EJF Newsletter — What does any nation owe to those who serve - Part III
Prologue
In the United States the standard for the care of veterans was set by President Abraham Lincoln after a disastrous civil war when he stated this nation is obligated:
To care for him who shall have borne the battle and for his widow and his orphan.
That set the stage for the formation of the present Department of Veterans Affairs, which is chartered to provide health care services, benefits programs, and access to national cemeteries to former military personnel and their dependents. The department carries out its duties through three main administrative divisions: Veterans Benefits Administration; Veterans Health Administration; and National Cemetery Administration.
To carry out these duties the department currently has a budget of ~$171 billion, of which apparently $57 billion goes to Veterans Health Administration.
For this extraordinary expense veterans should be entitled to reasonable health care while living. But the facts speak otherwise!
This series focuses on some of the many problems with the Veterans Health Administration. Hardly a day goes by that there is not a new scandal about VA healthcare and the facilities. But statistics and generalizations have lost their impact on our psyche simply through almost infinite repetition and we seldom hear a first-hand account of the impact on a veteran.
The series began with a statement of care, or rather the lack thereof, of MSgt, Mark Mosher, Force Recon, US Marine Corps, retired, who required minor surgery for a benign fatty tumor in his back at the U.S. Air Force Academy hospital in Colorado Springs, Colorado.
In Part II it was noted that further investigation by the local press revealed hundreds of patients at the USAFA hospital are at risk from the filthy conditions that put MSgt. Mosher's life in peril. An after action report by MSgt. Mosher is also included describing what must be considered the extreme indifference he has received seeking follow up treatment for his botched surgery.
When one begins to look further there are more problems with VA health care facilities than are publicly admitted to and in Part III a few, of the many more disasters that Veterans Health Administration has become, are reviewed.
Few things are more basic to life and to veterans than water. We hear a great deal about the water problems in Flint, Michigan. Not so much about what happened to Marines stationed on Camp Lejuene, North Carolina, between 1953 and 1987, problems the VA only now seems to be recognizing.
But the few examples presented in this series are only the tip of the iceberg!
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VA hospitals and administrators
Houston, Texas, has always had water problems and when electricity is lost, as it was during Hurricane Alicia in August 1983, the city also loses water pressure as the pumps shut down. Adding to the problems in 1983 were a swarm of tornadoes that swept through the city in May. Cleanup from tho tornadoes was still underway when the hurricane hit. Without pressure in the water pipes polluted ground water backwashed into them from various cracks and bad seals. As one result the Corry family all contracted giardia from drinking the tap water after power was restored.
Houston VA Hospital water supply
Even with pressure in the pipes some backwash and contamination from ground water and other sources is almost inevitable. A formerly-employed boiler technician describes the problems he saw at the Michael E. DeBakey Hospital Center.
The hospital uses industrial boilers to make steam for hospital operations — including cleaning water, sterilizing bedding, and other miscellaneous items. Frequently, the plumbing delivering water to operate the boilers lacked the necessary pressure to function properly, and malfunctions resulted.
Water problems were not limited to just the boilers. Nurse stations frequently submitted repair/maintenance work orders because they had no water to care for patients or for medical staff to conduct their work.
When the plumbing malfunctioned it compromised the safety, sanitation, and operation of the entire hospital because it prevented the bathrooms, fountains, utility sinks, washing machines, ice machines, etc. from working properly and hygienically. Many hospital toilets required repeated unstopping due to mud and debris that traveled through the pipes and obstructed water flow in the plumbing.
The water pressure problems resulted from the chronic problem of undertreated or untreated water from Houston's water authority. The water was full of mud that clogged valves that separated the Veterans' Administration water line from the city's water line.
Our source says he tried to find the origin of the problem, and asked power control technicians about mechanical bay 8 in the hospital where power, water and steam intersect. He also inquired whether bay 8 had a main filter, and was informed that there was no filtration system for the bay in question. Ironically, he knew that there was none but wanted someone with expertise to confirm what he already knew.
Dentistry had one filter in their water line, and some ice machines as well. Ice machines that did have filters required frequent changing because they filled up with dirt and sediment rapidly.
The Michael E. DeBakey Hospital Center operating rooms on the fifth floor had their own ice machines but these machines had no filters. Medical staff used ice made from the unfiltered city water to pack human organs.
Imagine how many people have likely been harmed by being exposed to unclean water. Veterans and the public should know this because people could become ill or die. Please look into this matter and help these veterans.
