VA Secretary Dr. David Shulkin and Inspector General Michael Missal were at odds again Wednesday -- this time over conditions and management at the Washington, D.C., VA Medical Center, a flagship institution in the VA's vast health care system.
In a 150-page follow-up to an interim report issued last April, Missal's office added more detail on a range of problems at the hospital that "put patients at risk" and pointed to "failed leadership at multiple levels" dating back to when Shulkin was the VA's undersecretary for health in 2015 and 2016.
In response, Shulkin, who claims political appointees are trying to oust him, issued his own release citing "a series of major improvements" that began immediately after the issuance of the interim report last April.
First among them was the firing of Hospital Director Brian Adkins and the naming of Lawrence Connell, a retired Army colonel, as his successor.
Shulkin, the only holdover from the Obama administration in President Donald Trump's cabinet, said Missal's recommendations were a "critical step in improving the overall performance of this facility."
He also listed improvements that had already taken place in what appeared to be an effort to take the sting out of the latest IG report.
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Shulkin's list said wait times for consultations on prosthetics had been reduced to zero. In addition, a command center was set up "that identified and promptly addressed new supply or equipment shortages," along with a 24-hour hotline for ordering urgent and emergent medical supplies.
In April, Missal, acting on a whistleblower's complaint, took the unusual step of issuing an interim report on problems at the D.C. Medical Center that he said endangered patients and needed urgent attention.
The interim report said storage areas for medical supplies at the facility, which serves 98,000 area veterans, were filthy, management was clueless on what was in the storage areas, medical supply rejects may have been used on patients, and more than $150 million in supplies and equipment had never been inventoried.
"Although our work is continuing, we believed it appropriate to publish this Interim Summary Report given the exigent nature of the issues we have preliminarily identified and the lack of confidence in VHA [Veterans Health Administration] adequately and timely fixing the root causes of these issues," Missal said in the interim report.
The charges were repeated with more detail in the latest IG report, which also cited leadership failures but did not directly blame Shulkin.
"Failed leadership at multiple levels within VA put patients and assets at the D.C. VA Medical Center at unnecessary risk and resulted in a breakdown of core services," Missal said. "It created a climate of complacency."
Both the interim IG report and the latest report clearly stated that no patients died or were harmed by the deficiencies at the D.C. Medical Center.
However, the latest reported added: "that there was no finding of patient harm was largely due to the efforts of many dedicated health care providers that overcame service deficiencies to ensure patients received needed care."
Rep. Tim Walz, D-Minnesota, the ranking member on the House Veterans Affairs Committee, reached a similar conclusion in his response to the latest IG report, in which he praised hospital staff for overcoming the leadership failures.
Walz, who has supported retaining Shulkin at the VA, said, "The findings detailed in OIG's report are indicative of a complete and total failure on the part of D.C. VA's leadership that led to a culture of complacency that put veterans at risk.
"It is on Secretary Shulkin and Lawrence Connell, D.C. VA's new director, to make things right by following IG's recommendations to the letter," Walz said in a statement.
The latest back-and-forth between Shulkin and the Inspector General's office followed the scathing report from the IG last month on Shulkin's travel expenses for a trip last July to Denmark and London. The IG's office charged that Shulkin improperly billed the Treasury for his wife's $4,132 airfare and was wrong to accept free tickets to the Wimbledon tennis tournament.
In addition, the IG's office charged that Shulkin used an aide as his "personal concierge" during the 11-day trip.
Shulkin initially posted a furious denial of the charges and accused Missal of pursuing "your agenda" to get him fired. The post was quickly taken down, and Shulkin later accepted responsibility, saying he had written a check to reimburse the government.
However, Shulkin also claimed he was the victim of ongoing "subversion" by political appointees at the White House and within the VA who see him as an obstacle to expanding private-sector health care choices for veterans.
Evidence for Shulkin's claims emerged in the form of an email, first reported by The Washington Post and later obtained by Military.com, in which Jake Leinenkugel, a White House adviser on veterans issues, openly plotted with Camilo Sandoval, a political appointee at the VA, on Shulkin's removal.
In the email, Leinenkugel told Sandoval that Shulkin should be "put on notice to exit" once other legislative priorities were passed.
At a Disabled American Veterans conference last week, Shulkin said he is out to get those at the VA who want him fired.
"People who have subversive ideas or are creating two different agendas don't have a place in the VA, and people have to make a decision whether they're going to be on the team or off the team," he said.
Gary Augustine, executive director of the DAV's Washington office, said, "It is political. It's getting a little nasty" at the VA, and "the secretary is caught in the middle of it."
Major Veterans Service Organizations have rallied to Shulkin's defense. Last week, they met at the White House with Chief of Staff John Kelly, and appeared to come away with assurances that there are no immediate plans to replace Shulkin.
Following the issuance of the IG's interim report last April on conditions at the D.C. Medical Center, the American Legion sponsored a town hall at the hospital at which Connell, the new director, presided.
Veterans in the audience who use the facility were up front with Connell.
The wife of a sick vet said, "You just can't do this to veterans."
A former Army staff sergeant said, "You're the captain of the Titanic."
Another vet said, "My neurologist, I don't know what he's doing."
Other vets told a different story about their treatment.
"I'm here to say good things about the center," said James Preston, a Vietnam veteran who said he survived three bouts with cancer. "It was this center that took care of me."
"I have nothing but good to say about the women's clinic" at the center, said former Petty Officer Second Class Lisa Del Duca.
"I haven't had any problems," said former Marine Lance Cpl. Orlando Herrera.
"We've got some issues we need to fix," Connell said, but he urged the vets to give the new team a chance.
"This is a new VA, and we'll be holding ourselves to the highest of standards," he said. "I will be the first to admit we've got to do better. I've got to earn your trust."
-- Richard Sisk can be reached at Richard.Sisk@Military.com.