Former Department of Veterans Affairs Secretary Dr. David Shulkin has high praise for VA employees caring for veterans and supporting the department's public health mission during the novel coronavirus pandemic. But he said VA leaders must act more aggressively to protect workers from exposure to the relentless virus.
The VA has performed "beautifully" in caring for veterans during the pandemic and has taken its mission as a public health backstop "very seriously," making hospital beds available to non-veteran patients as needed where hospitals are overwhelmed, he said.
But the department must do more to protect doctors, nurses and employees from contracting the deadly coronavirus, Shulkin said. As of April 23, 1,937 VA staff members have been confirmed with COVID-19 and 20 have died, including Vianna Thompson, a 52-year-old nurse at the VA Sierra Nevada Health Care System who died April 7, and two co-workers.
Shulkin said reports of the VA rationing personal protective equipment, or PPE -- shortages VA leadership, including Secretary Robert Wilkie, have repeatedly denied -- and the virus' unpredictable nature are disconcerting, raising questions about the department's preparedness and oversight.
"When I was secretary, we would spend a lot of time making sure we were prepared for natural disasters. ... While nobody was prepared for this type of national scope of response, I am very pleased to see VA has taken its fourth mission seriously," Shulkin said. "But too many are getting sick, and why this is happening is not clear. There's still a lot we don't know about this virus."
He said complaints from nurses that they don't have enough PPE, and Wilkie's assertions that the department is following Centers for Disease Control and Prevention guidelines, show a "disconnect between what we're hearing from people on the ground and what we're hearing from spokespeople."
"One of the things you learn when you run large organizations is that it's very hard to get good, accurate information. … That's why [as secretary], I put on a white coat and a stethoscope and actually went to the VA in Manhattan and took care of patients," Shulkin said. "You have to be listening to your employees to understand what their needs are and make sure they have the tools they need to care for patients safely."
Shulkin, who served as the head of the Veterans Health Administration under President Barack Obama and was appointed VA secretary in 2017 by President Donald Trump, was fired by Trump via Twitter in March 2018 following an internal department investigation that found the secretary had improperly accepted free tickets to a Wimbledon tennis match and had the VA pay air travel for wife, a dermatologist, to accompany him during a business trip to Europe.
Shulkin later said his ouster was linked to opposition within the White House over policy disagreements that included increasing veterans' access to private health services. He now runs Shulkin Solutions, a consulting firm that focuses on health care innovations such as artificial intelligence, data analytics, telehealth and robotics, along with veterans health services.
As an analyst, Shulkin said he has been studying the novel coronavirus' behavior to determine why it's so contagious. He believes stricter PPE standards may help slow the spread in hospitals and other congregant settings, to include requiring longer gowns that cover the neck and wrists completely, bootie covers that go to the knees, and higher-grade gowns and masks for ICU providers.
"Essentially, while we don't know the answers to all of this, we have to take extreme precautions," he said.
In 2017, Shulkin took over a department plagued by staffing shortages, with more than 49,000 vacancies. Taking an approach similar to the one he used to address the lengthy wait times more than 57,000 patients faced for medical appointments at the VA, he pushed for nurses with advanced degrees to have broader practice authority and hired contractors to fill gaps.
Still, although Shulkin decreased the number of vacancies at the VA to 34,000, shortages continue: At the start of the pandemic, the department had 44,000 vacancies.
The open spots, combined with pandemic-related staff absences, have stressed the system. For example, at the height of the pandemic at the VA's New York Harbor Health System Brooklyn Campus, ICU nurses were caring for four, and sometimes five, patients on ventilators during a shift.
They usually are responsible for just two ICU patients at a time.
"The biggest shortage one can absolutely expect [in] any pandemic is a staffing shortage, because your staff may not be available for work because they are sick or have to care for people at home that are sick," Shulkin said. "When you layer that on top of existing shortages, it just makes it even more difficult to do a good job. VA is taking steps to try to help alleviate these staffing shortages, and it's a critical thing they continue to focus on."
For the VA to finally solve its long-time staffing problems, he said, the department must adjust salaries and accelerate the hiring process, which now takes months.
"The Veterans Health Administration is limited in paying a doctor any more than the president's salary. That just doesn't make sense. We are either there to take care of our veterans and provide them the very best quality care or we're not. What does that have to do with the president's salary?" Shulkin asked.
He described the current VA staff as an "incredibly dedicated" workforce that knows they are putting themselves and their families in harm's way -- by reporting to work.
“My gratitude goes out to the men and women that are working in the VA system. They all know how important their jobs are right now and I'm just incredibly proud of the work that they're doing,” Shulkin said.