Stories like the above suggest the rumor that the VA plans on shutting down 1,100 facilities might be a good idea. While it is unquestioned that the Veterans Administration does a lot of good, it is also true it has some rotten branches that need to be pruned. For example:
Director of VA Hospital Removed for Misconduct After Thirty-Seven Veterans Die Awaiting Care
Reproduced under the Fair Use exception of 17 USC § 107 for noncommercial, nonprofit, and educational use.
The director of a Veterans Affairs hospital in Shreveport, Louisiana has been abruptly removed for misconduct and failure to follow policy after serving a scandal-ridden three years in his position. But rather than being put on leave pending further investigation, USA Today reports Toby Mathew was transferred to another VA job in Mississippi, a post at a regional VA office that oversees medical centers in four states, including Louisiana, where he will work on special projects.
Toby Mathew was hired as director of the Overton Brooks VA Medical Center in Shreveport, Louisiana in June 2014. [EJF comment: The question remaining is how did this incompetent individual ever reach a director position in the VA? How many more like him are there? And what will it take to get him fired?]
Four months later, in October 2014, reports surfaced that patients would routinely go days without sheets, pajamas, or proper toiletries “while the hospital spent millions on new furniture, TVs, and solar panels, ” Fox News reported Tuesday.
The VA hospital was then investigated after social worker Shea Wilkes discovered a secret wait-list of 2,700 names in 2013. Included on the list were 37 veterans who had died awaiting care.
Mathew was fired this year on April 13, 2017, for “ charges related to general misconduct, and failure to follow policy and provide effective oversight of the center's credentialing and privileging program,” according to an internal VA memo obtained by Fox News.
Lawmakers learned of the hospital's issues under Mathew last year. A high-ranking doctor followed the example of Wilkes, who became a high-profile advocate for whistle blowers, and wrote a 16-page report dated September 2, 2016, sending it to then-Veterans Affairs Secretary Bob McDonald and two members of Congress.
The report, reviewed by Fox News, alleged that Mathew had “ a constant pattern of bullying, intimidation, discrimination, harassment, and retaliation” against staff and negatively affected the careers of 55 employees.
“Nursing service has had critical positions vacant during the two-year tenure of Toby Mathew, with vacancy rates as high as 50 percent for nurse assistants and constant 30 percent for registered nurses,” the report stated, noting that Mathew refused to fill the positions.
Mathew also hired consultants during his tenure, sometimes paying $10,500 a month, more than the yearly salary of most VA physicians, according to the report.
Mathew is the highest-profile employee fired from the VA since Eric Shinseki, the seventh department secretary, left office in May 2014.
VA doctor who reported problems retaliated against
Abstracted from article by Malia Zimmerman, Will Carr
A highly rated pain management specialist at the Southeast Missouri John J. Pershing V.A. Medical Center in Poplar Bluff, Missouri, Dr. Dale Klein is paid $250,000 a year to work with veterans, but instead of helping those who served their country, he sits in a small office and does nothing.
All day! Every day!
A double board certified physician and Yale University Fellow, Dr. Klein said the Department of Veterans Affairs (V.A.) took away his patients and privileges almost a year ago after he blew the whistle on secret wait-lists and wait-time manipulation at the V.A. Medical Center in Poplar Bluff, as well as his suspicion that some veterans were reselling their prescriptions on the black market.
When his superiors did nothing, Dr. Klein went to the inspector general.
Dr. Klein was initially placed on administrative leave. The Missouri-V.A. closed his pain management clinic and tried to terminate him. According to court documents, the V.A. tried to fire Dr. Klein “not based on substandard care or lack of clinical competence” but instead for “consistent acceleration of trivial matters through his chain of command,” in other words he reported known problems to his superiors.
The Office of Special Counsel, an independent federal investigative agency in Washington, D.C., made it clear that since the doctor was a whistle blower, he could not be fired. But Dr. Klein said the retaliation continues and believes his superiors stripped him of his duties to silence him.
The situation grew so dire that Senate Homeland Security and Government Affairs Committee Chair Ron Johnson, R-Wisconsin, chose to step in, writing a letter in January to the acting V.A. Secretary requesting the V.A. “cease all retaliatory actions” against Dr. Klein.
Dr. Klein not the only victim of retaliation by VA
Continuing, Malia Zimmerman and Will Carr point out that Dr. Klein isn't the only V.A. employee who allegedly has been retaliated against. In fact, his story sounds eerily similar to that of Brian Smothers, who worked at the Denver V.A. from 2015 until November 2016 when he says conditions grew so hostile he quit.
Smothers was working as a peer support specialist when he found more than 3,500 veterans on what he believes were “secret” wait-lists at V.A. facilities in Denver, Golden and Colorado Springs.
