White House Fights to Restore Veterans' Trust: 'It's Not Going to Be Quick or Easy'

By Carlo Muñoz, Guardian UK

07 June 14

Revelations of misconduct, fraud and abuse by officials in Phoenix has turned up the heat on a beleaguered VA department. Can veterans trust the system ever again?

n May 2005, former marine corps corporal and Iraq war veteran Aaron Mankin's life was changed forever.

While on a mission with US forces in Iraq, Mankin's convoy was hit with a roadside bomb, leaving the vehicle and its passengers in a burning pile of steel and bodies. Mankin joined the thousands of wounded US veterans who would be returning home from the battlefields of Iraq and Afghanistan.

Suffering burns over 25% of his body, and losing his ears, nose, mouth and portions of his left hand, Mankin would spend the next several years going through endless medical procedures, rehabilitation, and the difficult process of readjusting to the civilian world as a wounded warrior.

Throughout that time, which included nearly 60 operations, Mankin was encouraged to believe in the doctors, nurses and administrators of the US Department of Veterans Affairs to bring him back from that devastating spring day in Iraq.

"Trust the system," Mankin said, recalling the mantra he had repeatedly heard from VA officials, whenever the former Marine would run into the scheduling delays and long wait times for care that have come to characterize government care for the country's newest generation of veterans.

House veterans' affairs committee chairman Jeff Miller was among those to call for Shinseki to resign. Photograph: Yuri Gripas/Reuters

But the recent revelations of misconduct, fraud and abuse by VA officials at the administration's branch in Phoenix, which reportedly led to the deaths of numerous veterans waiting for critical medical care, has shattered what little trust was left for the VA by Mankin and the thousands of other veterans. A scathing report released last month by the VA's inspector general chronicled efforts by healthcare administrators at the Phoenix branch to intentionally manipulate waiting lists for veterans seeking treatment, blocking access to treatment in an attempt to meet federal quotas for medical care.

"That trust has been violated … [and] the system is broken," Mankin said Tuesday, days after Eric Shinseki resigned as VA secretary amid a firestorm of controversy in Washington and across the country. "The time for saying 'thank you' has passed, and the time for [acting] thankful is now."

Shinseki’s resignation on Friday capped off a week-long effort by the Obama administration to quell public outcry over the administration's misconduct. The VA and Defense Department have kicked off overarching reviews of veterans' healthcare, to see if similar instances of fraud and abuse were going on elsewhere.

“The department must continue to provide the best available health care to our Service men and women, and their families, who have sacrificed so much on behalf of the Nation,” defense secretary Chuck Hagel wrote in a Pentagon-wide memo this week, announcing a comprehensive review of the military's health care program.

US veterans "deserve nothing short of our highest level of effort," the Pentagon chief added.

Lawmakers on Capitol Hill are also pressing several pieces of legislation to allow VA leaders more leeway to discipline or fire healthcare managers who fail to prevent cases of fraud like the ones carried out in Phoenix. On Thursday, senior senators announced an agreement that would allow some veterans to use private doctors if they face long wait times for VA appointments.

With Congress focused on the VA's next move, the organization's new chief will be responsible for implementing a series of institutional fixes to repair the VA's damaged reputation among veterans and the American public.

Taking the the Phoenix case and leveraging that public pressure to reverse the administration's lax culture of accountability will be the new secretary's biggest and toughest job, Veterans of Foreign Wars spokesman Joe Davis said.

"You have to start somewhere [and] learning from the mistakes" of the Phoenix debacle is where the new secretary should start, Davis said. "It is a blanket question mark that has been placed over the entire VA system," he added.

That effort will take "a complete bureaucratic shift" in how the VA does business, both technologically and culturally, Rieckhoff added, characterizing it as a "Borders to Amazon.com" type move.

‘Not the first scandal’

While news of the fraud and mismanagement at the Phoenix VA have sparked angry calls for reform, those revelations came as no surprise to the hundreds of thousands of veterans whose trust in the system has been whittled away for years, according to Paul Rieckhoff, head of the Iraq and Afghanistan Veterans of America

"This is not the first scandal" involving the VA, Rieckhoff said. "If you weren't outraged [before Phoenix] you were not paying attention."

In its report on the Phoenix branch, VA investigators noted the independent inspector general's office had issued 18 prior reports on the problems with the administration's management of patient waiting lists, going back to 2005. These shortfalls led to "deficiencies in scheduling, resulting in lengthy waiting times and a negative impact on patient care," at the local and national level, according to the report.

"Our reviews at a growing number of VA medical facilities … have confirmed that inappropriate scheduling practices are systemic throughout the [Veterans Health Administration]" according to the report.

Before his departure from the VA, Shinseki admitted that he had been misled by administration staff on what exactly was going on in Phoenix, admitting he "was too trusting of some" within the organization.

Rieckhoff backed Shinseki's resignation, noting "it was clear [he] had to go.” But he said the next VA chief will inherit the unenviable task of building back up the veterans' trust in the VA. "We want the VA to succeed, [but] now we have a new challenge. Not just now, but for [decades] to come."

About 1,700 veterans in need of care were "at risk of being lost or forgotten" after being kept off the official waiting list at the Carl T Hayden VA Medical Center in Phoenix Photograph: Michael Chow/AP

What exactly happened in Phoenix?

