Government Affairs Committee
The Waiting-List Scandal
BY PETE PETERSON, DIRECTOR
Almost three months after Public Law 113-146, the Veterans Access, Choice, and Accountability Act of 2014, was enacted, and six months after she was placed on paid leave, Sharon Helman was removed as director of the Phoenix VA Healthcare System. Helman was a key figure in the waiting-list scandal that forced the resignation of Gen. Eric K. Shinseki as VA Secretary and led to ongoing public attention and congressional action on how the Veterans Health Administration manages its affairs.
The VA, in a news release, said that Helman was fired following an investigation by the department’s Inspector General that substantiated misconduct and poor oversight.
Accusations by two whistleblowers—a medical doctor who had recently retired and a clinician who was still on staff—shined an unwanted spotlight on the Phoenix system. They said employees kept a “secret list” that concealed long wait times for medical appointments. The retired doctor alleged that this contributed to the deaths of perhaps three dozen veterans.
The outrage incited by these revelations was exacerbated as reports of similar scheduling schemes at several other VA medical centers began to appear.
What went unreported, however, was that this practice of gaming the system to make it appear that wait times for medical appointments are much shorter than the actual wait times had been going on for years, under at least two administrations, and was well known in the veterans community.
In fact, VVA brought this issue to the attention of top VA officials as far back as 2000. But with the spotlight on the critical need to stop the hemorrhaging of the seemingly ever-increasing claims backlog in adjudicating claims for compensation and pensions, and on the effort to better manage and track the dollars spent on health care for veterans outside the VA system—and on several other crises large and small—little attention was paid to fixing what had become a depressingly common practice in many VA medical centers.
So what made the difference this time? We believe that what caught the public’s imagination, and hence that of Congress, was the phrase “secret lists.” What should have been dealt with openness and transparency years ago but was not, compounded by political considerations, led to the downfall of Eric Shinseki, a decent and respected former Army Chief of Staff.
If there are any lessons in this sad saga, one is that VA bureaucrats better not scheme the system, no matter how tempting a questionable shortcut might seem.
Another is that top VA officials ought to listen better when informed of a practice that is a problem by knowledgeable individuals at some of the veterans service organizations—or from VA workers with integrity who see something wrong and report it to the appropriate authorities.
The VA, now under the leadership of former Proctor & Gamble CEO Bob McDonald, issued a Request for Proposals for a new Medical Appointment Scheduling System.
“The new MASS technology will help improve access to care for veterans by providing schedulers with state-of-the-art, management-based scheduling software,” the VA said. “This will replace a legacy scheduling system that has been in use since 1985.”
Reports leaking out of the VA Central Office have claimed that perhaps a thousand VA workers will be let go. However, provisions in PL 113-146, which empower the VA Secretary to dismiss senior executives for mismanagement and misconduct, run counter to long-standing Civil Service law, nor do they leave enough time for the necessary investigation by the office of the VA Inspector General or any other party.
Going back to the firing of Helman, most agreed that it was long overdue. At the same time, sniping at VA leadership continues. Rep. Kyrsten Sinema (D-Ariz.) perhaps put it best when she told reporters, “The removal of Helman demonstrates that the VA has listened to our concerns and is serious about holding accountable those who put veterans at risk.”
Whether the number fired is ninety or twenty is not the issue. Rather, the issue is whether VA senior officials will be held accountable for doing their jobs honestly. For the last eight or more years, VVA has conveyed to senior VA leadership the message that they should write into every position description and job measurement that lying to Congress or to one’s supervisor will cause immediate suspension, and action begun for removal. We still think that is needed.
Stay tuned, however, because the sniping is far from done, and the VA has a long way to go to right all its wrongs.
In the wake of the waiting-list scandal, Congress, in a spirit of bipartisanship rarely seen recently, passed what has come to be known as the Choice Act.
