This Is Absolutely Inexcusable...

[Lord Jim]

I'm surprised nobody has posted about it before now:

(CNN) -- A top official at the Department of Veterans Affairs has resigned amid the growing scandal about wait times and care at veterans' hospitals, the department's leader said Friday.

News about the resignation of Dr. Robert Petzel, undersecretary for health in the Department of Veterans Affairs, came one day after he spoke at a Senate hearing about the issue alongside Secretary of Veterans Affairs Eric Shinseki.

In a short statement, Shinseki announced that he accepted Petzel's resignation.

"As we know from the veteran community, most veterans are satisfied with the quality of their VA health care, but we must do more to improve timely access to that care," Shinseki said. "I am committed to strengthening veterans' trust and confidence in their VA healthcare system."

Petzel's resignation came a day after he testified before the Senate's Veterans Affairs' Committee looking into reported delays at numerous VA hospitals and a long list of serious problems and allegations of falsifying wait times, many of which were exposed and reported by CNN.

For six months, CNN has been reporting on delays in medical appointments suffered by veterans across the country and veterans who died or were seriously injured while waiting for appointments and care.

The VA requires its hospitals to provide care to patients in a timely manner, typically within 14 to 30 days.

The most disturbing and striking problems emerged in Arizona last month as inside sources revealed to CNN details of a secret waiting list for veterans at the Phoenix VA. Charges were leveled that at least 40 American veterans died in Phoenix while waiting for care at the VA there, many of whom were placed on the secret list.

But even as the Phoenix VA's problems have riveted the nation's attention, numerous whistle-blowers from other VA hospitals across the country have stepped forward. They described similar delays in care for veterans and also varying schemes by officials at those facilities to hide the delays -- in some cases even falsify records or efforts to "cook the books."

The secret waiting list in Phoenix was part of an elaborate scheme designed by Veterans Affairs managers there who were trying to hide that 1,400 to 1,600 sick veterans were forced to wait months to see a doctor, according to a recently retired top VA doctor and several high-level sources who spoke exclusively to CNN.

You can read the rest of the article here:

http://www.cnn.com/2014/05/16/politics/va-scandal/

This scandal has created a real conundrum for many liberals for a couple of reasons:

First, Shinseki's a big hero to that crowd for publicly criticizing US invasion plans prior to the Iraq War while still serving in uniform. They were outraged when this caused him to be forced into retirement, (of course these are the same folks who run around with their hair on fire whenever a uniformed general publicly criticizes the policies of a Democratic President, and demand that he be fired.) They were thrilled when he was appointed to head the VA because they saw the appointment as a poke in the eye to George W. Bush, an activity they always applaud. Consequently they're very reluctant to see him go, even as he is revealed to be a clueless, asleep-at-the-switch incompetent.

Second, and probably more important to these folks, (especially the liberals and leftists on The Hill, like Bernie Sanders, who heads the Senate Veterans Affairs Committee) is the fact that the VA has long been held up by them as a shining positive model for government run health care. They have pointed to it as a template for their beloved socialized medicine health care scheme, known euphemistically as "single payer".

To have it revealed that the VA is rife with corruption and incompetence, (pretty much like just about every other government run operation) really puts a crimp in their narrative. So you see them rushing to minimize the problems, claiming that overall it's still a wonderfully run program, (of course these are again the exact same folks who would be bubbling over with indignation and doing the hair on fire routine if this were a Defense Department program.)

I think what's been revealed here is a complete outrage, and that it appears that a thorough housecleaning at the VA is in order. It seems that a widespread culture of bureaucratic butt covering taking precedence over providing first class care to those who served our country has become systemic, and it needs to be purged root and branch.

And in the case of the worst of it, the secret list that led to deaths; in addition to firings, there should be criminal charges. Some person or persons should be doing a long stretch in the pen for that.

[rubato]

And yet you defend and want to preserve from improvement a health system for everyone else that is orders of magnitude worse? Where letting people die of treatable conditions is the norm? Where the wait period is "forever"?