“It looked like some kind of game they were playing with veteran's mental healthcare, and I was very upset,” Smothers said. “It became clear to me very quickly that many of the veterans that were on the PTSD clinical team's wait-list had been waiting for care for three, four, five, six months.”
The reason is profit Smothers claims: “People who run the V.A. and the mental health division hid these wait-lists so they could meet performance goals, and as a consequence of meeting these goals, got bonuses. They defrauded the federal government because it benefited them.”
Smothers is haunted by one veteran's death in particular, an Army Ranger in Colorado Springs who told the V.A. that he had been waiting for care and was suicidal. Instead of helping him, the V.A. allegedly placed that veteran on a wait list and he committed suicide a short time later.
After Smothers reported the allegations to the inspector general his superiors retaliated by forcing him to sit in his office, without any work assignments or authority to see patients. Human Resources also tried to get him to destroy the wait lists and sign an admission that he had “compromised the integrity of the healthcare system.”
The V.A. declined to address the allegations on camera and instead referred Fox News to the inspector general, who confirmed it had “ identified wait-time and other issues in recent published reports and testimony before Congress regarding Colorado V.A. facilities.”
Senator Johnson also intervened on Smothers' behalf and got the inspector general to launch an investigation. [EJF comment: The Veterans Administration in Colorado is also under other investigations for massive cost overruns on the yet to be completed Denver VA hospital.]
Additional comments on VA in Colorado and other states
Colorado Springs VA disgraces
Investigations of VA facilities in Colorado have continued, notably in Colorado Springs with its large concentration of military bases and veterans.
On May 23, 2016, the Colorado Springs Gazette published a broadside editorial denouncing the incompetence of the Veterans Administration, portions of which are quoted below:
“News flash: The Department of Veterans Affairs cannot get its act together.
During a congressional committee hearing this week, VA officials conceded they built the brand-new Floyd K. Lindstrom Clinic too small for demand. The 76,000-square-foot facility opened in Colorado Springs in 2014 and was apparently inadequate for demand from day one. The seemingly endless episodes of buffoonery would be comical if not so tragic. The issue of the clinic's size was given to explain why 25 percent of the facility's patients wait more than a month for care. VA officials said the demand was “ unexpected ” when they planned the facility.
The VA's notorious delays in service, and the agency's proven efforts to cover them up, are more than just an inconvenience. The lack of regard for customer service has killed people who devoted their lives to defending this country...
The VA is broken. It has not worked well for generations. To suggest otherwise is to accept that people who serve our country deserve long waits, poor customer service and a regimented health care system that excludes them from the health care choices available to Americans with conventional health insurance plans.
We are wasting time trying to fix the VA. It is time to consider vouchers, privatization or parceling out the agency's responsibilities to more functional elements of government. Our veterans deserve much better.”
And as this review was being written the Gazette also published an extensive review of the needless death of Marine Noah Harter in May 2015. An investigation found Harter's death was, in large measure, a result of no care by the VA clinic in Colorado Springs, a problem with which we began this series. But despite efforts to help suicidal veterans after more than a year the VA's suicide prevention hotline is still dysfunctional.
Denver VA disaster
Then there is the disaster of the new Denver VA hospital. Originally that could have been done as a quick and cheap renovation of an existing Army hospital for $30 million in 1995 but ballooned into $1.73 billion in 2015 due to VA incompetence and mismanagement.
Originally scheduled to open in 2014, the facility may partially open in 2018 by postponing completion of some units. Congress, naturally and as usual belatedly, was “horrified” (insofar as it garnered them headlines) by the massive cost overrun was looking for some “savings.” With typical cluelessness of all involved apparently the PTSD treatment and nursing home unit were dropped to claim savings of about $0.1 billion ($100 million). Obviously after 16+ years of endless wars treatment of PTSD would seem to be a major priority for the VA? Clearly it isn't!
The outrageous cost of $1.73, or $1.675 billion, or whatever imaginary number one might want to pick, ignores an estimated $350 million to equip the hospital, should the structure ever be finished.
Then will come the problem of finding enough competent staff to man and maintain this immense structure. Competence has not been a VA strong point and the good ones seem to leave fairly quickly. The University of Colorado offered in 1999 to build a shared hospital with the VA at the Aurora campus of their teaching and research hospital. The VA declined the offer. In retrospect, and into the future that was not a smart move for staffing and research.
Puerto Rico and other VA cesspools
January 20, 2017 — DeWayne Hamlin, the director of the notoriously corrupt VA Caribbean Healthcare System, was removed from the federal civil service. Mr. Hamlin subsequently appealed his removal to the Merit Systems Protection Board (MSPB). Because of particulars in his case that remains under active litigation, he was brought back to work at VA.
