Shinseki’s Other Shoe Drops

The findings of the newly released inspector general’s report are pretty grim:

Some 1,700 veterans waiting for an appointment at Veteran Affairs clinics across Phoenix, Ariz. were nowhere to be found in the system’s official wait list, federal investigators reported on Wednesday. Investigators for the Veteran Affairs Office of Inspector General said they had found initial evidence of “inappropriate scheduling practices” in the Phoenix Health Care System, which had led to “significant delays in access to care.”

Although data reported by Phoenix authorities suggested a statistical sample of 226 veterans waited an average of 24 days for their first primary care appointment, the review found that those 226 veterans actually waited on average 115 days to receive a primary care appointment. Only 16 percent got an appointment in 14 days or less, according to the interim report.

Shinseki’s days appear to be numbered:

Increased calls for political action came swiftly in the report’s wake and focused on VA Secretary Shinseki.

“I haven’t said this before, but I think it’s time for Gen. Shinseki to move on,” Sen. John McCain said in an appearence on CNN Wednesday. Rep. Jeff Miller, chairman of the House Veterans’ Affairs Committee, responded to the report with a statement that said Shinseki should “resign immediately.” … In addition to Miller, four other lawmakers also called on Shinseki to resign after the report was released, adding to the more than 50 members of Congress who have called for him to step down since the scandal broke last month. At least two new Democratic senators joined the chorus Wednesday, suggesting that more members of the president’s party are turning against his appointee in the wake of the OIG’s findings.

But Mataconis points out that removing Shinseki won’t solve the VA’s problems:

In the end, of course, the problems at the Department go far deeper than Eric Shinseki. In many cases, they predate him and to a large degree they involve the actions or failures to act of people under him over which he does not have direct supervisory control. Getting rid of the Secretary of Veterans Affairs isn’t going to solve the problems at the VA unless it is also accompanied by the removal of the people further down the chain responsible for these decisions. There also needs to be examination of the bizarre incentive structure that led to the creation of secret waiting lists that made it appears as though hospitals were doing a better job of addressing veteran’s health needs than they actually were. And, a reassessment of the idea that the VA should be the source of all the health care that veterans receive. … In other words, what’s needed is a transformation of the VA from the bottom up, not just the removal of the guy at the top.

Alesh Houdek argues that the real scandal here is in how long it took for anyone to blow the whistle:

Improvements in oversight and auditing are surely part of the solution here, but there’s a much more fundamental change that needs to happen: Regular line-level employees who see wrongdoing on the part of their coworkers, or are asked to engage in wrongdoing by their supervisors, need to be able to do something about it without threat of retaliation. Any human endeavor examined closely enough is a disgraceful mess, and most of us know this most directly from our jobs. But we also instantly recognize true malfeasance when we directly encounter it. So, of all the people who were involved or knew about these terrible practices who worked at the VA, why did it take so long for the truth to come out? …

Since the Phoenix revelations, employees from VA offices around the country have gone to the press with reports that similar practices exist at their offices. Had there been a robust and reactive system for internal whistleblowing, this would not have happened.

Update from a reader:

I am an ER nurse at a VA hospital (not in Arizona, thankfully). The comments from politicians on this scandal are just asinine.

Why is nobody asking why it takes over 100 days to get a primary care appointment? I hear these same complaints from people in the ER every day, that they come to the ER because it takes months to see their PCP. It takes that long because the VA is not given the budget to hire enough PCP’s. That’s the real fucking scandal. The politicians sent our troops to war and they are not willing to pay for their care when they come back.

Is the claim really that there is some nefarious plot to keep our Veterans from seeing their providers? Who believes that shit? We just don’t have enough primary care doctors and nurse practitioners to see them. Hire some more PCP’s and the wait times will decrease.

As for privatization, that is a fucking joke. Only about half of veterans actually use the VA for their health care now, because those who receive insurance through their employer usually go to private hospitals. The ones we see on a daily basis in the ER are older, poorer, often homeless, with more illness and co-morbidities. They are a distinct population and their level of care will decline if they don’t have a specialized service like the VA serving them.

You may not believe it, but most of us working at the VA actually believe in our mission. We mean it when we thank a veteran for their service. Rather than fixing the problem, and fixing our budget, they are just trying to shuttle more money to private hospitals and continue their anti-government grandstanding. The Republican party and the weak-kneed contingent of the Democratic party make me sick. The only Senator who seems to actually care about the veterans is Bernie Sanders.

Previous Dish on the VA scandal here, here, here, and here.