Right.


yrs,
rubato

[Econoline]

One disabled Vietnam veteran's opinion:

Take the Target Off Shinseki's Back
By MAX CLELAND | May 16, 2014

The toughest job in Washington is to prosecute war. The second toughest job is, as Abraham Lincoln once phrased it, “to care for him who has borne the battle.”

I tried to do that job once. I was the head of the Veterans Administration under President Jimmy Carter after the Vietnam War.

I found that many folks in the VA were committed to our mission of caring for those who had served our country in uniform. I found, however, that we couldn’t put the genie back in the bottle. We couldn’t heal all the wounds of war. I found that our job was to care, to fail and try to care again.

Now, the VA is caught up once again in dealing with the overwhelming number of claims for benefits and health care after the Iraq and Afghanistan wars. VA hospitals try to see veterans quickly.

However, allegations have surfaced that a cover-up of records has gone on in the VA, obscuring the fact that some veterans are not seen quickly for health care and others may have died because of it.

A man at the center of the controversy is the head of the VA, Eric Shinseki, himself a wounded veteran of the Vietnam War.

I’ve known Shinseki for over a decade. He is a truth teller to power.

How do I know that?

Because he testified, in his previous position as the Army chief of staff, before the U.S. Senate Armed Services Committee upon which I sat and said that if we went to war in Iraq it would take “hundreds of thousands” of troops, not the small investment Secretary of Defense Donald Rumsfeld was talking about. As a result, Rumsfeld announced Shinseki’s replacement a year earlier than normal.

The commander of the American Legion, an organization of which I am a member, has called for Shinseki’s resignation. This is ill-advised and misguided.

We veterans need facts, not a firing.

Before leaping to conclusions about Shinseki’s work as VA secretary over the past five years, some should take the time to consider these facts:

1. Veterans’ homelessness has been reduced by 24 percent.

2. The VA health-care system has enrolled 2 million additional veterans. These are veterans who choose to receive VA health care.

3. The latest American Customer Satisfaction Index (ACSI), an independent customer service survey, ranks the VA’s customer satisfaction among veteran patients to be the very best in the nation and equal or better then private-sector hospitals.

4. In many areas, the VA outperforms the private sector, especially in the management of hypertension, diabetes and other conditions.

5. The VA has decreased its disability claims backlog by nearly 50 percent.

6. The VA is now providing post 9-11 GI Bill educational benefits to more than 1 million students.

7. The VA handles approximately 236,000 health-care appointments each day, totaling 85 million appointments each year.

Even one appointment delay that harms a single veteran is one too many. No one would agree with that sentiment more then Shinseki.

But, in the name of common sense, no VA secretary should be asked to resign because a few staff members may have broken some VA rules by hiding the wait times for veterans’ appointments.

The mark of an effective leader is being able to first understand the nature of the problem and then bring together the right people to solve that very problem. That is exactly what Shinseki is doing. He has asked the VA inspector general to do a full review of all allegations regarding VA waiting lists. The IG’s report, which will be public when completed, is a critical step in allowing the secretary to accurately analyze the extent of the problems in Phoenix and to give him time to determine an effective solution. Meanwhile, to facilitate a complete and thorough review by the IG, Shinseki has ordered the director and associate director of the Phoenix VA to be put on administrative leave.

As a disabled veteran myself, there is no one I would rather have heading up the VA now, in this turbulent time, than Eric Shinseki. In my experience, he is the best there is. As the investigation unfolds and the truth comes out, our country and our veterans will come to realize that.

Max Cleland, a disabled Vietnam veteran, is a former U.S. senator and former administrator of the U.S. Department of Veterans Affairs.

http://www.politico.com/magazine/story/ ... z322rkANGt

(My emphasis.)



ETA: Jim, note his points #3 and #4.

[Lord Jim]

One disabled Vietnam veteran's opinion: One former Democratic Senator's opinion:

The mark of an effective leader is being able to first understand the nature of the problem and then bring together the right people to solve that very problem.

I would think the mark of an effective leader would be to be aware of the problem slightly before CNN is, (especially after five years on the job) but hey that's just me...

[Lord Jim]

One Congressional Medal Of Honor Recipient's Opinion:

Want to Fix VA Health Care? Get Rid of It

By Col. Jack Jacobs, U.S. Army (ret.)

