical space and “appropriately trained” administrative support personnel, according to the report.
The White House released the report Friday evening after President Obama met with Nabors and acting VA Secretary Sloan Gibson to discuss the findings. Obama last month tapped Nabors, one of his most trusted advisors, to help fix the array of problems at the beleaguered agency that have stoked outrage among Americans about the mistreatment of the nation's veterans.
Over the last year and a half, the VA has suffered from a steady stream of disturbing allegations. In addition to trying to reduce a stubbornly unwieldy claims backlog, the VA faces charges that it has used accounting tricks to reduce claim numbers, has gamed treatment delays and allowed 40 preventable deaths at a Phoenix veterans hospital.
The scandal eventually led to the resignation of former VA Secretary Eric Shinseki, a decorated Vietnam veteran who also served a chief of staff of the Army during the President George W. Bush's administration.
After hearing from Nabors and Gibson Friday, Obama asked Nabors to remain dispatched to the VA to continue to help the agency “in this time of transition.”
Since Nabors began the review, the agency has conducted its own “access audit” and taken several steps to try to improve veterans access to care, the White House said.
In the last month, the VA has contacted 135,000 veterans, scheduled 182,000 additional appointments and trained approximately 10,000 schedulers. It has also increased transparency by posting twice-monthly updates regarding the wait times and “access data,” and Gibson has begun a review into allegations of reprisals against whistleblowers.
Reacting to the report, Gibson said he appreciated and welcomed Nabors' “insight and leadership.”
“We know that unacceptable, systemic problems and cultural issues within our health system prevent Veterans from receiving timely care,” he said in a statement. “We can and must solve these problems as we work to earn back the trust of Veterans.”
Four days ago, Sen. Tom Coburn, R-Okla., a physician who has focused on ferreting out corruption during his long Senate career, issued a much more scathing review of the VA, describing the agency as wracked by incompetence, corruption and coverups.
The investigation found that the problems at the VA are far deeper than scheduling. Over the past decade, more than 1,000 veterans may have died as a result of the agency's misconduct, and the VA has paid out nearly $1 billion to veterans and their families for its medical malpractice, Coburn found.
The report said that underworked doctors, crooked contracting officers, criminal, perverts and cheats are all part of the broken culture that rewards failure and punishes honest employees.