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.

Whistleblowers

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.

Dr. Rossano is past Chair, Department of Psychology at Southeastern Louisiana University in Hammond. He is an expert in evolutionary psychology, and author, including Evolutionary Psychology: The Science of Human Behavior and Evolution, and Supernatural Selection: How Religion Evolved.

Why be spiritual? For an evolutionist, the why question always raises issues of ancestral origins and potential adaptive significance. Why did spirituality arise in our ancestors and did it serve some adaptive function? First, one must define terms. Researchers often define spirituality as a sense of meaning resulting from an experience of “losing” the self in “something larger.” Frequently the “something larger” has religious significance; but art, music, natural beauty, and even scientific discovery can prompt spiritual experiences. What seems more important is that the experience is inspirational. It transcends and uplifts us – often motivating us to strive for the betterment of ourselves and our world. So why would our ancestors have started to think this way? Was there any advantage to it?

About 100 miles east of Moscow are the famous Sungir Upper Paleolithic burials. Three bodies were lavishly interred there, bedecked head to toe with necklaces, head bands, waist and arm bands laced through with thousands of carefully crafted beads. Grave goods, such as tools and finely fashioned (and purely decorative) ivory hunting weapons were also buried with the bodies. It has been estimated nearly 10,000 personhours of labor went into this elaborate funeral. Among existing traditional societies, such a send-off is usually indicative of ancestor worship.

Ancestor worship is ubiquitous among traditional societies and Sungir suggests that its evolutionary roots reach back nearly 30,000 years. It assumes that the “something larger” is the tribal community itself, which includes not just the earthly, but the timeless preceding generations now watching from above. Living tribe members understand themselves as players in an ongoing cultural saga whose past is known through myths revealed in fire-side dances and whose future depends on fidelity to traditions and practices passed down to them from their elders.

Sungir gives us an idea of when our ancestors starting thinking spiritually. But why do so? It is notable that nothing comparable to Sungir has been found among any of our hominin cousins. The few possibly intentional burials present among non-sapiens (Neanderthals, for example) are barren of any convincing signs of ritual or afterlife belief. The same is true for cave art. The magnificent murals of Lascaux, Altamira, and Chauvet are exclusively Homo sapiens. Neanderthals rarely ventured into caves and when they did, they left behind no art.

The best explanation we have for this exclusivity is that our ancestors were trying to construct larger, more complex social networks – possibly in response to competition from other hominins such as Neanderthals. To do this, they had to envision an even larger social order. One that both encompassed and transcended the earthly tribes themselves. They had to think big – spiritually big. But thinking wasn’t enough. They had to feel that ‘bigness.’ They had to fire a passionate commitment to that community. They had lose themselves in it. Their art and rituals were strategies for making that spiritual community ‘real’ in an emotionally compelling way. Having inherited these same sentiments, an opportunity arises. Spirituality is everhopeful. If we can agree that we are part of something larger, then maybe we can set aside our differences and work together for a common good.

On February 16, attorneys for retired Colonels and psychologists Morgan Banks, Debra Dunivin and Larry James, and also two psychologists who are former employees of the American Psychological Association (APA), Drs. Stephen Behnke and Russ Newman, filed a defamation lawsuit against the Chicago attorney David Hoffman, his law firm, and APA, alleging reckless disregard for the truth and false statements in a 2015 report called the Hoffman Report.

Mr. Hoffman was hired by APA in 2014 to review interactions between military psychologists, APA officials, and the Bush administration. Then APA president Dr. Nadine Kaslow sought to resolve ongoing accusations that APA was involved in supporting unethical behavior by military psychologists. The accusations were voiced by human rights activists and psychologists, and had been outlined in several publications, including a book by New York Times’ journalist, James Risen, Pay Any Price.

Hoffman concluded that communications of a 2005 APA members’ task force amounted to “collusion” with military psychologists and therefore with the Department of Defense. A media furor commenced following publication of the Report, splashing the issue of “torture” and APA across national news outlets. APA paid Hoffman $4.1 million for the Report, according to sources.

