A Time for Political Action, not Political Grandstanding

soldier_flagA pair of high-profile Senate candidates, both Democrats, have distanced themselves from the Obama administration by calling for the resignation of Eric Shinseki, the Veterans Affairs (VA) Secretary. Alison Lundergan Grimes, from Kentucky, and Michelle Nunn, from Georgia, both called for new leadership at the VA as the department investigates 26 facilities across the nation regarding allegations of treatment delays and associated deaths. Earlier this week Mr. Obama reaffirmed his support for Shinseki, his embattled Cabinet member, stating, “Rick Shinseki has been a great soldier. He himself is a disabled veteran. And nobody cares more about our veterans than Rick Shinseki.” Mr. Obama also pledged to ensure accountability throughout the VA once internal reviews are completed. The administration did force the resignation of the VA’s top health official, Robert Petzel, yet he was already scheduled to retire this year.

While the two Senate candidates sought to distance themselves from the current administration, Nancy Pelosi (D-CA), the House Minority Leader, implied repeatedly yesterday that the former president, George W. Bush, is to blame for the current VA scandal. While claiming that her political party has labored diligently for veterans in recent years, Pelosi remarked that Mr. Obama “sees the ramifications of some seeds that were sown a long time ago, when you have two wars over a long period of time and many, many more, millions more veterans. And so, I know that he is upset about it.” She added, “Maybe when we go into war, we should be thinking about its consequences and its ramifications. You would think that would be a given, but maybe it wasn’t. And so, we go in a war in Afghanistan, leave Afghanistan for Iraq with unfinished business in Afghanistan. Ten years later, we have all of these additional veterans. In the past five years, two million more veterans needing benefits from the VA. That’s a huge, huge increase.”

Pelosi failed to mention that in 2009 the Obama administration authorized the implementation of the COIN (counter-insurgent) strategy, a strategy focused on “winning hearts and minds,” and that the U.S. military member death toll has since nearly tripled. In the first seven years of Operation Enduring Freedom (Afghanistan), under the Bush administration, the United States military lost 630 troops in Afghanistan, and 2,638 were wounded. Of all U.S. troop deaths in that nation, 73% have occurred since 2009; and in the 45 months following the implementation of Obama’s strategy, 15,036 troops have been wounded.

The VA crisis has become a platform for political grandstanding, yet the veterans who volunteered to sacrifice life and limb for their nation will not be helped by individuals who use them simply for political gain. Grimes, the Senate hopeful, claimed the current VA leadership is not in a position to restore trust with veterans, stating, “We owe a solemn obligation to our veterans, and our government defaulted on that contract. I don’t see how that breach of trust with our veterans can be repaired if the current leadership stays in place.” Unfortunately, Grimes is speaking only of the VA leadership, but the VA scandal has taken the place as a result of politicians on both sides of the aisle acting for years in ways that have produced and enabled a culture of greed and dishonesty. Those on Capitol Hill need to address this crisis carefully and thoroughly in order that our veterans are taken care of in a manner worthy of their sacrifice, and so that those who consider taking the oath of service in the years ahead do not refuse to do so because they fear that their nation will fail to honor their service and sacrifices.

FoxNews.com, “Dem Senate candidates break with Obama, call for Shinseki’s resignation” (23 May 2014)
Joel Gehrke, The Washington Examiner, “Nancy Pelosi blames George W. Bush for Veterans Affairs scandal” (22 May 2014)
Allen B. West, “U.S. military deaths in Afghanistan skyrocket under Obama” (n.d.)

“As Mad as Hell”

congressVeterans Affairs (VA) Secretary Eric Shinseki declared he is “as mad as hell” concerning allegations of treatment delays and preventable deaths at a VA medical facility in
Phoenix, Arizona. Appearing before a Senate panel today (15 May 2014), Shinseki vowed to hold employees accountable for any misconduct. The retired Army general said during the hearing, “Any adverse event for a veteran within our care is one too many.” Shinseki said he welcomes a White House review of his department, and also stated, “If allegations about manipulation of appointment scheduling are true, they are completely unacceptable – to veterans, to me and to our dedicated VA employees.”

