The Department of Veterans Affairs is embroiled in a scandal: Employees “cooked the books” to hide extraordinary delays in scheduling healthcare appointments. In Phoenix, 40 veterans reportedly died while waiting for appointments say sources who came forward last month. But, the existence of “inappropriate scheduling practices” was known to upper management four years ago.
One of the sources, Dr. Samuel Foote, a retired VA physician, reported that VA managers focused on generating numbers that would make superiors and the VA look good. “There’s really no incentive for the upper management to get accurate numbers,” Foote said. (CNN, 5/21) Thus, Secretary Eric Shinseki was able to say, in December 2013, that wait times were down.
Whistleblowers Break the Silence
Earlier intervention was thwarted when the agency tried to silence or discredit employees who voiced concerns.
One who spoke up was Lisa Lee, then a VA scheduler in Fort Collins, Colorado. After refusing to comply with an order to hide appointment waiting times, management placed her on unpaid administrative leave for two weeks, she says, then transferred her to Cheyenne, Wyoming. Lee filed an internal grievance, to no avail. Next, she took her concerns outside the agency to the Office of Special Counsel. Lee refused an agency offer to compensate her for lost pay, she says, because it included a requirement to stop whistleblowing.
Another who expressed concerns was Dr. Jose Mathews, head of psychiatry at the St. Louis hospital. He reported internally that doctors were shirking half of their caseload. Management responded by removing Mathews from his position and sending him to the basement.
Dr. Katherine Mitchell, director of the Phoenix VA’s emergency department, says she contacted the office of Sen. John McCain (R-Ariz.) last September to have a “confidential complaint” about a variety of healthcare issues forwarded to the VA’s Office of Inspector General. AZCentral reports that “Records show her list of concerns was not submitted to the inspector general, who investigates systemic problems and wrongdoing, but to the Office of Congressional and Legislative Affairs — a political liaison department in Washington.” Days later, the agency put her on administrative leave.”
Employees at other VA hospitals were inspired by the first whistleblower disclosures to share their observations, CNN reports, demonstrating that whistleblowing can be contagious if there is any encouragement.
Besides the toll on veterans, the VA’s whistleblower reprisals are striking for their banality. The same kinds of abuses occur in virtually every government agency, although VA appears to have more of them. Attorney Stephen Kohn says, “The VA is notoriously bad, and institutionally bad, and no one has taken any steps to fix it – Congress, the Office of Special Counsel, the inspector general.”
Congress has passed a succession of laws to protect whistleblowers, but each ultimately fails because legislators insist on funneling whistleblower cases through administrative courts that provide limited due process and little transparency, both essential to ensuring justice. Moreover, reprisal is rarely punished although whistleblowing is treated harshly.
“As a VA employee I have seen what happens to employees who speak up for patient safety and welfare within the system. The devastation of professional careers is usually the end result, and likely is the only transparent process that actually exists within the Phoenix VA Medical Center today.” – Dr. Katherine Mitchell [AZCentral]
The Administration Responds
President Obama has ordered an internal VA review and another to be led by a White House staffer. He has been supportive of Shinseki, saying, “’He has put his heart and soul into this thing and taken it very seriously,’” while saying that he’s waiting for results of an investigation. “[H]e made clear his main target for now was anyone who actually carried out improper practices at VA, rather than the retired Army general at the top,” reports CNN.
Shinseki has put three Phoenix officials on administrative leave, rescinded a bonus to the Phoenix VA Director, and accepted the resignation of the Undersecretary for Health. But, in claiming to be unaware of the extent of the problems, he implicates himself as one of them.
In TIME, Joe Klein writes that “An effective leader would have gone to Phoenix as soon as the scandal broke, expressed his outrage, held a town meeting for local VA outpatients and their families—dealt with their fury face-to-face—and let it be known that he was taking charge and heads were going to roll.” Klein’s strategy is fine for political damage control, but too little, too late for protecting veterans. A truly effective leader would have acted much earlier, to prevent harm in the first place. Forbes contributor Adam Hartung explains how in a discussion of Shinseki’s over-reliance on statistics.
When those long wait times were previously reported, the President publicly admitted to being appalled and told Secretary Shinseki to do something. The Secretary then declared a standard of no more than 125 days from incident to care had to be met. And he told employees of the VA to meet that goal, or they risked losing their jobs.
Shinseki failed to help employees develop a solution, Hartung notes. “He didn’t challenge his staff to find out the root cause of the problem and understand why these waits were so long. He didn’t hire outside consultants to evaluate the problem and propose solutions. He didn’t ask for “best practices” from industry.” (Republicans share the responsibility for any resource shortfalls, having thrown up roadblocks to funding VA services.)
If VA staff lacked resources and leadership to meet numerical goals, they might indeed resort to manipulating numbers. But, that doesn’t explain why Shinseki might be unaware that manipulation was (allegedly) taking place on a massive scale.
The previously mentioned reports of whistleblower reprisal and lack of transparency suggest that Shinseki failed also to provide leadership in terms of VA treatment of whistleblowers. Reports of waste, fraud and abuse do not flow naturally upstream, especially in an agency notorious for whistleblower reprisals. When subordinates thwart official policies by acting in their own interest and alter the official record, whistleblowers are critical to keeping upper management informed.
One of the first acts of any new department secretary, therefore, should be to immediately take steps to encourage and reward whistleblowers. In fairness to Sec. Shinseki, his own boss set a poor example.
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Photo Credit: Vietnam Women’s Memorial, Washington, DC., from Wikipedia.