Donovan Slack , USA TODAY
WASHINGTON – The head of the Department of Veterans Affairs in a rare White House briefing Wednesday laid bare the array of problems still plaguing the agency charged with providing health care to nearly 9 million of the nation’s veterans.
VA Secretary David Shulkin provided a candid assessment of the challenges that he and other leaders face in overhauling the department, including providing appointments more quickly. Veterans are waiting 60 days or longer at more than 30 VA facilities across the country, he said, and one in 10 time-sensitive appointments were not booked within time frames recommended by health care providers.
"I'm a doctor and I like to diagnose things, assess them and treat them," Shulkin said. "Many of these challenges...have been decades in building, and they span multiple administrations, and this is the time for us to really address these chronic problems that have affected veterans and in many ways have harmed veterans and their families."
"I'm going to tackle these issue heads on," he said.
Shulkin ticked off a litany of problems, including with the quality of medical care provided to veterans. He said the agency has identified 14 VA medical centers that provide lower quality care than nearby private sector hospitals. They include three VA medical centers in Tennessee (Memphis, Nashville, and Murfreesburo), two in California (Loma Linda and Fresno), and two in Texas (El Paso and Big Spring).
He said all received one star out of five in the VA's internal rating system, which the VA released publicly for the first time in December after USA TODAY obtained and published the internal ratings. Other facilities with a one-star ranking include VA hospitals in Detroit; Phoenix; Biloxi, Miss.; Dublin, Ga.; Fayetteville, N.C; White City, Ore.; and Fort Harrison, Mt.
Shulkin said he has dispatched teams to help improve the care at those locations. "Veterans shouldn't have to accept low quality care, and they deserve our very best," he said.
In the meantime, Shulkin said he wants to streamline the process for veterans to seek treatment in the private sector — though he also outlined problems in programs that allow them to do that.
He said the department's needlessly complicated bureaucracy has led to the denial of one out of five veteran requests to get VA-sponsored care at non-VA facilities. And when they have been granted, the agency often hasn't paid the tab for months. Currently, $50 million worth of bills have been outstanding for six months or longer, Shulkin said.
"Providers are increasingly frustrated with the VA’s ability to get them payments, to the point that some of them are actually leaving our network," he said. "And that’s obviously working against us."
Shulkin said veteran claims for disability benefits also are languishing with 90,000 claims pending for six months or longer.
Another area in critical need of improvement is the VA's infrastructure, he said, adding that hundreds of the agency's buildings are in disrepair and the price tag to fix them is at least $18 billion. Some 449 date to the Civil and Revolutionary Wars, and overall, VA buildings are 60 years old on average.
Shulkin's revelations marked an unusual strategy for the historically secretive VA — and for the Trump administration — to announce problems proactively rather than react to them after they are leaked to media or revealed publicly through investigations.
Shulkin's candid assessments come a month after the VA inspector general issued an urgent warning that equipment shortages and dirty sterile areas at the Washington VA Medical Center were placing patients in danger. Internal documents obtained by USA TODAY show VA officials knew about the problems for years, although Shulkin said at the time that he was surprised by the inspector general’s revelations.
Since taking the reins of the beleaguered VA in February, Shulkin has pushed for more transparency. He unveiled a web site last month that reveals for the first time exactly how care at VA hospitals compares with nearby private-sector hospitals and national averages. The site, accesstocare.va.gov, also shows if veterans are satisfied with wait times at every hospital and clinic across the country, and how long they actually wait to see doctors on average.
On Wednesday, he announced that a national White House hotline for VA complaints (855-948-2311) will be up and running Thursday. He called it a "soft launch," perhaps anticipating delays in answering a flood of calls, and pledged it would be fully operational by mid-August. The hotline makes good on one of President Trump's campaign promises.
Trump has said he calls Shulkin the “100-to-nothing man” because he was confirmed by the Senate in a 100-0 vote. He is the only Obama administration holdover among Trump’s Cabinet secretaries. Previously, he was the VA's under secretary for health for nearly two years, beginning in July 2015.
USA TODAY has previously reported on the steep challenges Shulkin faces, particularly the multiple layers of bureaucracy at the VA that can squelch and even thwart improvement efforts. The VA is the second largest federal agency, behind the Pentagon, with more than 300,000 employees.
Shulkin’s own pronouncements at times have taken months to be enacted – if they even get implemented at all. In one case, he said he decided to change the way veterans are called back for appointments. But several months later, the change still hadn’t been applied across the roughly 150 VA medical centers and was, in fact, made optional.
In another case, critical information about a veteran patient’s suicide didn’t reach him until a USA TODAY reporter informed him. Charles Ingram set himself on fire outside a New Jersey VA clinic in March 2016, but VA employees initially had told Shulkin he wasn’t a patient waiting for care. He was. Shulkin later removed the director of the hospital overseeing the clinic.
He also swiftly removed the director of the VA hospital in Washington within an hour of the inspector general’s report last month, though the problems there had been brewing for years. The inspector general found that the hospital lacked an inventory system and ran out critical equipment, including vascular patches to seal blood vessels.
The VA has been riven by scandal since at least 2013 when an application backlog for veterans seeking disability benefits soared to more than half a million. In 2014, USA TODAY Network member The Arizona Republic revealed that veterans died waiting for appointments at the Phoenix VA while schedulers kept secret wait lists masking how long they were waiting.
The reports prompted investigations that found schedulers in 40 VA medical facilities in 19 states and Puerto Rico falsified wait times. The VA released the results of those investigations in response to a Freedom of Information Act request from USA TODAY.
Trump has said fixing the VA is among his highest priorities. In his budget proposal released last week, the VA is among only a few agencies that would see increases in funding, along with the Department of Defense and Homeland Security.
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