While Congress tries various remedies to fix what ails Veterans Affairs hospitals, it may be time to admit this patient can’t be cured in its current incarnation.
In 2017 the Veterans Health Administration accounted for 38 percent of the $182.3 billion Department of Veterans Affairs budget, serving 9 million of the 22 million veterans at 144 hospitals, 1,200 outpatient sites and 300 mental health centers. Most veterans rely on private insurance, Medicare or Medicaid.
In 2014 the VA’s required wait time of 14 days for new enrollees and 14 to 30 days for others was ignored at 42 medical centers to improve performance records. The VA inspector general reported more than 120,000 veterans waited an extended period or were denied care.
An estimated 1,700 veterans were relegated to a “secret list” to improve performance records in Phoenix, where wait times averaged 115 days and 35 deaths occurred awaiting treatment.
Congress subsequently approved legislation to address staffing shortages and remove problem personnel.
Yet USA Today and other media report incompetence remains pervasive. The VA has hired medical personnel with numerous malpractice claims. When problem doctors depart, it frequently fails to flag them in the National Practitioner Data Bank.
USA Today reported the Iowa City VA hired neurosurgeon John Henry Schneider despite numerous malpractice claims, including four settlements for surgical mistakes leaving patients “maimed, dead or paralyzed.” His license was revoked in Wyoming, but not Montana.
In Iowa City, he performed four brain surgeries within four weeks on a 65-year-old veteran who died in August from an infection, and three spine surgeries on a 77-year-old veteran — two to clean up an infection from the first. He resigned before being fired.
A 1999 federal law prohibited the VA from hiring medical workers with revoked licenses. Yet in 2002 the VA told local hospitals they could be hired after consideration “of all relevant facts surrounding” if they retained a license in one state.
An Oklahoma VA hospital hired a psychiatrist sanctioned for sexual misconduct who would later sleep with a patient.
Among those not flagged in the national database was podiatrist Thomas Franchini, who made mistakes in 88 cases harming veterans at its Maine hospital but now practices in New York City. The VA stated the database was only for medical doctors and dentists.
USA Today examined confidential VA records from 2014-15 and found 230 secret settlements (some involving whistleblowers) costing $6.7 million. Worker mistakes or misdeeds meriting dismissal accounted for 126. In 70 instances, workers were banned from VA facilities for years or life, but without specific reasons.
Mario DeSanctis, the former director of the VA Medical Center in Tomah, Wis., and his lawyers received $163,000. Local police, concerned the facility dispensed dangerous doses of powerful narcotics, called it “Candy Land.”
Radiologist Jorge Salcedo misread dozens of CT scans to detect tumors and blood clots at a Washington state VA. He got $45,000 in leave time and a clean reference.
The VA purged negative records in three-quarters of the cases, providing neutral or positive references to prospective employers, according to USA Today.
Other incompetence included a veteran treated in Memphis to repair broken blood vessels who was discovered to have 10-inches of plastic tube packaging embedded in his leg, which was amputated three weeks later. The VA cited Memphis for 1,000 threats to patient safety.
VA Secretary David Shulkin is now requiring department review of settlements greater than $5,000, while Congress approved the VA Accountability and Whistleblower Protection Act, making it easier to terminate employees for misconduct.
Congress tried to alleviate pressure on an understaffed VA in 2014 with the $16 billion Veterans Choice and Accountability Act, including $10 billion for veterans to receive care outside the VA and $2.5 billion to hire 12,000 more medical personnel.
But hospitals with the longest wait times didn’t get a larger share of funds, and far fewer doctors and nurses were hired than envisioned. In April, the VA had 45,360 vacancies. Attrition is a problem. In 2015, the VA hired 8,528 nurses, but lost 4,966.
And “choice” only occurs when the VA can’t schedule an internal visit within 30 days or the travel distance exceeds 40 miles. A “choice backlog” exists because VA officials have been slow to determine when it’s available. Meanwhile, patient reimbursement is often delayed.
Shulkin has proposed a program to allow veterans to select any private sector physician without restrictions. VA supporters claim that could gut the system, arguing outside practitioners lack experience dealing with such military medical issues as traumatic brain injuries, post-traumatic stress disorder, polytrauma and prosthetics.
The problems within the VA cry out for meaningful reform — not just continually reshuffling existing cards. Veterans must be allowed greater choice in getting timely and competent medical and mental health assistance.