Barack Obama assigned deputy chief of staff Rob Nabors to review policies for patient safety and the scheduling of appointments, an assignment that was announced late Wednesday (14 May). Problems similar to those reported at the VA in Phoenix are also being reported from other facilities across the nation. Senator Patty Murray (D-WA), declared that the hearing “needs to be a wake-up call for the department,” and noted that outside reviews have outlined problems related to treatment delays and healthcare quality for at least 14 years. She added, “It’s extremely disappointing that the department has repeatedly failed to address wait times for health care.” Murray called for Shinseki to take “decisive action to restore veterans’ confidence in VA, create a culture of transparency and accountability and to change these system-wide, years-long problems.” Senator John McCain (R-AZ) claimed the current administration “has failed to respond in an effective manner” to the recent allegations against the VA, and that the situation “has created in our veterans’ community a crisis of confidence toward the VA – the very agency that was established to care for them.” McCain added, “Treating those to whom we owe the most so callously – so ungratefully – is unconscionable and we should all be ashamed.”

Some congressional Republicans have joined the American Legion in calling for Shinseki’s resignation, an action resisted by both the VA Secretary and the White House. Mr. Obama stated, “While we get to the bottom of what happened in Phoenix, it’s clear the VA needs to do more to ensure quality care for our veterans.” Last week, the House Veterans Affairs Committee voted to subpoena all emails and other records in which VA officials, including Shinseki, may have discussed the destruction of “an alternate interim waitlist” for veterans seeking healthcare in Phoenix.

The day before Shinseki testified in Washington DC, federal investigators visited the Edward Hines, Jr., VA Hospital in the Chicagoland area to examine an allegation there regarding secret lists that were used to conceal extended patient wait times for appointments. Senator Mark Kirk (R-IL) opined that the claims targeting the Chicago facility are credible enough to warrant an expansion of the formal investigation targeting the one in Phoenix, stating, “The inspector general should immediately broaden its investigation to include Hines VA and to deliver a swift and immediate report.” Kirk observed there is a link between the facilities as Sharon Helman, the director of the Phoenix hospital, served as the director at the Chicago hospital from 2010-2012. Joan Ricard, the Illinois’ hospital’s current director, maintains there was no separate patient waitlist at that facility. She stated in a written document, “I am not aware of any occurrences of data manipulation here at Hines, past or present, and I have received no evidence or specific facts about data manipulation at the Hines VA.” However, Germaine Clarno, a VA social worker and the president of the American Federation of Government Employees VA Local 781, claims otherwise. She informed CBS news this past Tuesday (13 May) that the names of veterans were placed on secret waiting lists when they first sought appointments and were not formally booked into the system until appointment times became available within the VA’s maximum wait goal of two weeks. Clarno also reported that executives and physicians wanted “to make numbers look better for their own recognition and for bonuses.”

It was also reported today that at least three mental health officials were suspended from the Malcom Randall VA hospital in Gainesville, Virginia, after an official from the Inspector General’s office for the Washington, DC, bureau of the Department of Veterans Affairs discovered a secret waiting list containing 200 patient names. The list was found setting on a mental health employee’s disk. When news surfaced from Arizona regarding the utilization of secret lists, the upper management at the Gainesville facility offered amnesty to any employees who came forward with such lists. However, speaking under conditions of anonymity, employees stated they did not believe they would have received amnesty if they had come forward. None did, and two prior sweeps by the local Inspector General’s office discovered no such lists. Employees also mentioned that a number of veterans at the Gainesville facility committed suicide while waiting to receive mental health care.

Shinseki should be “as mad as hell” about the problematic issues plaguing the VA, but so should the White House, both sides of the aisle in Congress and in the Senate, and the American people.  The policies in place at the VA need to be overhauled, and the climate that has permitted such egregious practices to take place must be decimated and replaced with a culture of integrity.  That will not take place with a few resignations and firings.