In the February 16 legal Complaint, a 187-page document filed in the Ohio, Court of Common Pleas, Civil Division, the attorneys for the Plaintiffs allege that the primary conclusions in the Report were not only false, but that Hoffman knew they were false. The complaint states that military psychologists, who had tried to prevent abuses in military interrogations, were painted as having worked to protect possibly abusive procedures. The Complaint alleges reckless disregard for the truth and actual malice in both how the investigation was conducted and in how Hoffman and APA handled matters following the completion and publication of the Report.

The Plaintiffs are represented by James E. Arnold of Columbus, Ohio, who is attorney for all Plaintiffs, attorney and psychologist Dr. Bonny Forrest of San Diego, California, who is attorney for Plaintiffs Banks, Dunivin, James and Newman, and Louis J. Freeh, Former FBI Director, from Washington, DC, who is an attorney for Dr. Behnke.

In the February Complaint, the attorneys describe details alleging how the expansion of the investigation was hidden, how Hoffman over-relied on the accusers and aligned with the accusers’ goals, and that Hoffman failed to consider and follow evidence that contradicted the final conclusions. The Complaint also states that the Report relied on “overstatements,” “misstatements,” and “unsupported inferences.”

The attorneys also allege that APA failed to adequately review the Report, failed to give Plaintiffs an opportunity to respond to allegations, and failed to respond to evidence of the mistakes and errors in the Report.

According to a press release also posted on February 16, Plaintiffs will seek a jury trial, for compensatory and punitive damages for reputational and economic harm.

The Times asked Dr. Forrest what was the reason the conflict had reached this level, and she referred to the joint statement, included in the press release. In that statement, the Plaintiffs write, “We have reached out repeatedly and persistently to APA’s counsel since October 2015 and to Sidley since June 2016 to try to correct the record and repair the damage caused by Hoffman’s false accusations without further damaging the APA. Those efforts have failed, and we now have no avenue left except this lawsuit.”

The press release noted, that Hoffman, “… cherry-picked evidence, ignored contradictory evidence, mischaracterized facts, and failed to follow obvious investigatory leads. Whenever facts might be open to more than one interpretation, he consistently chose the interpretation that portrayed the plaintiffs’ motives in the worst possible light. And, despite acknowledging privately to the APA that he found no evidence of the criminal behavior others alleged, he used terms such as ‘collusion,’ ‘joint enterprise’ and ‘deliberate avoidance’ that are drawn directly from the language of criminal prosecutions.”

“He was hired to write a neutral and objective report but instead assumed guilt and, like a prosecutor, set out to prove it,” commented Dr. Forrest in the press release.

In the 2015 Hoffman Report, Mr. Hoffman wrote that APA staff and officials were “intimately involved” in “behind-the-scenes coordination with the DoD.” Hoffman also concluded that the motivation for this was a “desire to curry favor with the government.” He wrote that because of this relationship with the military psychologists, APA officials essentially acted “to support the implementation by DoD of the interrogation techniques that DoD wanted to implement…”

However, the Plaintiffs’ attorneys state that the Report became a “prosecutorial brief,” and “Hoffman’s primary allegation rests on false statements about military interrogation policies in 2005, the year in which an APA task force was formulating guidelines for psychologists involved in interrogations.”

“Hoffman’s allegations have been proven false by evidence that was in his possession,” noted the attorneys for the Plaintiffs. “Despite that proof, neither Hoffman nor the APA have taken any significant steps to repair the damage he has done to the plaintiffs’ livelihoods and reputations.”

The complaint lists twelve counts: six are all plaintiffs against all defendants, four are all plaintiffs against Hoffman and his law firm, one is Behnke, Dunivin, and James against all defendants, and one is all plaintiffs against APA.

The Plaintiffs’ attorneys wrote, the “…narrative was adopted from long-standing critics of the Plaintiffs and the APA on whom Hoffman relied heavily during his investigation. Their narrative was driven by two goals: banning psychologists from any role in the interrogation process and holding psychologists ‘accountable’ for their alleged complicity in torture. Despite having been rebuffed by the Federal Bureau of Investigation (FBI), for years they had been advocating for criminal prosecutions of the Plaintiffs and others.”