As part of the Inspector General's inquiry into the Phoenix branch, investigators pored through hundreds of medical records of patients who died while on a waiting list to receive care, or whose death "is alleged to be related to a delay in care," according to the report. Investigators also questioned all staff at the Phoenix branch "with direct knowledge of patient scheduling practices and policies" related to the location's management of its wait list.

But the key to cracking the fraud came in the more than 500,000 emails and 140,000 network files kept on 10 encrypted computers at the VA facility, which contained the details of the massive scheme to cover up the massive wait list delays.

VA administrators at the Phoenix branch had essentially set up dueling wait lists for patient care, according to the report. One list included 1,400 veterans who had requested care. Thry had been placed on the facility's official waiting list to receive treatment.

A second list, which included 1,700 patients who also requested medical treatment, was also created, but those veterans were intentionally left off the official waiting list.

By creating the dual lists, VA administrators kept an unofficial tally of those veterans seeking treatment, a total of 3,100 patients, but only acknowledged an official patient wait list of 1,400.

That official rate of veterans seeking care at the Phoenix branch allowed the facility to meet federal standards for VA wait lists. As a result of a dual lists, veterans at the Phoenix VA averaged 115 days wait time for an initial primary care appointment. But when average times were calculated, based on the official patient wait list, that number dropped to 24 days.

The dual lists also, according to the report, put those veterans left off the official waiting list "at risk of being forgotten or lost in the Phoenix [facility's] convoluted scheduling process."

The reasoning behind letting 1,700 veterans languish on the Phoenix facility's unofficial waiting list, some dying before they had a chance to make it onto the official list, was simple, according to VA investigators. In a visit to Phoenix on Thursday, acting VA secretary Sloan Gibson said at least 35 of the 1,700 veterans have died.

Meeting or exceeding federal standards for patient wait lists "is one of the factors considered for awards and salary increases" for VA hospital staff and administrators, the report states.

"We've hit a boiling point”, congressman Cory Gardner said in an interview, regarding the growing frustration among lawmakers over the decision to willingly deny veterans' medical care in order to improve one's chances for a pay raises or promotions.

"The fact that we have secret wait lists is an example of the systemic failures" within the veterans health care system, he said. "It's sickening."

Gardner, a Colorado Republican, has sponsored legislation to restrict pay and bonus restrictions to negligent VA administrators.

Why you can't just clean house

On Wednesday, Gibson attempted to soothe congressional concerns, announcing the wait-listed veterans who were intentionally denied care at the Phoenix branch have now been slated to receive treatment.

But the problems that surfaced in the Phoenix branch may have been the offshoot of larger, cultural issues that have plagued the institution for decades. The VA is led by "political appointees in Washington but run by [bureaucrats] in the field … and there is some rub there," said the VFW's Davis.

Rieckhoff noted that disconnect also extends to the VA and its ties to the Defense Department. "Too much is lost between DOD and the VA," he said, noting that lack of collaboration or communication on veterans' health care has contributed to a culture where oversight and accountability is lacking. "The VA cannot do this alone," he added.

The problem is compounded by the fact that VA leadership have little power to reprimand or fire health care administrators who have been accused of misconduct, according to Davis.

In the wake of the 2007 scandal at the Walter Reed army medical center – in which a Washington Post investigation found wounded service members were subject to hazardous conditions at the dilapidated complex – then defense secretary Robert Gates summarily dismissed the top Army brass who oversaw the facility.

Gates was able to fire those involved with Walter Reed, since those officers fell under the official military chain of command, Davis said. In the VA, Shinseki and now Gibson are dealing with a civilian workforce, backed by powerful federal labor unions. Being able to exercise the kind of swift reprimands Gates did at Walter Reed would be extremely difficult, if not impossible, within the Veterans Administration, he said.

With little fear of official repercussions, combined with the massive pressure to meet the needs of a growing number of wounded veterans, the culture of accountability within the VA had simply crumbled under that weight, Davis and Rieckhoff said.

Congressional lawmakers on Thursday moved to grant VA leaders the ability to enforce accountability into the administration's workforce. Senators John McCain and Bernie Sanders are pushing legislation to allow the VA secretary expanded powers to dismiss health care managers, senior administrators and staff for poor performance. Senate majority leader Harry Reid told reporters Thursday he plans to fast-track the bill through the upper chamber.

"If there is accountability, that will change the culture," inside the VA, Gardner said.

A Marshall plan for the VA

Cases of fraud and misconduct in Phoenix have given veterans groups, like the IAVA and VFW, a platform to shed light on the problems facing wounded soldiers coming home. But Rieckoff and others are working to ensure that once the political spotlight fades from the VA, the efforts to reform the organization will not fade with it.

"We are very concerned everyone is going to turn the page" from the problems plaguing the VA, Rieckhoff said. "This is not over, this is far from over."

IAVA is pressing a so-called "Marshall plan" to build off the momentum created by the Phoenix fiasco, an eight-point plan designed to institutionalize reforms to veterans health care. A key part of that plan, according to Rieckhoff, will be to name a veteran of the Iraq or Afghanistan wars as the next VA secretary. Veterans of those wars account for less than 15% of VA patients.

While declining to name specific candidates, Rieckhoff noted "there is a lot of talent in that pool [of veterans] to meet that challenge." White House officials have reportedly considered retired Gen Stanley McChrystal, former top commander of US forces in Afghanistan, as a possible replacement for Shinseki.

But whoever the White House settles on to lead the embattled agency, that fight will continue long after the end of the Obama administration. "This is not going to be quick [or] easy," he said.