Hamlin was returned to work at the VA despite his attempt to fire whistle blower Joseph Colon, who alerted officials that Hamlin was arrested for intoxicated driving and found with painkiller pills for which he didn't have a prescription. Diversion of opiates from the VA system for recreational purposes is a major problem at the VA.
Worse, when a subordinate enraged Hamlin by refusing to carry out the wrongful firing, that subordinate, Rosayma Lopez, was offered $300,000 in taxpayer money to quit. Ms. Lopez refused to take the cash. These incidents were just some of many serious problems at the Puerto Rico veterans hospital Hamlin directed. But even after all of those incidents, former VA Secretary Bob McDonald flew Hamlin to Washington to shape other managers in his image at a “ Leaders Developing Leaders” seminar.
So even firing the most corrupt and incompetent VA directors and employees of the VA is next to impossible. Even in Phoenix, Arizona, where the Director is a convicted felon after admitting his criminal actions vis a vis the VA hospital he heads, it has not proven possible to remove him despite the fact that over 40 veterans died awaiting care.
Problems with falsifying appointment wait times have also been reported at the Austin, Texas, VA clinic.
The Cheyenne, Wyoming, hospital and its subordinate clinic in Fort Collins, Colorado, have also been investigated for falsifying records and disciplining employees who refused to cooperate.
At the Columbia, South Carolina VA Medical Center an inspector's September 2013 report noted that due to mismanagement thousands of veterans had their appointments for colon cancer screenings delayed. This resulted in over 50 patients having a delayed diagnosis for colon cancer and some later died from the disease. Additionally, a 2008 report found that critical documents for processing of veterans' disability claims had been shredded. Although this had occurred at least 40 locations nationwide, the Columbia location had the most cases.(1/5 of the overall cases) Also, between 2009 and 2013, the backlog of disability claims in Columbia more than doubled from 33% to 71%.
This list could go on indefinitely but would add little to the obvious conclusion that Veteran Administration health care is corrupt and incompetent on a national scale, with little to no hope of repair.
Firsthand experience with VA by veterans
So how are veterans being treated when the VA Hospital isn't doing its best to kill them? Anecdotes from individual veterans speak of the frustration some feel. Other veterans seem to live charmed lives and cakewalk through the VA maze. And no one, inside or outside the government, seem able to decipher their byzantine bureaucracy and its actions.
Pagosa Springs, Colorado, Vietnam veteran speaks out
In response to the report by MSgt. Mosher about the problems at the Air Force Academy hospital, our correspondent is a Vietnam vet and has been in the VA health care system for many years, mostly in Denver, Colorado, and Cheyenne, Wyoming. Overall he has experienced good care for a variety of conditions. However, there was an incident in Cheyenne where his primary doctor was less than concerned with his care and he had to go to chief of staff for resolution and change of primary doctors, Fortunately, that happened almost immediately.
When I moved to the Denver system, I found the healthcare to be excellent, but the bureaucracy was an impediment that I had to learn to work around. I pretty much managed my own care by working with the system. But while I had a primary doctor, getting an appointment was a problem, the clinic was a long way from my home, and changing to a different one was difficult. As a workaround I used the urgent care facility at the hospital for 2 years before I was able to get the primary changed to a closer clinic.
While the nurses and technicians at the Denver clinic were good, the doctor was less concerned with my health than he was about advancing in the system. In my last appointment there my health concerns were brushed off without even an examination.
I have since moved to Pagosa Springs, Colorado, and am now under the VA Choice program and fall under the Albuquerque VA system. Now I can see any private doctor I want because the nearest VA is more than 40 miles away. Under the VA Choice program I have had two major surgeries, disc fusion in my neck and knee replacement done in local facilities and approved through the VA Choice Care program. I could not be happier with the care I have received outside the VA.
There has been some interaction with VA Choice Care and the doctors that I had to manage to ensure the outcomes were what I wanted. But for the last 15-20 years, it was pretty much my responsibility to manage my care and I worked the VA system to my advantage. However, I found that if I waited for the VA bureaucracy to move at its own pace I would not get my problems taken care of when needed.
I was never one to “ follow orders ” blindly when they did not make sense. So when my health was at stake, I took what ever steps I needed to get the care needed.
When I hear stories like these, I cannot help but feel that these veterans are “ good soldiers, ” doing what they are told, and waiting their turn. The VA bureaucracy does not always work that way. When the issues are serious it is up to the veteran to work around the system. The nurses and technicians in the VA are usually very good and truly care, but getting around a bloated and inefficient bureaucracy to get the help you need is the trick to getting good care. Once the vet learns to work the system to their advantage, they can get what they need when they need it. [ EJF comment: This approach works for those who are able but many veterans are not able because of their disabilities and that is why VA healthcare is desperately needed for them.]