Public Law 113-146 was designed to counter some of the glaring inefficiencies in scheduling appointments for veterans to see medical specialists, as well as primary care clinicians, within reasonable wait times. The law allows veterans who cannot be seen within thirty days or who live more than forty miles from a VA medical center or community-based outpatient clinic to seek medical care outside of the VA healthcare system. The law also permits the VA secretary to fire senior officials, albeit with an “expedited appeals process.” The law also funds the hiring of additional medical staff, the construction of new CBOCs, and some $10 billion to deal with unanticipated emergencies.
So, because the Obama Administration really has no way of knowing just what the demand will be for non-VA health care, and because of the growing demands for more clinicians and equipment to help handle the anticipated influx of veterans of Iraq and Afghanistan, the administration wants to divert some $10 billion set aside in the Veterans Choice Program for subsidizing non-VA health care for eligible veterans to instead support “essential investments in VA system priorities.”
Many members of Congress will not applaud the VA’s stance. They heralded what they thought they had done—to give veterans more choice in obtaining timely health care—and now, after all the hubbub, the initial demand for more choice may not have been all that it appeared to be.
By the time you read this, the VA will have rendered a decision on health care and compensation for service members who flew in and maintained the aircraft in CONUS after the Vietnam War. Many of these aircraft had residue of Agent Orange and other herbicides in and on them. We hope that this decision will be one that will signal the beginning of a new and more honest version of the VA, and that these deserving veterans will be taken care of properly.
What is needed are efforts on all our parts to locate those who had contact with these tainted aircraft, particularly in the Ohio and the Massachusetts Air National Guards, and urge them or their survivors to come forward.
True to his word, President Obama ended U.S. combat operations in Afghanistan three days after Christmas.
In his formal statement, the President said, “For more than thirteen years, ever since nearly three thousand innocent lives were taken from us on 9/11, our nation has been at war in Afghanistan. Now, thanks to the extraordinary sacrifices of our men and women in uniform, our combat mission in Afghanistan is ending, and the longest war in American history is coming to a responsible conclusion.”
Note that while the U.S. effort cost the lives of more than 2,200 American servicemen and women, it ended not in victory but with a “responsible conclusion.” Al Qaeda and the Taliban and various warlords will continue their quest to oust the “democratically elected” government of Afghanistan, which still remains, President Obama noted, a “dangerous place.”
For our wounded, the President said, “We pledge to give our many wounded warriors, with wounds seen and unseen, the world-class care and treatment they have earned.” For the survivors of “the more than 2,200 American patriots who made the ultimate sacrifice in Afghanistan, we pledge to stand with their Gold Star families who need the everlasting love and support of a grateful nation.”
Now, as our nation faces the latest legacy of the invasion of Iraq, the takeover of perhaps one-third of Syria and Iraq by the Middle East’s version of Pol Pot’s Khmer Rouge in Cambodia, our political and military leaders ought to heed the lessons of the past half-century. And whatever course they take, it is imperative that they comprehend that caring for veterans is a continuation of military action. They must provide for the rights and proper care and treatment of those Americans who don the uniform and serve the nation.
The news release was as blunt as it was basic: “The Centers for Medicare & Medicaid Services has determined that the evidence is sufficient to add a lung cancer screening counseling and shared decision-making visit, and for appropriate beneficiaries, annual screening for lung cancer with low dose computed tomography (LDCT), as an additional preventive service benefit under the Medicare program.”
There are, however, a list of eligibility criteria that need to be met, including:
It is no secret that Vietnam veterans, as a class, tend to smoke more than others in our age cohort who never saw service in a war zone. From our work with the Lung Cancer Coalition, we know about the benefits of this screening, most importantly in lives saved from the ravages of this disease.
Under the since-departed Under Secretary for Health, the Veterans Health Administration was supposed to have started pilot studies to test the efficacy and value of this screening.
It seems clear, however, that the pilot project, now reportedly limited to eight VA medical centers, ought to begin in every VAMC ASAP. Why? Because every year some eight thousand veterans show up at a VA healthcare facility with lung cancer, most always in an advanced stage. After five years, some 85 percent of these women and men are deceased after very costly care and treatment. It is not only the right thing to do in regard to the life and quality of life for affected veterans, but it is much cheaper to catch these cancers at the earliest possible time.
It’s time to reverse these numbers and save thousands of lives of worthy women and men.