WASHINGTON -- In a scathing appraisal, a review ordered by President Barack Obama of the troubled Veterans Affairs health care system concludes that medical care for veterans is beset by "significant and chronic system failures," substantially verifying problems raised by whistleblowers and internal and congressional investigators.
A summary of the review by deputy White House chief of staff Rob Nabors says the Veterans Health Administration must be restructured and that a "corrosive culture" has hurt morale and affected the timeliness of health care. The review also found that a 14-day standard for scheduling veterans' medical appointments is unrealistic and that some employees manipulated the wait times so they would appear to be shorter.
The review is the latest blistering assessment of the VA in the wake of reports of patients dying while waiting for appointments and of treatment delays in VA facilities nationwide. The White House released a summary of the review following President Barack Obama's meeting Friday with Nabors and Acting VA Secretary Sloan Gibson.
The review offers a series of recommendations, including a need for more doctors, nurses and trained administrative staff. Those recommendations are likely to face skepticism among some congressional Republicans who have blamed the VA's problems on mismanagement, not lack of resources.
The White House released the summary after Obama returned from a two-day trip to Minneapolis and promptly ducked into an Oval Office to get an update on the administration's response to the VA troubles from Gibson and Nabors.
"We know that unacceptable, systemic problems and cultural issues within our health system prevent veterans from receiving timely care," Gibson said in a statement following the meeting. "We can and must solve these problems as we work to earn back the trust of veterans."
Rep. Jeff Miller, the Republican chairman of the House Veterans' Affairs Committee, said the report was a late but welcome response from the White House and vowed to work with the administration to fix the system.
"It appears the White House has finally come to terms with the serious and systemic VA health care problems we've been investigating and documenting for years," he said in a statement.
The review contains a searing critique of the Veterans Health Administration, the VA sub-agency responsible for medical care. Earlier this week the VA announced that Dr. Robert L. Jesse, who has been acting undersecretary for health and head of the VHA, was resigning. Jesse has been acting undersecretary for health since May 16, when Robert Petzel resigned under pressure months before he was set to retire.
Nabors' report found that the VHA, the country's biggest health care system, acts with little transparency or accountability and many recommendations to improve care are slowly implemented or ignored. The VHA serves nearly 8.8 million veterans a year in more than 1,700 health care sites. But the report says concerns raised by the public, monitors or even VA leadership, the report said, have been dismissed at the VHA as "exaggerated, unimportant, or 'will pass.'"
Among Nabors' other findings:
- As of June 23, the independent Office of Special Counsel, a government investigative arm, had more than 50 pending cases that allege threats to patient health or safety.
- One-fourth of all the whistleblower cases under review across the federal government come from the VA. The department "encourages discontent and backlash against employees."
- The VA's lack of resources reflects troubles in the health care field as a whole and in the federal government. But the VA has been unable to connect its budget needs to specific outcomes.
- The VA needs to better prepare for changes in the demographic profile of veterans, including more female veterans, a surge in mental health needs and a growing number of older veterans.
Obama asked Nabors to stay at the VA temporarily to continue to provide assistance.
The White House said that over the past month, the VA has contacted 135,000 veterans and scheduled about 182,000 additional appointments. It has also used more mobile medical units to attend to veterans awaiting care.
Sen. Bernie Sanders, the Vermont independent who heads the Senate's Veterans' Affairs Committee, said the VA must restructure decision-making between its headquarters and its regional officials and that regional and local offices can no longer hide problems when they surface.
"No organization the size of VA can operate effectively without a high level of transparency and accountability," he said. "Clearly that is not the case now at the VA. "
Since reports surfaced of treatment delays and of patients dying while on waiting lists, the VA has been the subject of internal, independent and congressional investigations. The VA has confirmed that dozens of veterans died while awaiting appointments at VA facilities in the Phoenix area, although officials say it's unclear whether the delays were the cause of the deaths.
One VA audit found that 10 percent of veterans seeking medical care at VA hospitals and clinics have to wait at least 30 days for an appointment. More than 56,000 veterans have had to wait at least three months for initial appointments, the report said, and an additional 46,000 veterans who asked for appointments over the past decade never got them.
This week, the independent Office of Special Counsel concluded there was "a troubling pattern of deficient patient care" at the Veterans Affairs that VA officials downplayed. Among the findings were canceled appointments with no follow up, contaminated drinking water and improper handling of surgical equipment.
Associated Press writer Kevin Freking contributed to this report.