The Associated Press, “VA hospital White House review welcomed by department head” (15 May 2014)
The Associated Press, “Edward Hines, Jr. VA Hospital in Chicago scrutinized over alleged secret waitlist” (15 May 2014)
WCJB, ABC News, “Three suspended for falsified waiting list at Gainesville VA hospital” (15 May 2014)

St. Louis VA Under Fire

stlouisIn both a federal whistleblower complaint filed in 2013 and in an interview with the Associated Press (AP) on 12 May 2014, Dr. Jose Mathews, former chief of psychiatry at the Veterans Administration (VA) hospital in St. Louis, Missouri, claimed veterans often wait for more than a month to receive mental health treatment due to psychiatrists and other staff members being negligent in their duties. Mathews, who took the position in November 2012, relayed his initial astonishment regarding the psychiatrists’ workload – on average about six patients a day. He believed about twice that number should be seen. He remarked in the AP interview, “I could account for only a four-hour workday.” While the amount of time spent with each patient varies, the majority of visits last about 30 minutes. Mathews added, “There is no conceivable reason a full-time psychiatrist should be seeing just six patients in a day. It was causing this huge delay in access to care.” Mathews stated that his efforts to implement changes aimed at providing more efficient and timely treatment was met with opposition by staff members, though the average number of patients seen daily per psychiatrist increased to nine by July 2013. The chief of staff called Mathews into his office to inform him “There was a mutiny,” and was then reassigned to a compensation and evaluation team in September 2013.

Other concerns were raised in the whistleblower complaint and in a letter to Sen. McCaskill. Mathews cited data that placed the St. Louis “facility well above the national average for productivity,” but countered, “This misleading data provided for budgetary funding appropriations does not correspond with the reality.” The former chief of psychiatry also questioned why nearly all staffers receive bonuses, regardless of their productivity; why his requests for investigations into the deaths of two veterans were denied; and whether staff members failed intentionally to report a psychiatric patient’s suicide attempt while an accreditation commission was visiting the facility. The VA facility in St. Louis came under scrutiny on more than one occasion just a few years ago. In 2010 there were 1,812 veterans who were potentially exposed to HIV and hepatitis as a result of faulty sterilization practices in the dental clinic. Fortunately, testing revealed no exposure to the diseases in any of the veterans who were treated. Another sanitation concern was raised in February 2011 when rust stains were discovered on surgical equipment, resulting in the closure of all operating rooms at the facility. The faulty equipment was cleaned or replaced several months later, and the operating rooms were reopened. The VA revised its policies following the incident, and opened a new $7 million sterile processing lab in May 2012.

Following the AP interview, the U.S. Senators from Missouri – Roy Blunt (R) and Claire McCaskill (D) – sent a joint letter to VA Secretary Eric Shinseki seeking information regarding the number of mental health providers at the St. Louis VA, their workload, and the timeliness of patient treatment. The letter declared, “If true, these claims would demonstrate an unacceptable lack of leadership at the VA in St. Louis that is putting the health and safety of veterans at risk.” Marcena Gunter, a hospital spokesperson, noted in an email, “We take these allegations seriously. The St. Louis VA Medical Center leadership is aware of and is addressing the alleged issues.”

As a counselor, I believe that having six clients/patients per day is actually a heavy load.  Of course, that is with the understanding that each client/patient is seen for fifty minutes to an hour on average (which is typical), as opposed to 30 minutes.  Thirty minutes generally seems like an inadequate amount of time to conduct quality counseling.  One must not forget that therapists are also required to complete a great deal of paperwork related to counseling, especially in facilities such as the VA in which diagnoses are required.  However, the reception of bonuses being given regardless of merit, the failure to investigate patient deaths, and failing to report a suicide when a high-profile team was visiting are indicative of a problematic environment.

