UT San Diego: VA Chief Expresses Regret and Resigns

Veterans Affairs Secretary Eric Shinseki resigned Friday as President Barack Obama said the agency must hire more health providers and modernize its systems to meet the needs of nearly 10 million enrolled members.

Shinseki expressed regret for delayed medical care, records tampering and other problems that have amounted to one of the agency’s biggest scandals in recent years. Much of the crisis centers on the Phoenix VA health system, where about 1,700 veterans never got the treatment they sought and where waiting lists were apparently falsified, but troubles have been identified at dozens of other VA networks.

“I extend an apology to the people whom I care most deeply about — that’s the veterans of this great country — to their families and loved ones, whom I have been honored to serve for over five years now,” Shinseki said.

An interim audit released this week showed that schedulers were instructed to manipulate appointments at 64 percent of the VA facilities that the VA Office of Inspector General has investigated. The office intends to broaden its probe to include all VA medical systems nationwide.

In San Diego, VA spokeswoman Cindy Butler said that while an internal audit didn’t show any problems with local scheduling practices, an employee subsequently came forward and lodged a complaint.

“We took that complaint directly to the local inspector general office here in San Diego, and they are looking into it,” Butler said.

No specifics on the nature of the employee’s complaint were available Friday.

In Washington, Obama replaced Shinseki with Sloan Gibson as interim secretary. Gibson had been appointed as the agency’s No. 2 official in February after spending more than 20 years in the banking sector and heading United Service Organizations (USO).

Shinseki fell victim to the delayed-care scandal despite initially having the support of most veterans groups and lawmakers, and many of them still praised him Friday for his longtime service in the Army and his VA accomplishments. Those achievements included shortening the list of veterans awaiting processing of their disability applications, reducing the ranks of homeless veterans, increasing payments to victims of Agent Orange exposure and allowing more vets with post-traumatic stress disorder to qualify for benefits.

But after the inspector general’s interim report was released this week, calls for Shinseki’s ouster increased significantly.

Among those seeking his dismissal was Rep. Scott Peters, D-San Diego, whose 52nd Congressional District includes the VA medical center in La Jolla.

“He didn’t have the confidence of people to be able to continue to lead,” Peters said Friday.

Peters also said that he believes in San Diego “wait times are less and people are a lot more pleased with the culture of the VA. I’ve been impressed by the quality of care I’ve seen.”

This month, officials with the San Diego VA Healthcare System said they were making adjustments so the network could offer earlier appointments to the fewer than 200 patients who were waiting for more than 90 days to see a specialist. Patients who still can’t be accommodated sooner would be allowed to seek care in the private sector, the officials added.

Overall, more than 99 percent of patients in the San Diego VA system are seen within 14 days of their request for a primary-care appointment, and 98 percent get specialist care within that time frame, according to the local network.

Gary Rossio, former head of the local system, said caregivers during his tenure didn’t resort to schedule manipulation partly due to the strong connections forged between the network’s administrators and local veterans organizations such as the San Diego Veterans Coalition. He believes that dynamic continues today.

“I think there is a camaraderie and a rapport here between the veterans community and the hospital,” Rossio said. “That connection, I think, gives the ability to make a call and get on a problem with something like scheduling before it flares.”

Stephen Arends serves as co-chair of the “One VA” community advisory board in San Diego, which he said can serve as a national model. The board meets monthly with VA medical officials and top managers as part of its efforts to ensure that veterans are getting timely access and services.

“Whether it’s been a problem with call-center wait times or having enough trained employees to schedule appointments, our VA team in San Diego is doing things correctly,” Arends said in an email.

In a subsequent phone conversation, he said one aspect that needs improvement is the process of transitioning injured troops out of the military and getting them speedy access to the full range of treatment services and disability benefits.

Nationally, the VA runs 150 hospitals and more than 800 outpatient clinics.

The inspector general’s audit, which Shinseki ordered, has found that a wait-time target of 14 days for new appointments largely has been unattainable given the agency’s limited number of doctors and nurses versus its growing population of patients. The investigators also said the benchmark has been vulnerable to unethical behavior, with managers at numerous VA centers pressuring schedulers to falsify appointment records so they could meet performance standards — and thus receive raises or bonuses.

The methods of deceit included creating a fake set of appointment records, logging appointment dates that differed from what patients actually requested and leaving off some veterans from membership lists so their lengthy waits wouldn’t drag down a center’s track record.

On Friday, Shinseki’s apology came during the convention of the National Coalition for Homeless Veterans in Washington.

He also said he had taken action to fire certain officials at the Phoenix VA center.

“Leadership and integrity problems can and must be fixed now,” Shinseki said.

In addition, the VA said it’s withholding performance bonuses from senior officials and removing patients’ wait times as a factor in determining those bonuses.

The head of the Military Officers Association of America, retired Navy Vice Adm. Norb Ryan, called for a high-level commission to review the VA from top to bottom. The last such comprehensive review was done two decades ago.

“We must act now to understand the challenges that lie ahead so that the VA is prepared for the long-term needs of the millions of veterans who have served our nation during the last 12 years of war,” Ryan said.

Retired doctor Howard Somers and his wife, Jean, of San Diego see a pressing need for new VA leadership. The couple lost their son, Daniel, to suicide last year after the 30-year-old former soldier and Iraq War veteran encountered problem after problem getting help for PTSD from the VA center in Phoenix.

“We have mixed feelings about Shinseki leaving,” Howard Somers said. “But there has to be more assertive leadership from the top because the VA is such an overwhelmingly ineffective and inefficient bureaucracy.”

Besides working with members of Congress and VA officials to bring about reforms, the couple is launching an effort called Operation Engage America to improve the responsiveness and coordination of VA care. The project’s first event is scheduled to take place from 1-5 p.m. on June 7 at American Legion Post 731, 7245 Linda Vista Road.

Original link: http://www.utsandiego.com/news/2014/may/31/tp-va-chief-expresses-regret-and-resigns/