Cultural change critical to rescuing VA, experts say
By Mike Wereschagin, Carl Prine and Adam Smeltz | The Pittsburgh Tribune-Review | Published: June 1, 2014
PITTSBURGH — The country's largest hospital system lost its top two leaders in two weeks, is under fire from powerful politicians and interest groups, and awaits an internal overhaul in the glare of an election-year political spotlight.
And the man at the helm — acting Veterans Affairs Secretary Sloan Gibson — just joined the department in February.
“I don't envy him,” Hershel Gober, who twice served as acting VA secretary during President Clinton's second term, told the Tribune-Review.
“He's going to have to spend about 20 hours a day there. There is so much he's got to read, so much he's got to understand,” Gober said.
As the Department of Veterans Affairs tries to find its way through one of the worst crises in its history, critics inside and outside say nothing less than a cultural change will rescue the embattled agency.
Secretary Eric Shinseki resigned on Friday, two weeks to the day after Undersecretary for Health Robert Petzel retired. Shinseki was forced out by the growing scandal of secret waiting lists at VA hospitals across the country, including one in Pittsburgh that included more than 600 veterans.
But other incidents have shaken the public's confidence in the federal government's second-largest department. At least six veterans died and 16 fell ill during an outbreak of Legionnaires' disease in Pittsburgh from February 2011 to November 2012, to name just one.
“Having a different secretary is not going to be enough,” said Sen. Bob Casey Jr., D-Scranton. “There are probably others who have to be removed, and even when you remove them and make changes, the key is going to be the result. Can you reduce — substantially — the backlog? Can you restore confidence?”
Changing the way the VA operates won't be easy, in part because of its size. Its 2,022-page budget lays out more than $150 billion in spending. Its workforce is about the size of Pittsburgh's population.
Start at the top
Those chosen to run the sprawling department traditionally have been veterans, said Gober, a Vietnam War veteran.
Maybe that should change, he said.
“I think the new secretary coming in should not be a military man. It should be a person who has experience with veterans' issues,” Gober said. “A general or an admiral can order his people to do something, and they have to do it. In the VA, you're dealing with doctors, nurses, a bureaucracy (of) people worried about promotions, salaries, bonuses.”
Most agree medical care is not generally the problem in VA hospitals.
“When the VA gets to it, it generally provides a high standard of medical care. I don't think the issue is all that often with the actual doctors or health care providers. It's with these insular bureaucrats who are responsible for the logistics of how the veterans get in front of the medical providers,” said W. Robb Graham, a malpractice attorney in Medford, N.J., who specializes in VA cases.
The House passed a bill on May 21 that makes it easier to fire VA managers. Other reforms, such as a measure sponsored by Rep. Tulsi Gabbard, a Hawaii Democrat who served two combat tours in Iraq, would steer some veterans into private hospitals.
“They've got to figure out a way, in the near term, to provide those veterans with health care,” Casey said. “If that means they have to get health care away from these VA hospitals, they've got to do it. If that means Congress needs to appropriate more money, we've got to do it. Whatever it takes to get that done, we've got to do it.”
The VA's budget increased dramatically in recent years: from nearly $98 billion in 2009 to more than $150 billion this year. During that time, 2 million veterans registered for care with the VA, many of them bearing the scars of more than 10 years of war in Iraq and Afghanistan.
“The answer to the problem is increasing the staffing — more physicians, more nurses, more administrative assistants to support the people,” said J. David Cox Sr., national president of the American Federation of Government Employees, which represents more than 205,000 VA workers.
Open environment critical
Executives must break a pattern of retaliation and condemnation of employees who raise concerns about problems. Feelings of intimidation can extend beyond a worker's tenure with the VA, Cox said. One former employee declined to speak on the record to the Trib about the VA Pittsburgh's wait list out of fear that her friends still at the agency would be retaliated against.
“You have to have an environment where people are not afraid to tell the truth,” Cox said. “I'm afraid we have an environment where everyone is programmed to say everything is OK when it isn't. That's been proven in the health care system in Pennsylvania several times,” including the Legionnaires' outbreak.
That might have been part of Shinseki's undoing, Gober said.
If managers hid inadequate staffing or increasing wait times, the problems could have grown out of control, he said. When Gober ran the VA, one of his first orders to his inner circle was to give him the bad news first, he said.
“You can delay giving me the good news, but don't you ever delay giving me the bad news,” Gober said. “Good news can wait. But bad news — if I don't know about it, I can't fix it.”
An early test of the VA's openness will come from Pittsburgh, where hospital Director Terry Gerigk Wolf disclosed the wait list to local members of Congress. U.S. Rep. Mike Doyle, D-Forest Hills, said Wolf's superiors asked her not to talk to congressmen.
Now that the word is out, VA Pittsburgh leaders face a key test in whether they can satisfy members of Congress who want them to get in touch with the more than 600 people on that list.
“We'll see whether or not they're going to be effective,” Casey said. “The next days ... are going to be critical.”