Stars & Stripes (The Associated Press), “St. Louis VA doctor: I was demoted for trying to improve productivity” (13 May 2014)

Shinseki Subpoenaed

va1-copyThe Veterans Administration (VA) has long been notorious for its extended delays and patient backlogs. It has come under fire recently for a number of veteran deaths related to such delays. Last week, a House committee voted to subpoena VA Secretary Eric Shinseki to obtain documents, including emails, related to an alleged secret “waiting list” for ailing veterans at the VA healthcare facility in Phoenix, Arizona. Several whistleblowers claim that administrators ordered thousands of appointment requests to be redirected to a secret unofficial list that would prevent them from being reported; and that the names of patients who died were removed from the list altogether. Dr. Samuel Foote, who worked for the VA for decades, stated, “This was basically an elaborate scheme to cover up patient wait times.” He added, “The main problem was we had a huge demand, and we had a relatively limited supply of service. Rather than dealing with the problem, they were just covering it up.”

House committee members reported that a previous response from Shinseki in regard to these matters failed to adequately answer their questions, and several of them are calling for his resignation. The American Legion also called for his resignation, not only because of this particular controversy, but due to other controversies related to veterans’ care over the last few years as well. However, Shinseki, a retired Army general, has received vocal support from the White House, and brushed aside all calls for his resignation. Shinseki is supposed to testify at a hearing this week before the Senate Veterans’ Affairs Committee regarding the state of the VA healthcare system.

NBC NEWS – Jim Miklaszewski & Becky Bratu, “Whistleblower Says VA Hospital Covered Up Problems, Delayed Care
CBS NEWS – Jennifer Janisch, “Email reveals deliberate effort by VA hospital to hide patient waits
FOX NEWS – Steve Centanni, “House panel subpoenas VA Secretary Shinseki for Phoenix hospital documents



Religious Preference?

SisyphuswrockThe U.S. Army has officially recognized “Humanism” as a religious preference. Humanism is a secular, non-theistic philosophy that emphasizes the value and agency of human beings, individually and collectively, and claims adherence to rationalism and empiricism in opposition to established religious doctrines. The new “religious” preference was acknowledged after Major Ray Bradley made the request in 2011 to have humanism listed with other faiths and belief systems in the Army’s religious preference code.  His case received intervening support from the American Civil Liberties Union (ACLU) and the Military Association of Atheists and Freethinkers (MAAF). MAAF President Jason Torpy expressed optimism that this inclusion will result in a wider recognition of humanists, and provide their inclusion in Chaplain Corps services and various therapy offerings. Noted Torpy, “Being able to identify as who we are in the Army is a great step forward. The real need is not just to have a binary appreciation: ‘Well, you believe in God, then we’ll attend to that, and if you believe in nothing, you can sit in the corner.’ Nontheistic practices have to be included in the discussion because our soldiers have to deal with life and death, and love and loss as well.” Torpy neither explained any further why a secular non-theistic philosophy should be considered a religious preference; nor how members of the Chaplain Corps and Medical Corps (Behavioral Health) already serve military members with matters of life and death, love and loss regardless of faith or non-faith affiliation.

Provide a Helping Hand to the Military

USObootsMilitary members face hardship, not only due to serving in combat zones and in high-stress work environments, but also as a result of facing difficulties related to their living conditions and healthcare. Some are injured severely during wartime, losing limbs or being limited in their mobility. Others have traumatic brain injuries (TBIs) or suffer from posttraumatic stress disorder (PTSD), matters that make their return to civilian life less than ideal. It is estimated that only about one percent of Americans will ever serve in the military, yet the other 99 percent are not incapable of helping veterans. If you want to help take care of our veterans, here are a few suggestions of how you may provide for them.

Provide a Ride
Disabled American Veterans (DAV) provides free transportation to veterans who are unable to afford travel to Veterans Affairs (VA) medical facilities. Volunteer to drive a DAV vehicle.  DAV also offers other volunteer opportunities as well.

Provide Frequent Flyer Miles
The Fisher House Foundation provides homes on the grounds of military and VA medical facilities across the nation. These homes assist family members by enabling them to be near their loved ones during hospitalization related to combat injury, illness, or disease. Sometimes families are unable to cover travel costs in these situations. The Hero Miles Program, which is operated by Fisher House, uses donated frequent flyer miles to provide their long-distance travel. You may also donate household items to Fisher House, or volunteer with them.