On Thursday VA Secretary Eric Shinseki was grilled by members of Congress about significant and perhaps deadly delays in health care for America’s veterans. Some on Capitol Hill, and some leaders of veterans organizations, have demanded his resignation.

But the problem with the VA is not its boss. It doesn’t matter whether Eric Shinseki stays or goes, or whether he’s done a good job during his five-year tenure in trying to address the VA’s many long-term issues in delivering quality care. The problem is the VA. The medical component of the Department of Veterans Affairs needs to be abolished. We need to shut the doors of the thousands of medical facilities around the country that are failing to serve our veterans.

Eric Shinseki, whom I have known for many years, had an illustrious career as a soldier. A graduate of West Point, he was severely wounded in Vietnam. As Army Chief of Staff in 2003, he warned that the post-combat mission in Iraq would require several hundred thousand troops. He was vilified for his views by some in the Pentagon, and by U.S. officials who had no combat experience to inform their own opinions, but he was proven right.

As VA Secretary, he did not prepare his department for the enormous increase in caseload it has faced because of aging Baby Boom veterans and the influx of Iraq and Afghanistan veterans. He bravely – some say foolishly – decided that VA care would be available to all veterans with either post-traumatic stress or illnesses that result from exposure to Agent Orange. As a result, waiting times for evaluation and care stretched to as long as two years, earning him a fresh helping of abuse and probably convincing him that no good deed goes unpunished.

Since then, backlogs have been greatly reduced, and care at many VA hospitals is as good as that at other facilities. But no matter. Gen. Shinseki would be the first to remind his critics and supporters alike that he is responsible for everything that happens, or does not happen, in his department.

It’s a common response in a situation like this to ascribe the failure to leadership and replace the leader. We do this all the time in politics and business, and it’s a measure of our misunderstanding of the nature of bureaucracy that we are shocked when things don’t improve much.

Sometimes, we need to think more strategically about solving problems, and a place to start is by asking ourselves what we want and need from the Department of Veterans Affairs.

The relationship between the VA and the American public used to be a very close one. The VA was founded and then expanded to a huge size to serve the needs of veterans at a time when we had lots of them, when nearly every household included someone who wore, or once wore, a uniform.

That’s no longer the case. Most Americans no longer know anyone in uniform, and so for many, military service, and the obligation to take care of those who serve, has become an abstraction. We say we love our troops, but that’s because we don’t have to be the troops.

And now we have a huge bureaucracy that most citizens know little about, and our expectations have been mismanaged. We think this large government structure can take care of our veterans, but it can’t, no matter who is in charge, or how much money we throw at it. Bureaucracies are excellent at doing routine things in a routine way, but as any physician can attest, medicine is not routine.

We have created a large bureaucracy with thousands of hospitals, clinics, waiting rooms and employees to deliver medical care, and it needs to be abandoned. It makes no sense to have a parallel universe to take care of our veterans, separate doctors, separate facilities, equipment and even protocols. There is no reason that veterans who would otherwise wait for months to be seen at a VA health clinic can’t be seen by private doctors, the same doctors who treat everyone else. The procedure doesn’t need to be complicated: patient is seen by private doctor, private doctor treats patient, doctor sends bill to government, government pays doctor.

We already have Medicare and Medicaid, which could serve as templates for a veterans program without facilities or physicians. Maybe the Veterans Health Administration, the medical component of the VA, could be absorbed into those systems, with the proviso that veterans shouldn’t have to pay either a premium or a co-pay. Yes, it would still be bureaucracy, but at least it would be less redundant.

I understand that despite the current sound and fury in Washington, there is little long-term will to treat veterans properly or foot the bill for their medical needs. I also understand that the same politicians who usually give veterans’ needs short shrift would be loath to close down the VA facilities in their districts, no matter how dysfunctional. But if we want to deliver the best possible care to our veterans, if we really want to solve this problem, we should stop trying to repair a broken system and consider closing those doors for good.

http://www.nbcnews.com/storyline/va-hos ... it-n106601

[Econoline]

I fail to see how closing 153 hospitals and 773 outpatient centers would result in better care and shorter waits for anybody. 'Splain, Lucy.

