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Veterans Affairs Dept. reformers find the fix is not in

Two years ago, the Department of Veterans Affairs was rocked by scandal — reports of poor care and months-long wait periods in VA hospital that lled to the resignation of VA Secretary Eric Shinseki’s resignation and sweeping reforms. But recent reports indicate that the same problems are emerging once more. Hari Sreenivasan talks to Quil Lawrence of NPR about why the new system is plagued by old issues.

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    But, first: medical care for U.S. military veterans, who two years — we remember, two years ago, the Department of Veteran Affairs was overtaken by news reports of poor care for the people it's supposed to serve.

    Wait times to see doctors in some places stretched for months, and some VA staff covered it up. A number of reforms followed, but now those very reforms are in the spotlight.

    Hari Sreenivasan has the story.


    A few minutes ago, Secretary Shinseki offered me his own resignation. With considerable regret, I accepted.


    The resignation of VA secretary Eric Shinseki, secretary of veterans affairs and a decorated former chief of staff, was one of the most visible signs of a crisis that gripped the VA in 2014.

    It started when Dr. Sam Foote at the Phoenix branch of the VA blew the whistle on the incredibly long waiting times for veterans to see doctors at his facility. Dr. Foote told reporters, including Gwen Ifill, that the hospital's director manipulated the data to make the waits seem much shorter.

  • DR. SAM FOOTE, Former Director, Phoenix VA Health Care System:

    We were doing pretty well until about 2010, and then the demand just ramped up. And rather than own up to the problem, the VA decided to cover it up, because there's no incentive for Washington to get good numbers.


    The VA inspector general found that Phoenix-area veterans seeking care had to wait an average of 115 days, almost four months, for a first appointment. And 1,700 veterans were kept off any official waiting list, and were at risk of being lost or forgotten.

    Other investigations found this type of problem existed at many VA hospitals throughout the United States. The president and Congress vowed to fix the problem. One of the reforms authorized veterans to go to doctors in private practice if they couldn't get timely appointments at the VA.

    But, according to recent reports, the wait times with the new system are just as long as they were before the reforms were implemented.

    And with me now to tell us about this new system, but plagued by old problems, is Quil Lawrence. He covers veteran issues at NPR.

    So, Quil, this was supposed to be the fix. Why is the fix broken?


    Well, it goes back to that moment of scandal. There was a sense of urgency in Congress. And some political rivals, Jeff Miller, Republican of Florida, and Bernie Sanders of Vermont, who is now much better known, from opposite ends of the spectrum came together with this plan to get all of these veterans, this backlog who were waiting for care, to see private doctors.

    It was supposed to be a simple plan. With a card, they could go and use — it seemed at first that they would just be able to go into a private clinic and present this card and get care.

    But what was given to the VA was a law to set up a whole new network to get care for anyone who had been waiting 30 days or was 40 miles away from a VA clinic. And Congress gave the VA just 90 days to set this up. They tried to — they first thought they might be able to do it themselves, decided they needed to go outside to get some private contractors to set up the system more quickly.

    And only two of the 57 companies they approached to try and do this were willing to give it a shot. The result has been really just an extra layer of bureaucracy that a lot of veterans tell me makes them wait even more than they were waiting before or just as much. Wait times haven't gone down.


    So, give me some examples.

    You and other public media reporters around the country have been talking to some of these people impacted by this. What happens to them and what is their process like?



    Yes, NPR is cooperating with member stations around the country. We have been looking into this for several months. I went down to Pennsylvania and talked to Bishop Small. He's a Navy veteran who has some terrible chronic pain issues in his legs.

    He had been trying to get physical therapy for awhile. When are you in this much pain, it can sometimes cause depression. He hasn't been able to find work. And he thought the Choice Program would be perfect for him. He had been told that it was going to take him more than 30 days to get an appointment at his local VA.

    And after calling the third-party companies, calling and calling and calling, the first place they sent him to informed him they were no longer participating in the Choice Program. This is one of the problems they have had. They can't seem to set up a network. And the network participants are getting paid so slowly that some of them drop out. They just don't want to participate in the Vets Choice Program anymore.


    So, the doctors aren't getting paid, and perhaps that is a reflection on how quickly they are calling these folks back.



    Yes, we spoke to another veteran in Montana, Tony Lapinski. He's an Air Force veteran. And he was also just waiting around. He had a growth in his spine. He didn't know what it was. He thought it might be nothing, thought it could be the sort of thing a doctor would tell him later, well, this is cancer. If you had come to us sooner, we could have done something.

    When he finally was able to see a specialist, he found out that the VA wasn't paying these people on time. And this has caused another knock-on problem with this program, is that some veterans, when their providers don't get paid by the VA, these providers try and bill the veterans.

    And hundreds of vets have had their credit ratings slashed because the VA isn't paying the doctors who gave them care.


    All right, so what happens now? Clearly, trying to set up an entire health care network in 90 days, we should maybe learn from that. But what are members of Congress trying to do? Are there any new reform efforts to try to fix the fix?


    Yes, there are efforts under way to consolidate all the VA's many programs for care outside the VA system.

    Those are happening now. There had been a goal to get them done by Memorial Day. I'm now hearing that is unlikely. But there is also a lot of resentment in Congress among people who drafted this that the VA hasn't moved quickly enough on it, that it's now a year-and-a-half in, and it is still not really delivering on what it promised to be.


    What about the veterans themselves? It seems that getting care, after what they have been through, and the delay after delay after delay, maybe contributes to even more problems of depression or perhaps worse health care outcomes because they couldn't see someone soon enough.



    And I should say I have spoken to some vets who use this program and had no problem with it. But we have also just heard loads of complications. We talked to a veteran in San Diego, a Navy veteran named Amanda Wirtz. And she said she was in so much pain from complications related to a tumor this January, that she was near suicidal.

    She tried to get an appointment through Veterans Choice, and the best they could do was give her an appointment two months out. We found that some veterans are actually trying the Choice Program, and then it takes so long that thousands and thousands of them are returning to the VA and just saying, well, the appointment I would get here would be faster.

    Overall, wait times at the VA are worse than they were when this program started. They say that's because of a huge influx of demand. But the assessments, outside assessments of this program are that it just hasn't moved the needle.


    All right, Quil Lawrence of NPR, thanks so much.


    Thank you.

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