Provide a House
When severely injured veterans arrive back home, their housing often lacks the accommodation required to help them handle their physical disabilities. Homes for Our Troops builds specially modified houses for veterans that enable them to live independently. The houses are provided at no cost to the veterans, with funding provided through fund-raisers and donations. Volunteer to construct a house, donate equipment, or give a financial gift so that a home may be built.

Provide Pet Care
Guardian Angels for Soldier’s Pet provides foster care for dogs and cats belonging to deployed military members and wounded veterans receiving VA medical treatment. Volunteer with this group to provide care for one of these pets.

Provide for Wounded Warriors
The Wounded Warrior Project (WWP) provides rehabilitation, activities, and career counseling for our nation’s wounded military members and their families. You may support WWP in several ways. Host a Supporter Event, send letters to injured military members, provide monthly financial support, or make a donation in honor of a loved one.

Provide for Active Duty Troops
The United Service Organizations (USO) exists to “lift the spirits of America’s troops and their families.”
With hundreds of locations around the world, the USO relies on the generosity of individuals, organizations and corporations to support its mission. That mission is accomplished as the USO provides comfort, relaxation, entertainment, and a connection to loved ones. The USO relies upon both volunteers and donations.

Say, “Thanks!”
Some military members have experienced not only the traumatic events related to combat, but then come home only to have someone in the airport or on the street demean them because of their service. It is much better for the emotional health of our veterans to hear two simple words, “Thank you.” If you know any veterans or see individuals in uniform, let them know you appreciate your service.

We Are All Dishonored

Three executives from the Phoenix Veterans Affairs Health Care System – the director, Sharon Helman, associate director, Lance Robinson, and an unnamed employee – were placed on administrative leave as an investigation is underway to examine claims of corruption and unnecessary fatalities. The facility has been under scrutiny in recent weeks after it was alleged that as many as 40 patients may have died due to healthcare delays. The treatment delays were hidden intentionally through the use of multiple appointment lists – public lists and secret lists. Helman and the facility’s chief of staff denied any knowledge of secret lists, and claimed they discovered no evidence of patients dying as a result of delayed treatment.

The Phoenix facility is not the only VA hospital to come under fire recently. In the past year alone, facilities in Washington, South Carolina, Georgia, and Florida were linked to poor oversight and delays in patient treatment. In March 2013, an unusually forceful letter was sent to the White House office that handles complaints from federal whistle blowers. It stated emphatically that problematic patterns were discovered at the VA facility in Jackson, Mississippi, and raised serious questions regarding management practices. It detailed problems from the previous six years, including inadequate sterilization procedures, chronic understaffing of the primary care unit, and missed diagnoses by the radiology department. Five of the complaints lodged at the Jackson facility came from separate individuals in different departments.

A CNN investigative report last November noted that military veterans are dying needlessly due to long waits and delayed care at VA healthcare facilities. The report stated outright that the U.S. Department of Veterans Affairs is not only aware of the problems, but has done nothing effectively to prevent them. At the Williams Jennings Bryan Dorn Veterans Medical Center in Columbia, South Carolina, many veterans waited months for simple gastrointestinal procedures (e.g., colonoscopy, endoscopy), and were dying because their cancers were not discovered quickly enough. Six such deaths were confirmed by the VA, yet medical investigators believed the number of deaths related to delays could exceed 20. The investigators reviewed 280 cases of gastrointestinal cancer patients at the facility and found that 52 were “associated with a delay in diagnosis and treatment.”

A follow-up CNN investigative report, released in January, stated that at least 19 veterans died due to delays in simple medical screenings at various VA healthcare facilities, while another 63 are dying as a result of delayed diagnoses or treatment. The report was based on an internal document from the U.S. Department of Veterans Affairs. In the Florida region, five veterans died, and 14 veterans or their families were sent disclosures notifying them that they suffered “adverse events” because of delayed or denied care or diagnosis. Two veterans died and four families were sent such disclosures or notifications in the Rocky Mountain region, and seven veterans or their families were sent disclosures in the Texas region.

