Saturday, 24 May 2014

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Where is Honor at the VA?

By Robert B. Charles

     Secretary of Veterans Affairs (VA) Eric Shinseki is a man of honor, who ought to be politically bullet proof.  A four-star general, two combat tours in Vietnam, a former wartime chairman of the Joint Chiefs and land mine survivor, his military career is the definition of high-integrity leadership.  But he is not bullet proof.  Here is why.

General Shinseki has been head of the VA since 2008, more than five years.  Between April 2009 and today, there have been ten semi-annual Inspector General’s (IG) reports done on the VA.  Another is now pending.  Each is a damning six- month compilation.  In the very first report, Shinseki learned of 102 individual IG reports on major VA problems.  In his second, he learned of 133 new problems.  In his third 120, fourth 143, fifth 140, sixth 161, seventh 140, eighth 159, ninth 164, tenth 185.  So, the number of problems and investigations on his watch has been rising, not falling.

What did five years of mounting investigations reveal?  A lot.  The first consolidated semi-annual IG report – five years ago – reported to the general that “An OIG audit determined the Veterans Health Administration (VHA) lacks an effective method to track and report unused appointments, particularly those canceled in advance and those never scheduled.”  So, within his first six months, the general knew VHA had major scheduling, appointment allocation, and wait time problems.  What is the current investigation about?  VHA wait times alleged to have been the proximate cause of veteran deaths.  Ironically, the cover of that first IG report?  An Arlington headstone.

What did the second report find? Among other system failures, “noncompliance” across the VA with critical “directives.” “VHA’s failure to comply on such a large scale suggested fundamental defects in organizational structure.”  Again, the process by which the VA managed all appointments and information technology was found deeply flawed.  Wrote the IG, of the system for veterans’ medical appointments:  “Oversight … was ineffective,” thus “VA expended over $70 million” but “does not have a deployable [appointments system].”  Worse, there was “a fundamental inability on the part of [the VA] to properly manage [important] IT projects internally.”

Nor could the VA leadership, including the general, have missed this point.   In March of 2009, there was a media bombshell: The multi-million dollar project “to develop a core computer application to schedule patient appointments at hospitals run by the VA has all but collapsed, and senior executives are worried about the repercussions it could cause on the Hill … according to an internal memo.” So, there it was:  Leadership knew the system was failing veterans.

The third IG report? “Many veterans do not receive timely medical examinations because VA medical facilities do not commit sufficient medical resources to them” and “program weaknesses persist.”  The fourth and fifth amplified.  In the sixth, mishandling of medical systems in “16 regional offices,” and a return to the failed appointments system:  Specifically, the VA “made little interim progress in one key area—ensuring contact with patients during the time interval between acceptance into a mental health residential rehabilitation program and the start of the program.”  In other words, appointments for mental health were a continuing problem.  Suicides were rising.

Seven?  The general’s VA “lacked financial and budgetary controls,” had “ineffective oversight and stewardship of VA funds.” More Arlington headstones.  Eight? “At 5 years after separation, 3.7 percent of [veterans were] experiencing … homelessness,” and “were more likely to be diagnosed with mental disorders …” Nine? Hundreds more arrests, more systemic problems.  Ten?  More non-compliance, negligence and criminal issues.

So, here comes the five-year head of VA to testify before Congress.  And what does he say?  He says that learning of mismanagement now “makes him mad as hell.”  He fires a senior administrator.  President Obama’s staff says he has “complete confidence,” but is “outraged” by failures at his VA.   Really?

After five years of systemic disconnect and program failure, after breaking trust with nearly 65 million patriotic and ailing American veterans, the head of the VA is “mad as hell?”  The president is “outraged?”  Really?  I am sorry.  My father died in a VA hospital.  Too many of my relatives are at Arlington to accept this.

Responsibility for systemic failure goes to the top.  The president has too much pride or too little shame to accept responsibility for another systemic failure, let alone to resign.  But General Shinseki, you are a man of honor – still.  Is it not a little late to get “mad as hell,” in view of the last five years and all those IG reports?  Why must so many good men and women suffer so much, after defending us with their lives, limbs, hearts and minds?  Where is honor at the VA?  Surely we can do better.  We must.

This article first appeared in The Hill.
Charles ran a House oversight subcommittee for five years, served as assistant secretary of State under Colin Powell, and was a Naval Intelligence Officer, USNR, for ten years.  He currently runs a consulting firm in Washington D.C.