[Sue U]

The procedure doesn’t need to be complicated: patient is seen by private doctor, private doctor treats patient, doctor sends bill to government, government pays doctor.

Commie!

[Econoline]

Yeah, I saw that too. I guess he's just saying that in the U.S., a Canadian-style single-payer system would probably work better than a British-style NHS-based system? (I actually agree with that, as far as it goes.) But I still can't get past the suggestion of "closing those doors for good" (like I said, that's a lot of doors: 153 hospitals and 773 outpatient centers) and how that could in any way have a positive rather than a negative impact on anyone's health care, and result in shorter waits rather than longer waits for anybody.

[Long Run]

Who says the hospitals have to be shut down? If there is a demand, the hospitals will just have new owners.

On the front lines, the doctors, nurses and other health care providers are dedicated to doing their best with what resources they have, but the VA system is no shining testament to a single payer argument.

[Econoline]

Well, it certainly sounded to me as if Col. Jacobs was saying that all VA medical facilities should be shut down. But you're right, just as there were oligarchs waiting in line to take over state-run enterprises when former Soviet states wanted to get rid of them after the collapse of the USSR, there is probably a much larger pool of oligarchs here in the USA who are ready to swoop in and make a killing handsome profit if any of our state-run enterprises come on the market.

As for "single payer": my point was that the VA hospitals and clinics are more like the British NHS than the Canadian single-payer system (that would be more akin to our Medicare system), and that it sounded like Col. Jacobs was advocating a true single-payer system to replace the current VA.

Oh, and AFAIK veterans are not required to use the VA facilities exclusively and they are not prohibited from using any other hospital or doctor they prefer.

[Scooter]

there is probably a much larger pool of oligarchs here in the USA who are ready to swoop in and make a killing handsome profit if any of our state-run enterprises come on the market.

Socialize the costs, privitize the profits. It's the conservative gospel.

[Scooter]

From here:

Who do you think receives higher-quality health care. Medicare patients who are free to pick their own doctors and specialists? Or aging veterans stuck in those presumably filthy VA hospitals with their antiquated equipment, uncaring administrators, and incompetent staff? An answer came in 2003, when the prestigious New England Journal of Medicine published a study that compared veterans health facilities on 11 measures of quality with fee-for-service Medicare. On all 11 measures, the quality of care in veterans facilities proved to be "significantly better."

The Annals of Internal Medicine recently published a study that compared veterans health facilities with commercial managed-care systems in their treatment of diabetes patients. In seven out of seven measures of quality, the VA provided better care.

Pushed by large employers who are eager to know what they are buying when they purchase health care for their employees, an outfit called the National Committee for Quality Assurance today ranks health-care plans on 17 different performance measures. These include how well the plans manage high blood pressure or how precisely they adhere to standard protocols of evidence-based medicine such as prescribing beta blockers for patients recovering from a heart attack. Winning NCQA's seal of approval is the gold standard in the health-care industry. And who do you suppose this year's winner is: Johns Hopkins? Mayo Clinic? Massachusetts General? Nope. In every single category, the VHA system outperforms the highest rated non-VHA hospitals.

In the latest independent survey, 81 percent of VHA hospital patients express satisfaction with the care they receive, compared to 77 percent of Medicare and Medicaid patients.

Outside experts agree that the VHA has become an industry leader in its safety and quality measures. Dr. Donald M. Berwick, president of the Institute for Health Care Improvement and one of the nation's top health-care quality experts, praises the VHA's information technology as "spectacular." The venerable Institute of Medicine notes that the VHA's "integrated health information system, including its framework for using performance measures to improve quality, is considered one of the best in the nation."

The story of how and why the VHA became the benchmark for quality medicine in the United States suggests that much of what we think we know about health care and medical economics is just wrong. It's natural to believe that more competition and consumer choice in health care would lead to greater quality and lower costs, because in almost every other realm, it does...

But when it comes to health care, it's a government bureaucracy that's setting the standard for maintaining best practices while reducing costs, and it's the private sector that's lagging in quality. That unexpected reality needs examining if we're to have any hope of understanding what's wrong with America's health-care system and how to fix it. It turns out that precisely because the VHA is a big, government-run system that has nearly a lifetime relationship with its patients, it has incentives for investing in quality and keeping its patients well—incentives that are lacking in for-profit medicine.

