The real VA scandal: No will to help veterans

The scandal that engulfed the Department of Veterans Affairs these past few weeks was sordid and sad. More disturbingly, it has only gotten worse, illuminating the deep-seated problems that still plague the VA. Our veterans deserve better, starting with a full house-cleaning.

The VA’s current round of problems began with VA Secretary David Shulkin and his wife, Dr. Merle Bari, a dermatologist in private practice. Dr. Shulkin, along with some top staff people — and, most problematically, his wife — went to Europe last summer to attend the International Ministerial Conference on Veterans’ Issues in London. In making travel plans, Shulkin asked his staff to arrange legitimate business meetings in Copenhagen during the trip. An anonymous complaint alleged that Shulkin improperly accepted Wimbledon tickets, spent too much time sightseeing, and that Bari hadn’t really met the criteria needed for the government to pay her tab.  

{mosads}How did all this happen? Last Friday, the VA’s chief of staff, Vivieca Wright Simpson, admitted she had doctored an email in order to get Bari’s airfare paid for by the government. When made aware of the issue, Shulkin reimbursed the government — but Wright Simpson was permitted to retire from government “service” with full benefits. She didn’t resign in shame. She didn’t get fired. She simply retired, after 32 years working at the agency, as if nothing inappropriate had happened.

And therein, perhaps, lies the root of the VA’s problems: a culture where a senior staff person thinks it is acceptable to forge documents in order to please the boss. Worse, there were no consequences for an act that was not just unethical, but illegal.

Let’s go back a few years, to 2014, when the VA admitted — again, after a cover-up — that some 1,700 veterans were waiting an average of 115 days for a doctor’s appointment at the Phoenix VA hospital, and 40 veterans died while doing so. Sadly, the situation was not limited to the Phoenix facility: there was gross mismanagement of a gastroenterology program in South Carolina, and a Legionnaires’ disease outbreak in Pittsburgh that killed six vets.

The VA’s culture, investigators discovered, was rife with false record-keeping. President Obama’s secretary of Veterans Affairs, Gen. Eric Shinseki, resigned and his replacement, former Procter & Gamble CEO Robert McDonald, quickly implemented management reforms modeled on private-sector practices.

According to an article in the December 2016 Harvard Business Review, the McDonald reforms turned the VA ship around with remarkable speed. After two-and-a-half years, pending claims dropped by more than 90 percent, wait times dropped across the board, and almost every VA hospital began offering same-day service. For an organization that serves more than 9 million veterans, has more than 365,000 employees, 1,700 facilities, and an annual budget of more than $152 billion — a sum greater than General Motors’ annual sales — that is a massive change.

It didn’t come without pain: McDonald replaced 14 of the agency’s top 17 managers. And importantly, McDonald recruited Shulkin as his assistant secretary for health. Two years alter, President Trump elevated Shulkin to the top position and he was confirmed by the Senate 100-0 (no small feat in this toxic political environment).     

Since taking over at the VA, Shulkin — a specialist in health care management who formerly ran New York’s Beth Israel Medical Center and Morristown (N.J.) Medical Center — has focused on improved transparency and patient-centered care.

Shulkin acknowledged that there remained a backlog of 90,000 disability claims that would take more than 125 days each to process. The agency’s report card on hospital performance for 2017 still identified 14 hospitals that received scores of “1” — the lowest possible on the 1-to-5 scale — but that 64 percent of VA hospitals (94 out of 146) showed some improvement from the previous year.

Perhaps the most disturbing problem, is the suicide rate among veterans. It is estimated that 20 veterans kill themselves every day. In 2014, the suicide rate for veterans was 22 percent higher than adults who had not served in the military, and 2.5 times higher among female veterans when compared to U.S. non-veteran adult women. 

Significantly, a study done by the National Academies of Science, Engineering and Medicine for the VA found that half of U.S. veterans who served in Afghanistan and Iraq are not getting the care they need.

Recently, I was talking with several of my classmates from the U.S. Naval Academy, all retired from the Navy now but successful in second careers or volunteering in their communities. I asked them about their experiences with the VA system. They praised generally good care — once they learned how to navigate an unnecessarily bureaucratic system. But they did share far too many horror stories about classmates who were trying to access benefits tied to a problem most Americans have forgotten: Agent Orange.

For example, in the summer of 1970, following our Plebe Year, we embarked on our Youngster Cruise. Half of us were sent aboard ships heading for the North Sea, and half went to Vietnam. (I was in the first group.) The Vietnam-bound group docked in Da Nang, and helped load Marines and their equipment aboard the ships for transit back to the United States. Afterward, they were treated to barbecue and beer — along with exposure to Agent Orange — on the beach prior to sailing.

Today, more than a few of those classmates have died or are suffering from cancers and neurological illnesses linked with Agent Orange. Yet the VA is sclerotic in dealing with the remnants of a crisis it thought it had put to rest. One classmate, who spent his Navy career as a medical doctor, applied to the VA for benefits related to his Agent Orange-linked Parkinson’s disease. Ten months after providing proof of his Vietnam service, the VA hasn’t acted on his case.

When I asked my friends for their reaction to the Shulkin “Travelgate” story, they were nonplussed by the so-called scandal. If the secretary knew about the chief of staff’s forgery, he should resign immediately. If he didn’t, he needs to buckle down and address the VA’s real problems with greater vigor. To a person they are tired of the partisan bickering that has diverted our attention from real problems and the will to address them.

“They are trigger-loaded to say no,” commented Bill Short, a career naval officer who is spearheading a citizen’s effort to get the VA to be more responsive. “We need to change the VA culture so that the default is to say yes and figure out how to help veterans.”

He is right. The real scandal isn’t even the agency’s blind eye toward Wright Simpson’s unethical behavior. It is the ongoing immorality of not adequately helping those who have given so much to serve the country.

Steve  Cohen is an attorney at Pollock Cohen LLP in New York and a former member of the board of directors of the United States Naval Institute.