A former New York lieutenant governor says many problems with the Department of Veterans Affairs health care is the fault of organized labor, and the Senate legislation intended to eliminate long patient wait times is a pro-union bill that will not help veterans.
Betsy McCaughey, now a patient advocate, said the bill passed on Wednesday "will not save the lives of vets stuck on the wait list.
"This bill as currently written is designed to protect union jobs, not ailing veterans. In fact, the VA is run largely by unions, for unions," McCaughey told the House Veterans Affairs Committee.
The Senate bill was sponsored by Sens. John McCain, R-Ariz., and Bernie Sanders, I-Vt., and included provisions drawn from bills previously introduced by other, mostly Republican lawmakers. The bill will now go to a conference committee of Senators and House members to work out final language before a final vote.
McCaughey and other witnesses also testified that the VA is locked into inefficient and outdated processes and regionalized health care delivery networks that are not standardized.
The other witnesses were Tim S. McClain, president of Humana Government Business, a Tricare managed care contractor for military facilities, and Dan Collard, a senior leader at Studer Group, a health care consulting firm.
Acting Under Secretary for Health Dr. Robert Jesse, the only government witness who testified on Thursday, acknowledged that the department failed veterans.
"We know that we have let veterans down but we are going to make it right," he said. Jesse was appointed to the job after his predecessor resigned last month.
The VA is reeling from revelations that many hospitals and clinics across the system manipulated patient appointment data in order to make it look like the facilities were hitting appointment goals. In many cases they hid the patient backlog by keeping a separate, hidden list of those seeking appointments, adding them to the legitimate list as space became available.
Manipulation of appointment schedules had been revealed in the past but came to a head in April after CNN reported that up to 40 veterans on a secret list with the VA medical Center in Phoenix, Arizona, died before seeing a doctor.
VA investigators have confirmed that 18 veterans on the secret Phoenix list died before getting an appointment, and the FBI has reportedly opened a criminal investigation into the data manipulation. VA IG inspectors also are passing along to the Justice Department information that could lead to criminal charges elsewhere.
The VA also found that more than 100,000 veterans seeking an appointment either did not get one or waited longer than 90 days for one.
All three of the witnesses on Thursday told lawmakers that the VA is locked into inefficient and outdated processes, including being heavily reliant on measuring performance by meeting certain metrics rather than outcomes – that is, patient health.
Additionally, the VA suffers because its 21 regional operations – called Veterans Integrated System Networks – do not always adhere to the same systems or uniformly follow directives.
"If you’ve seen one VISN, you’ve seen one VISN," Collard told the lawmakers, repeating a remark spoken Monday night by VA Acting Inspector General Richard Griffin. The point is that each operates somewhat differently than the other.
Collard said it is clear from his company’s work with more than 900 health care organizations that the VA would benefit from standardizing programs and processes across the entire department. Hospitals and clinics that implement standardized approaches to care produce the best outcomes, he said.
"These organizations build cultures of accountability, alignment, consistency and sustainability," he said.
McClain told the panel that Congress should work with VA health care to design a standardized "veteran-centric healthcare delivery system" based on integrated care delivery, care coordination and wellness.
In testimony Thursday, Jesse said the schedule manipulation reflected a "breach of trust [that] is irresponsible, indefensible and unacceptable to the department."
Jesse said the VA going forward would have "pro-active, personalized patient-driven care," and he agreed that the department needs to standardize programs and systems.
One of the issues raised is that a veteran enrolled in VA health care in one VISN has to re-enroll to get care in another if he moves.
"They’re not supposed to [do that]," he said of the VISNs. Once enrolled a veterans is supposed to be considered enrolled regardless of where he goes for VA care, he said.
The VA believes the organizational structure of the VISNs and local health care systems meets the department’s needs, he told the committee in a written statement.
"However, in light of recent events, we also intend to take a fresh look at our Central Office configuration and end strength, as well as VISN functions and staffing levels," he said.
The VA has already frozen new hires at the central headquarters and VISN offices while. Meanwhile, the VA is fast tracking the hiring of additional health care providers and patient support staff, he said.
Jesse did not address the claim put out by McCaughey that the McCain-Sanders bill is a union jobs-protection bill. But Marilyn Park, legislative representative for American Federation of Government Employees, the union representing VA workers, dismissed McCaughey’s testimony as misinformed.
"We are not part of the problem. We are a key part of the solution," she said.
Park noted that it was a union member with the VA Medical Center in Pittsburgh, who revealed in 2013 that hospital management knew early on about an outbreak of Legionnaire’s disease but did not inform employees or take other precautionary measures.
"It was our employee, Kathy Dahl, who blew the whistle and revealed problems at the Pittsburgh VA," Park said.
-- Bryant Jordan can be reached at firstname.lastname@example.org