When perceptions are at odds with the facts, clearly it must be the facts that are wrong.

[Crackpot]

Happy now Jim?

[Lord Jim]

Happy now Jim?

CP, Shinseki is a decent fellow, but it was obvious that his temperament and management style were grossly unsuited to the monumental task involved in reforming the administration of the VA. (If it wasn't obvious before, it certainly was after his deer in the headlights performance since all these revelations started coming to light.)

This isn't a job for a mild mannered, gentlemanly Omar Bradley type...

The demands of this task require an ass-kicking, relentless, take-no-prisoners George Patton type...

That isn't General Shinseki...

Removing Shinseki certainly isn't going to solve the problems, but it became more and more apparent that so long as he remained in charge, there couldn't even be a meaningful start to solving the problems...He just wasn't the guy for the job...

My personal favorite to replace him would be ret. Gen. Russel L. Honoré, who was the one who finally got on top of the mess in New Orleans after Katrina:

On August 31, 2005, Honoré was designated commander of Joint Task Force Katrina responsible for coordinating military relief efforts for Hurricane Katrina-affected areas across the Gulf Coast. Honoré's arrival in New Orleans came after what was widely believed to be a poor performance by the state and local agencies and the Federal Emergency Management Agency (FEMA) and its director Michael D. Brown.

He gained media celebrity and accolades for his apparent turning around of the situation in the city as well as his gruff management style which contrasted with what many felt were the empty platitudes of civilian officials. In one widely played clip, Honore was seen on the streets of the city, barking orders to subordinates and, in one case, berating a soldier who displayed a weapon, telling him "We're on a rescue mission damn it!" New Orleans Mayor Ray Nagin was quoted on a radio interview September 1, 2005, saying: "Now, I will tell you this -- and I give the president some credit on this -- he sent one John Wayne dude down here that can get some stuff done, and his name is Gen. Honoré. And he came off the doggone chopper, and he started cussing and people started moving."

http://en.wikipedia.org/wiki/Russel_L._Honor%C3%A9

That looks like the right skill set for the job to me...

A hands-on, mission-driven guy who doesn't give a shit about being Mr. Popularity...

ETA:

Another advantage Honoré would have, is that his nomination wouldn't be subject to a lot of partisan bickering; it would sail through quickly.

Of course why he, (or any other quality person for that matter) would want to take on this Everglades-sized swamp draining job is another question...

[BoSoxGal]

Do you know what's disingenuous about that reply, LJ?

They never even gave him a chance to fix it. This kind of fraud isn't usually found by routine audits, thus it took the whistle-blowers to bring it to light.

General Shinseki didn't even get an opportunity to address this issue, he's run out of office within days of the revelations.

General Shinseki, by the way, did two tours as a forward artillery commander in Vietnam. I'm pretty sure he'd have been very well up to the task of reforming the VA following these revelations, if given half the chance.

[Lord Jim]

They never even gave him a chance to fix it.

BSG, the man has been Secretary of the VA for five years...

[Econoline]

They never even gave him a chance to fix it.

BSG, the man has been Secretary of the VA for five years...

...and the quality of care in VA hospitals has, in most respects, been steadily improving during that time, despite the fact that funding has not kept up with the dramatically increased patient loads. (Did you read the article that Scooter linked to above?)

As BSG pointed out, "This kind of fraud isn't usually found by routine audits, thus it took the whistle-blowers to bring it to light. " I fail to see how the departure of General Shinseki as soon as the revelations came to light will help matters at all, but I guess that's just me.

[Econoline]

Let's see, now...

You hire administrators as less than the going rate in private industry but promise them bonuses that will make up the difference if they meet certain performance benchmarks....

Then, you systematically withhold the additional resources that might allow them to meet those benchmarks...

Gee, what could go wrong?

What? Some of them try to cook the books so that they could get those bonuses anyway?


Your winnings, Jim...

[Econoline]

[Lord Jim]

That's me told twice...