Can a Former Big Business Exec Ensure Veterans Get Healthcare?
Last week, the American public was informed of just how poorly the Administration of Veterans’ Affairs operates and just how corrosive the agency’s culture can be.
Supplementing a November report — which revealed that veterans of the U.S. armed forces are needlessly dying because of delays in diagnosis and treatment – CNN learned that records of deceased veterans were changed or physically altered to conceal how many died waiting for care at the Phoenix VA hospital. Whistleblower Pauline DeWenter — the scheduling clerk at that facility — told the publication that she was tasked with managing what was called the “secret waiting list,” on which the names of veterans’ waiting for medical were placed and sometimes left for months without any attention. She explained that there not enough doctors and not enough appointments, to handle the high number of new patients. “‘Deceased’ notes on files were removed to make statistics look better,” she said, while “at least seven times since last October, records that showed that veterans died while waiting for care … were physically altered, or written over, by someone else.”
An internal document from the U.S. Department of Veterans’ Affairs obtained by CNN at the end of last year painted a picture of government healthcare bureaucracy that overlooked simple medical screenings, like colonoscopies and endoscopies, that could have prevented a number of deaths. As the investigation progressed, the numbers only grew worse. At the Phoenix hospital alone, at least 40 U.S. veterans died waiting for appointments, while an internal VA audit released in early June found that more than 120,000 veterans were left waiting or never received care.
A White House report delivered to President Barack Obama on Friday framed that gross mismanagement and misallocation of federal resources in the usual government-speak. “A corrosive culture has led to personnel problems across the Department that are seriously impacting morale and by extension, the timeliness of healthcare,” the report stated. “The problems inherent within an agency with an extensive field structure are exacerbated by poor management and communication structures, distrust between some VA employees and management, a history of retaliation toward employees raising issues, and a lack of accountability across all grade levels.” Furthermore, “there is a tendency to transfer problems rather than solve problems,” the report found. “This is in part due to the difficulty of hiring and firing in the federal government.”
If managerial and bureaucratic problems are not enough, the report also showed that the administration has been slow to adapt to the changing demographics among younger veterans from the wars in Afghanistan and Iraq who have different needs than other veterans.
The White House, in typical fashion, has announced that the VA has taken important steps to rectifying these issues since the waiting lists became public, noting that the agency has scheduled 182,000 appointments and allocated nearly $400 million toward accelerated care. In addition, performance bonuses for senior healthcare executives have been eliminated.
Even before that report was published, it was clear that the efforts of the president and VA secretary Eric Shinseki — who was appointed by Obama in 2009 — had failed to reform the bureaucracy that is the VA. Within weeks of the scandal breaking, Shinseki, a veteran himself, had resigned. In his place, the administration nominated Robert A. McDonald on Monday, a former chief executive of Procter & Gamble (NYSE:PG), to be the next secretary of Veterans Affairs. His appointment means the Obama administration is looking to an outsider to fix the agency’s bureaucratic problems and the mismanagement, which have been caused, to some degree, by the surge in the number of veterans of the wars in Iraq and Afghanistan needing medical care. While McDonald is a West Point graduate who served in the military, the fact that Obama picked a expert manager to solve the substantial problems at VA — a healthcare network with over 1,700 facilities that serve more than eight million veterans a year — suggests that the president no longer thinks a military leader can resolve the crisis.
“This is definitely a surprising pick,” wrote Paul Rieckhoff, the chief executive and founder of Iraq and Afghanistan Veterans of America, in a Sunday press release. “McDonald is not a name that was on anyone’s radar over the last few weeks. His branding background may prove helpful because there are few organizations in America with a worse reputation toward customers than the VA right now.” In this new position, McDonald will have to quickly prove he “is committed to and understands the post-9/11 generation of veterans.” If confirmed, he will face reforming a $154 billion-a-year department — where managerial and technological dysfunction, plus a corrosive culture that punishes whistleblowing — is rampant.
McDonald’s nomination may be surprising to some observers, but during his 2009 through 2013 tenure at Procter & Gamble, he oversaw more than 120,000 employees of a company with operations around the globe and more than five billion customers. Still, addressing the problem most concerning veterans — the delayed care — will be no easy task. Patients seeking care have sharply increased in recent years, while the number of available doctors and nurse practitioners has barely grown.
Just hours before his resignation, Shinseki addressed the National Coalition for Homeless Veterans — apologizing to the American people, lawmakers, and veterans for the life-threatening corrupt practices that materialized at a number of medical facilities. He also outlined imminent changes the VA will take to begin eliminating the systemic problems that lead to the manipulation of waiting lists used to cover up how long veterans would really have to wait to see a physician; senior administrators at the Phoenix medical facility will be removed, and Shinseki said that he would use all the power at his disposal to hold accountable those individuals “who instigated or tolerated dishonorable or irresponsible scheduling.” This represents quite a shift from the attitude the secretary presented at a Senate hearing held in early May, when he testified that the agency would wait to act until a government investigation proved the allegations correct. Of course, since then, the VA’s Office of Inspector General issued a preliminary report.
“Our reviews at a growing number of VA medical facilities have thus far provided insight into the current extent of these inappropriate scheduling issues throughout the VA healthcare system and have confirmed that inappropriate scheduling practices” are widespread, the Wednesday release read. The White House report confirmed that finding, but added an twist: few veterans received care within the government-mandated 14-day period because the rules that restrict the agency from making veterans wait longer than two weeks for care are “ill-defined.” Defining standards of care will be a key task for McDonald.
Response to the report by lawmakers was mixed. But while the early days of the controversy were tainted by partisan accusations, Congress appears committed to crafting reform legislation. “While it’s extremely unfortunate President Obama did not heed our warnings about the very real and very deadly problems within the VA healthcare system sooner, we stand ready to work with stakeholders inside and outside the administration to institute VA reforms that will improve services to America’s veterans while bringing real accountability and efficiency to the department,” Republican Representative Jeff Miller of Florida, the Chair of the House Committee on Veterans’ Affairs, told Politico. Meanwhile, in a statement issued following the report, Senate Veterans’ Affairs Committee Chair Bernie Sanders, an Independent from Vermont, noted the it was the job of Congress and the nation “to make the necessary changes so that every veteran in the VA system gets the quality and timely healthcare they are entitled to.”
To win confirmation, McDonald will have to win the support of lawmakers of both parties.
In a statement released shortly after his appointment, Speaker of the House John Boehner, an Ohio Republican, acknowledged McDonald was “a good man, a veteran, and a strong leader.” But he believes McDonald will only be successful “if his boss, the president, first commits to doing whatever it takes to give our veterans the world-class healthcare system they deserve by articulating a vision for sweeping reform.”
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