If President Barack Obama’s nominee to lead the Department of Veterans Affairs is confirmed by the Senate, it’s well established that he'll have a tough job awaiting him.
Bob McDonald, a West Point graduate and former chief executive of Procter & Gamble, is set to formally receive the nomination on Monday.
But last Friday, as if to put a fine point on just what the next secretary will face, the White House released a summary of a report President Obama received about the agency’s challenges.
VA’s health network lacks accountability, and the agency suffers from a host of other problems, including a “corrosive culture” of employee discontent and management retaliation, according to the report by Deputy White House Chief of Staff Rob Nabors. Nabors produced the review at Obama’s request.
In the report, Nabors, who met with Obama and acting VA Secretary Sloan Gibson on Friday, said that the Veterans Health Administration “needs to be restructured and reformed.”
The report covered ground that has played out before countless congressional panels in recent weeks and has been featured in varied reports, from the agency’s inspector general to the Office of Special Counsel and the department itself. The IG’s report last month said that VA medical centers nationwide falsified appointment records to hide extensive treatment delays. The problems led to a leadership shake-up that included the resignation of Eric Shinseki as secretary and the demotion of two top officials.
Nabors’s report hit some points particularly hard, emphasizing the dysfunction in the Veterans Health Administration, citing the need for more resources and criticizing a poor management style throughout VA that harms “by extension, the timeliness of health care.”
Among the other conclusions, the report determined that VA’s goal of scheduling patients within 14 days is “arbitrary, ill-defined and misunderstood,” and that it may have “incentivized inappropriate actions.”
VA officials have said that outdated scheduling software contributed to the record-keeping issues, but the briefing document said technology was “secondary” to the need for additional medical staff to help treat patients.
The report noted that shortages of health professionals are not unique to VA, but it said slowness in federal hiring and difficulty competing with private-sector wages have exacerbated the problem for the department.
“VA has also demonstrated an inability to clearly articulate budgetary needs and to tie budgetary needs to specific outcomes,” the report said.
It also said VA headquarters needs to be more hands-on with field facilities, noting that clinics are generally “not accountable or transparent to veterans, the secretary or the department as a whole.” The report added that many employees believe the issues raised by leadership and the public are “exaggerated, unimportant, or ‘will pass.’ “
On the other hand, the briefing document said VA culture encourages retaliation against employees who expose wrongdoing. The report said one-fourth of all whistleblower cases with the U.S. Office of Special Counsel come from VA.
The OSC investigates allegations of wrongdoing in the federal workplace and protects employees who report the problems from reprisal. The agency said this month that it is reviewing complaints from 37 VA employees.
Describing the vast majority of VA employees as “dedicated, hardworking, and committed to the Veterans they serve,” the report said VA should complete the OSC’s whistleblower certification program.
Senate Veterans’ Affairs Committee Chairman Bernie Sanders, I-Vt., said in a statement Friday that VA must do a better job of understanding what is taking place on the ground, adding that regional and local offices have to stop hiding serious problems.
“No organization the size of VA can operate effectively without a high level of transparency and accountability,” Sanders said. “Clearly that is not the case now at VA. The communication and decision-making between the central office and regional offices must be radically restructured.”
“There is a strong sentiment among many veterans and stakeholders that in general VA provides high quality health care “once you get in the door” and that the current system needs to be fixed, not abandoned or weakened,” the report released Friday said.
The White House on Friday also outlined steps VA has taken to improve access to care and address the scheduling issues. The actions include contacting veterans who are still waiting for appointments, hiring more staff, expanding the use of non-VA clinics to care for patients, posting twice-monthly updates on access data and directing a review of how the agency treats whistleblowers.