Some allege that the VA has failed to provide key information to Congress and the public that demonstrates the agency’s ability to provide service-related benefits quickly, and that such an ability has virtually collapsed under the current administration. Internal VA documents, obtained by the Center for Investigative Reporting and authenticated by the agency, revealed that delays faced by newly returning veterans in receiving disability compensation and other benefits are much longer than the VA has acknowledged publicly. The VA tracks and reports the average wait time as 273 days, yet the internal data indicates veterans filing their first claim – including those who served in Iraq and Afghanistan, wait nearly two months longer. Those filing for the first time in major population centers wait up to twice as long – 642 days in New York, 619 days in Los Angeles and 542 days in Chicago. The ranks of veterans waiting over a year for their benefits grew from 11,000 in 2009 to 245,000 in December 2012 – an increase of over 2,000 percent.

Back in 2009, amid escalating controversy regarding procedures that exposed 10,000 veterans to the AIDS and hepatitis viruses, it was revealed that a VA facility in Pennsylvania gave substandard radiation treatments to nearly 100 cancer patients. Veterans groups and lawmakers claimed VA healthcare facilities permitted such violations because federal regulations permit doctors to conduct their services with minimal external scrutiny. One congressman declared at that time that the VA healthcare system was exhibiting signs of an “institutional breakdown.” During that same period, Joe Wilson, deputy director of the Veterans Affairs and Rehabilitation Commission for the American Legion, claimed that complacency, poor funding, and poor oversight led to the violations that failed the cancer patients in Philadelphia and possibly infected 53 veterans with hepatitis and HIV from unsterilized equipment at three VA health centers in Florida, Tennessee and Georgia. Wilson testified before Congress in 2009 that “lack of inspections” and a “lack of transparency” were to blame for the problems.

Wilson informed Fox News that poor funding aggravated the problems, with finances often misspent on repairs for aging facilities that are incapable of operating new technology and equipment in a proper fashion. The average age of VA facilities is almost 50 years, while those in the private sector are about 12 years.  Investigations conducted in 2009 revealed that systemic problems existed. Just under half of VA facilities that were given surprise inspections had proper training and guidelines in place for common endoscopic procedures, for example. A VA representative claimed back then that Eric Shinseki, VA Secretary General, and senior leaders were conducting a “top to bottom review” of the department, and implementing “aggressive actions to make sure the right policies and procedures are in place to protect our veterans and provide them with the quality health care they have earned.” However, veterans’ advocates maintained that would be insufficient, and that they had seen no evidence of changes that could remedy what they described as a broken healthcare system.

In August 2007, presidential candidate Barack Obama gave a campaign speech to veterans that specifically addressed waiting lists, denied care, and poor treatment, and promised his administration would be different. He stated, “No veteran should have to fill out a 23-page claim to get care, or wait months – even years – to get an appointment at the VA.” He added, “When we fail to keep faith with our veterans, the bond between our nation and our nation’s heroes becomes frayed. When a veteran is denied care, we are all dishonored.”

CNN Investigations, “Veterans dying because of health care delays” (30 JAN 14) by Scott Bronstein, Nelli Black, and Drew Griffin
CNN Investigations, “Hospital delays are killing America’s war veterans” (21 NOV 13) by Scott Bronstein, Nelli Black & Drew Griffin
The Washington Post, “3 at Phoenix VA hospital on leave over allegations” (1 MAY 14) by Brian Skoloff
The Washington Post – ‘The Federal Diary’, “VA’s reputation for health care takes a thrashing” (12 SEP 13) by Joe Davidson
The New York Times, “A Pattern of Problems at a Hospital for Veterans” (18 MAR 13) by James Dao
The Center for Investigative Reporting, “VA’s ability to quickly provide benefits plummets under Obama” (11 MAR 13) by Aaron Glantz
Fox News, “VA Medical System in Shambles, Veterans Groups Say” (24 JUN 09) by Joseph Abrams


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