By Maj. Gen. Jerry R. Curry, US Army (Ret.)
According to the New York Times, “More than 57,000 patients have been waiting more than three months for medical appointments at hospitals and clinics run by the Department of Veterans Affairs.” According to a recent VA audit, corruption in VA facilities is systemic to the point of being endemic. Further, the VA audit reveals that Phoenix is the epicenter of this health care scandal.
Indications are that in Phoenix at least eighteen veterans have died while waiting for a timely scheduling of a medical appointment. The situation is so dire that the Federal Bureau of Investigation is opening a criminal probe into the VA’s scheduling practices.
It is not uncommon for a new patient to have to wait two months or more to get a new primary care appointment. These unconscionable delays didn’t happen all by themselves. Two things got them started. First came a shortage at the VA of doctor and nurse practitioners, which placed a strain on an already poorly functioning system.
Then there was an attempt to overcome the shortage by significantly increasing doctor-nurse patient visit output, even going so far as to falsify medical records. This was because job performance reviews were in part based on how quickly a new patient could be scheduled for a doctor’s appointment. The goal was to schedule an appointment within 14 days of an initial request.
If new patients were seen within 14 days, it was duly noted on the administrators’ job performance reviews which helped qualify top performers for bonuses. Evidently it never occurred to the VA that employees would, for personal financial gain, game the system by altering data and manipulating the record of patient wait times, especially when they came to realize that the 14 day new appointment goal was unattainable.
So over a period of many years when whistleblowers pointed out that the 14 day goal created perverse incentives for administrators, they were ignored or told that the problem was being fixed. Of course there is nothing more ludicrous than having those who originally created a criminal problem to prescribe and implement a suggested cure for it.
But that is exactly what the VA did; then it punished the whistle-blowers for trying to fix the system. Leaders who can be identified as having taken part in such reprisals against whistle-blowers should be summarily fired.
In the VA, the buck stops with the Administrator and his Deputy or Assistant Administrators. They are responsible for all the VA does or fails to do. So let us begin addressing VA problems by acknowledging that there is such a thing as leaders taking responsibility for their own actions and for the actions of those who work for them, including being responsible for acting on information which may or may not be public knowledge; but which they should have ferreted out on their own. This includes the timely scheduling of veterans’ health care appointments.
A new Administrator must demonstrate to all of his employees that he is deadly serious about cleaning up the mess at the VA. This can most effectively be done by placing an indefinite moratorium on all bonuses paid out to VA employees.
At the same time criminal charges should be filed against all those involved with “cooking the VA books” and defrauding the American people, the government, veterans, their families and VA employees. In addition their security clearances should be suspended, along with their access passes to all military and government facilities.
Veterans retiring or being honorably discharged from the military services should stay on the military’s active duty payroll until their VA benefits are approved and they start receiving them. They should have an opportunity to seek private health care if VA doctors, hospitals and clinics are not available or if they live farther than an hour’s driving time from a VA facility.
The VA should determine what are a reasonable number of patients for a doctor to see each day and — within reason – see that they daily treat that many. VA clinics and hospitals unable to schedule a medical appointment within two weeks should immediately issue a voucher that can be presented to a private civilian doctor or hospital to pay for the veteran’s medical treatment.
The number of VA facility staff at hospitals and clinics should be based on actual patient needs and the number of patients receiving care. Staff personnel found guilty of abusing or being disrespectful to patients, providing unsatisfactory care, or otherwise failing to perform their duties, should be summarily fired or demoted.
These are a few things the VA can do now to help reduce its systemic problems and, as necessary; it should increase its numbers of doctor and nurse practitioners. Such actions can help, but they cannot replace the need for strong, dedicated, enlightened leadership at the top of the VA. The VA isn’t failing because it lacks medical expertise; it is failing because it lacks strong, aggressive leadership.
The federal government and the VA don’t need leaders who point their fingers at the failures of others, but leaders who take responsibility for their own failures and the failures of those they lead. Phoenix should be encouraged to trail-blaze the way in implementing these reforms.
Jerry Curry is a retired Army Major General, Deputy Assistant Secretary of Defense in the Carter administration; Acting Press Secretary to the Secretary of Defense in the Reagan administration; and Administrator of the National Highway Traffic and Safety Administration in the Bush Sr. administration.