Broken service periods result in denial of benefits
As a service-connected disabled military retiree (Navy, with 21 years of active duty under my belt) I have struggled with the VA for over twenty years, with various issues that seem ludicrous. My congressman's veterans' representative was dumbstruck when he read my documentation about these issues. Even my mental health professional, whom I speak with once a month at the Golden VA Clinic in Golden, Colorado, is flabbergasted that I have had to tolerate the things I have experienced at the hands of the VA.
For example, these issues include telling me that in spite of their finding that I have a “degenerative disc disorder” my severe chronic back pain is “non-skeletal.”
I have found that various departments within the VA don't communicate with each other, nor do they apparently share documentation. I've discovered that one department has one of my four DD-214's, while another has two of them. Many of their decisions are then based on incomplete data.
I had my Montgomery GI Bill stolen from me by the VA in 1997, with several different reasons why, all of which are lies and as far from the real truth as you can get. I have also requested compensation for a completely unnecessary surgery that was performed on me while I was on active duty that the VA has completely ignored, and hasn't even been mentioned as denied in any of their documentation.
I need resolution to these issues with the VA, but going to the DAV, the VFW, my congressman's office, or anyone else, for that matter, has been fruitless. Thus far. I am still awaiting an answer to an appeal to a reply I received, after requesting a congressional inquiry one-and-a-half months ago. I have even written President Trump, but I haven't received any reply from the White House, either.
Conclusions
When tabulating problems with a massive and incompetent bureaucracy like the U.S. Veteran Administration it is a question of where to stop? Clearly there are many more stories documenting gross incompetence, theft, medical disasters, etc. than have been presented in the three parts of this newsletter.
Firsthand personal stories from veterans like the examples presented here are preferred. But while veterans are good at bitching many are suffering from PTSD and TBI. As a result they rarely write coherently about the damage the VA has done to them or their often futile attempts to find help. I hope the stories included here amount to something more than just a bitch session because it is obvious veterans are not getting the care and benefits American taxpayers are paying for.
Of the existing VA health programs the VA Veterans Choice program, as noted by veteran Gary above, is the most popular and successful for those who have been able to sign up for and use it to obtain medical care from other private and public providers. But, as noted in this review, even that program has lumps.
Media stories are valuable but tend to be little more than politically-correct government press releases that attempt to whitewash problems at a single VA facility. Some excerpts from such stories are included and sometimes the press does a great job of digging out and documenting the corruption, incompetent management, and mind-boggling cost overruns. For an example see the Denver Post documentary on the Aurora VA Hospital (well maybe someday it will be a hospital).
However, it is disgusting to read of VA hospital directors found to be so grossly and dangerously incompetent that veterans are dying for lack of care. Yet when they are terminated it often turns out that they are still on the payroll just sitting at a different desk. And numerous stories along these lines can be found with any search engine.
Nothing has been said yet about the failure of the VA's veteran suicide hotline where, if the suicidal veteran doesn't get a busy signal, they are often placed on hold for 30 minutes or so. Assuming, of course, that the veteran will, or can wait than long to talk to someone. How many veterans simply hang up and kill themselves?
As a Colorado Springs Gazette editorial noted:
“The VA is broken. It has not worked well for generations. To suggest otherwise is to accept that people who serve our country deserve long waits, poor customer service and a regimented health care system that excludes them from the health care choices available to Americans with conventional health insurance plans.
We are wasting time trying to fix the VA. It is time to consider vouchers, privatization or parceling out the agency's responsibilities to more functional elements of government. Our veterans deserve much better.”
Hopefully, our tabulation and documentation of problems with VA facilities all across the country will help put the magnitude and pervasiveness of the mismanagement and incompetence in perspective and help promote reform and restructuring for the sake of our veterans futures. But history makes it clear that the usual Congressional fix of throwing more money at the VA will not solve the problems and will likely make them worse. It appears the Veteran Administration is already too large and too scattered to be effectively managed by a government bureaucrat.
One suggestion for the future of the VA health division would be to greatly expand the VA Veteran Choice program so that for most medical procedures veterans would go to community doctors and hospitals and eliminate all local VA clinics. There would remain a need for a limited number of research and specialty hospitals within the VA conjoined with teaching and research hospitals in the private and public sector.
Whatever is done the solutions won't be easy or painless and the odds for failure are high.
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Issues The Equal Justice Foundation Deals With
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