The February 16 Complaint lays out arguments that Hoffman had documents in his possession and that he omitted these in his analysis and text of the Report. These documents, say the attorneys for the Plaintiffs, showed clearly that the military psychologists were working to restrict abusive procedures rather than allow abusive practices. “In fact, the then-existing military policies – some of which the military Plaintiffs helped to draft – were restrictive and were incorporated by reference into the PENS Guidelines. And the PENS participants were fully aware of the history of abusive interrogations, which were discussed in documents circulated at the PENS meetings,” the attorneys write. This evidence, which contradicted the views of the critics, was omitted or distorted, or failed to be followed-up as investigation leads, argue the attorneys in the Complaint.

The Complaint and other documents can be found at http://www.hoffmanreportapa.com/ and at The Modern Psychologist.

Among the examples given in the 187 page–document, the Complaint authors say that Hoffman distorted and omitted key pieces of the history of governmental and DoD policies governing military interrogations. Specifically, they write, he incorrectly emphasizes the outdated policies as the context for the PENS Task Force’s work.

Also, the Report consistently confuses the military policies with the CIA policies, notes the complaint, and ignores the evidence that the two approaches had “dramatically diverged,” omitting policy statements that would have clarified the differences.

And, Hoffman failed “… to describe the role the military Plaintiffs played in writing the regional policies, as well as taking other steps to prevent abuses at the sites to which they were posted.”

In reviewing circumstances, the attorneys write that as the investigation progressed, Hoffman and his team violated norms for conducting such an investigation and APA failed to exercise adequate oversight. “Hoffman obscured the investigation’s scope and the questions he began to pursue, misled the Plaintiffs about its goals, failed to warn them when the investigation had clearly become adverse to their interests, and purposely avoided following leads that would have produced facts that contradicted his narrative.”

“The investigation’s new direction was not disclosed to anyone other than the Accusers and the Special Committee,” the attorneys state. “The Plaintiffs were kept in the dark.”

The complaint alleges that the APA Board published the Report in a hasty manner and without adequate review, saying, “Within 24 hours of receiving the draft Report on June 27, 2015, the Board, on the advice of Hoffman, published it to two of the most vocal and active Accusers …”

The authors of the Complaint state that the board knew of the Accusers’ active engagement with the press during the course of the investigation, and, the Report was leaked to James Risen of The New York Times.

The APA Board immediately voted to post the full Report to the public on the APA website. The APA governing Council had less that 48 hours to review the Report and 6,000– plus pages of exhibits, including information that contradicted the Report’s conclusions, said the authors of the Complaint. “So hasty was the Board’s review and release of the Report that, as many have noted, the APA ignored its own policies that prohibit making deliberations about ethics investigations public.”

The Defendants did not give the Plaintiffs an opportunity to respond to the allegations in the Report, stated the attorneys for the Plaintiffs. For example, Dr. Behnke was immediately terminated without a notice period or without being allowed to meet with the APA board, even though he had been employed for 15 years. Plantiffs Banks, Dunivin, and Newman were “never even notified that the Report was complete or that it was about to be published.” Col. James received an online copy the day before it was released to the Council.

The Complaint lists views from others that pointed to problems in the Report and the process, but that have been ignored by APA.

“In a June 11, 2016, open letter, eight former APA presidents summarized the concerns expressed by four of the APA’s divisions and others as including ‘an apparent failure to properly vet [the Report], failure to protect the rights and reputations of those portrayed negatively, lack of due process for employees who were forced to resign, and more.’”

One of the APA’s largest divisions has passed a vote of no confidence in the Board’s actions, and another has said that the Board’s treatment of those named in the report “without a due process finding of wrongdoing is itself an unprofessional, counterproductive, and potentially unethical action.”

Despite these conflicts, APA re-hired Hoffman to review portions of the information the Plaintiffs provided, a step that ten former chairs of the Ethics Committee have stated that there is a potential conflict in re-hiring Hoffman, said the authors.

The Complaint states, “The false light in which the Plaintiffs Behnke, Dunivin, and James have been placed would be highly offensive to the reasonable person,” and has caused mental anguish, emotional distress, and “severe personal and professional humiliation and injury to their reputations in the community – reputations they have built over many years.”

[See story in Times Vol 6 No 8, “Hoffman Report Rocks Am Psychological Assn” page one.]