In the spring of 2014, enough reporters and whistleblowers came together to break through the national consciousness and spark an outrage in citizens and Congress. Schedules and waiting lists had been manipulated at the Phoenix VA. Veterans died while waiting for medical care while executives maintained their bonuses for performance.
“The VA has always been terrible,” said one source who worked in the New Orleans VA more than thirty years ago. “It was fantastic for training, but it was also hit and miss for the veterans. Some received great care, but others did not.”
For years the anecdotal view was that each VA facility had its own culture, some good and some not so good for the veterans. “If you’ve seen one VA, you’ve seen one VA,” is the phrase related by a source. But the Phoenix scandal turned the spotlight on system-wide problems.
The VA’s “Veterans Health Administration” is massive. According to the Government Accounting Office (GAO). The VA system includes 167 VA medical centers and more than 1,000 outpatient facilities that serve about 6.7 million veterans. The VA system is also the largest employer of psychologists, with 4,947 on the rolls for 2015.
According to the GAO, the health system has faced a growing demand by veterans for its health care services, a trend that is expected to continue. From 2011 to 2015, the total number of outpatient medical appointments increased by about 20 percent.
The mental health needs for veterans are serious. This July Military Times reported continuing high rates of suicide among veterans, an average 20 individuals a day. In 2014, the most recent year available data, 7,400 veterans took their own lives, said Military Times.
For this report, we looked into the scandal, examined some of the connections to Louisiana, and asked insiders from three regions of the state about their views. While some of those we talked to offered their names, we choose to protect all identities.
Scandal Breaks at the Phoenix VA
In April 2014 the Arizona Republic broke the story that the Phoenix Veterans Health Administration (VHA) hospital employees had falsified records to make it appear that the 14- day limit for medical care was being met. The goal was connected to executive bonuses.CNN reported that at least 40 Air Force Veterans had died while waiting for care.
Investigations conducted by the VA Office of Inspector General (OIG) and the Justice Department found that schedulers were being pressured to use the false waiting lists in numerous hospitals around the country.
In his report, “Friendly Fire: Death, Delay, and Dismay at the VA,” Senator Tom Coburn’s office said that more than 1,000 veterans may have died over the last decade due to malpractice, fraudulent scheduling practices, insufficient oversight and accountability.
After the Phoenix story broke, other whistleblowers from around the country joined the national picture and other VA facilities were put in the spotlight. On of these was the Overton Brooks VA Medical Center in Shreveport. There, social worker and Army veteran figured out that lists were being manipulated and raised his concerns. Wilkes would later find himself under investigation by the VA’s OIG, and in the middle of a firestorm.
But the OIG did find evidence that employees were using separate spreadsheets outside of the VA’s official scheduling and patient records systems. OIG investigation confirmed that the Mental Health Clinic had created a spreadsheet that identified 2,700 veterans who needed to be assigned a mental health provider. And other investigations around the county pointed to a widespread manipulation of data that covered over veterans’ unmet health needs.
These lists are a “total fiction,” one source said.
Another source from another region explained to the Times, “Oh, we were told to do it. There wasn’t an option. You’d be punished if you didn’t comply.”
“They will retaliate against you immediately,” the source said. “They have a variety of ways to punish anyone who doesn’t conform,” said the source. They put the complaint into a committee so that nothing happens, then they find something to irrelevant to write you up about, the source said. “They can mess with your schedule and cause any number of problems for you.”
The source also explained that management can put pressure on patients to come up with complaints about your work, and then exaggerate the patients’ feedback, using it to discipline you.
After the Phoenix scandal broke, the VA culture also became a focus. In a White House Investigation, the Obama Administration Deputy Chief of Staff, Rob Nabors, called the problems, “significant and chronic,” and the culture “corrosive.”
Defenders of the VA pointed to increases in caseloads: 46 percent in outpatient visits in the last six years. Some report that the increases are linked to the aging Vietnam veterans and the complex challenges with the Iraq and Afghanistan veterans, who suffer from traumatic brain injury, amputations, and PTSD.
Secretary Eric Shinseki, a former Army general, was forced to step down from his Cabinet post. He was replaced by Robert “Bob” McDonald, who vowed to overhaul the department.
One effort was an attempt to give veterans more control.
Veteran’s Choice – A Failed Fix
President Obama and Congress quickly passed the “Veterans Access, Choice and Accountability Act of 2014,” which was designed to allow veterans to go outside of the VA system to obtain health care services when the wait times were too long or when they had to travel long distances to a provider.
It was supposed to be simple. Veterans would have a card that would allow them to access services when needed. But the card was not easy or simple.
Veterans on DisabledVeterans.org commented frankly about the experience.
“I have been waiting since May of 2015 for Healthnet to pay for an MRI that I was authorized to have, now the hospital is coming after me. This program is a joke, I was authorized 26 chiropractic appointments with the same program. My chiropractor now refuses to see me until he gets paid for the 1st 5 appointments.”
Hmm, a joke? Naaa I call it what it is, a cluster f**k! Card says that you have to call before using it, or that the VA will not pay for the doctor or hospital visit. So I guess that means if I am having a heart attack I have to call the VA BEFORE the ambulance?”
“Card says that you have to call in five to seven working days to make the appointment BEFORE the card can be used or again the VA can refuse to pay for it. […] Jeeze who writes this stuff up?”
“Nice scam, Forcing veterans to go back to the VA by not paying the Bills.”
In a May 2016 PBS report, reporter Hari Sreenivasan found that overall, the wait times for the Choice program were worse than the regular system. Veterans could not get the approvals, when they did, the providers could not get paid. Because of the multiple approvals required. Providers would come back to the veterans for payment.
Serious Issues in Mental Health
Mental health also has come into the spotlight again. A 2016 study by Rand and funded by the Department of Defense, reported improvements, but within the report there were also serious, on-going problems in the VA’s approach to mental health for veterans.
Researchers studied over 40,000 active-duty service members diagnosed with PTSD or depression. They found the suicide rate for soldiers in this group was 264 per 100,000, compared to a civilian suicide rate of 13 per 100,000 people.
Only one-third of patients newly diagnosed with PTSD, and less than a quarter of those with depression, were engaged in even minimum levels of psychotherapy and medication management.
One insider said that the report was an effort to “whitewash” the problems in the VA system, and pointed to how the reviewers avoided addressing other serious deficiencies in care. The source said the report glossed over the dramatic issues in scientific support and lack of realistic follow-up, and that the report overlooked inconsistency and inadequacy of how and by whom therapy is provided.
“This is the same type of stuff we have seen; it’s maintained very poor quality of care in the nation’s primary care system and now it is being applied in the analysis of the VA system.”
“The VA is a medical model,” another source said, “and it has always been. Most veterans don’t get the real psychotherapy or psychological help they need.”
Another source said, psychology was “swallowed up,” by the other elements of the system and medical culture.
In 2012, a VA emergency-room physician, Dr. Katherine Mitchell, in the Phoenix hospital warned the director that the system was overloaded and dangerous. She was told that she was deficient in communication skills and transferred, according to the Arizona Republic. In 2013 an internal medicine physician Dr. Sam Foote, tried to alert the OIG to the same problems. Two months later Foote retired. After that he collaborated with the Republic.
Germaine Clarno, social worker from the Chicago VA system, told her supervisors about false wait times and when that did not work she went to the press and Congress. Afterward, she was harshly criticized.
In Louisiana, Shea Wilkes, a social worker and disabled Army veteran, and formally an assistant to the director of the Mental Health Division at Overton Brooks VA Medical Center, found himself in the middle of the storm.
As reported on Watchdog.org, Wilkes was seeing quality problems that disturbed him. He noticed that managers were still meeting their goals and discovered the false waiting lists. When Wilkes alerted his superiors, they failed to act and he filed a complaint with the VA OIG.
But then Wilkes found himself a target of the Inspector General’s investigation.
“You know it is going to be hell after you come forward,” he told Tori Richards at Watchdog. “But never in your wildest dreams do you expect the magnitude of what you did to result in what happens after. All this said,” he said. “I would and will do it again if I have to. It gives you such relief to get it off your chest.”
Clarno and Wilkes joined together to create VA Truth Tellers, Clarno saying to the Arizona Republic that “We’ve banded together. We are not giving up.”
And eventually the whistleblowers found an ally in the U.S. Office of Special Counsel (OSC) an independent federal investigative agency to protect whistleblowers. This past February the OSC slammed the VA Inspector General.
“The OIG’s decision to investigate this straw man resulted in inadequate reviews that failed to address the whistleblowers’ legitimate concerns about access to care for mental health patients at Hines and Overton Brooks,” wrote Special Counsel Carolyn Lerner in reports.
“The focus and tone of the IG’s investigations appear to be intended to discredit the whistleblowers by focusing on the word ‘secret,’ rather than reviewing the access to care issues identified by the whistleblowers and in the OSC referrals,” wrote Lerner.
Wilkes and his attorney finally received a call that the VA OIG l had dropped the investigation of Wilkes.
“What they would’ve been investigating him for was accessing a list that wasn’t supposed to exist,” attorney Richard John said to Watchdog. “They had no intention of ever prosecuting him. They did it solely for purpose of intimidation. It has a chilling effect on other people coming forward as witnesses.”
In 2015, this independent OSC received about 3,800 whistleblower complaints from workers in all federal agencies. More than a third came from VA employees.
Special Counsel Lerner warned, “The VA must continue working to make its culture more welcoming to whistleblowers in all of its facilities”
Is the VA Getting Better?
According to an April report in the Washington Post, Debra Draper, GAO’s health investigator, told members of Congress that the system is still hindered by “ambiguous policies, inconsistent processes, inadequate oversight and accountability … “
“And today we have seen at best little progress by the VA in addressing those issues,” she said. “We are very concerned …”
The Special Counsel to President said in February this year, that the OIG failed to consider whether the 2,700 veterans in need of a mental health provider reflected the larger concern about access and mental health provider shortages, or what steps could be taken to remedy these challenges.”
“The OIG’s decision to investigate this straw man resulted in inadequate reviews that failed to address the whistleblowers’ legitimate concerns about access to care for mental health patients at Hines and Overton Brooks,” wrote Special Counsel Carolyn Lerner.
In an April GAO study, delays for a veteran requesting an appointment were still critical. “Sixty of the 180 newly enrolled veterans in GAO’s review had not been seen by providers at the time of the review; nearly half were unable to access primary care…” said the reviewers. Of those 120 who were seen, they waited 22 to 71 days to see a care provider.
After all the dust has settled, it seems that little may have changed for our veterans.