Colin Powell was referring to the invasion of Iraq when he famously said, “You break it, you own it.” But he just as easily could have been talking about the Department of Veterans Affairs.
A decade of combat in two war zones, combined with an aging population of Vietnam War-era veterans, has left the VA health care system bursting at the seams.
As more and more veterans have sought care from the system, delays have become the norm, most notably in access to mental health care and the processing of disability claims. With each allegation of delayed treatment, the VA has responded with promises of additional resources and claims of slow improvement.
But all that falls flat now. There is growing evidence that VA hospitals and clinics throughout the country have been falsifying records to make wait lists appear shorter.
That is an indication of systemic problems at the VA, with health care providers who cannot keep up with the rising demand, employees who cave to mounting pressure by cooking the books, and leadership in Washington that failed to respond, even as it became clear what was happening.
And that is a call for widespread changes at the VA, which has a moral obligation to deal with the rising demand for its services with timeliness and proficiency. VA Secretary Eric Shinseki, put in charge by President Barack Obama in 2009 to fix these kinds of problems, has to find a solution now, or step aside so someone else can.
To be sure, the demand is unprecedented. From 2002 to 2012, the VA handled a steady increase in outpatient visits, from 46.5 million annually to 83.6 million. The number of veterans receiving mental health treatment grew from less than 900,000 in 2006 to more than 1.2 million in 2012. The 1 million new disability claims filed in 2009 were an all-time high, until 2010 and 2011, when new records were set.
The Obama administration addressed the disability backlog by authorizing additional overtime for claims processors. As a result, the backlog fell from a high of 611,000 a year ago to 344,000, the VA said.
Some veterans groups, however, have said the cases processed in the last year have a high number of mistakes, and the employees are no longer working overtime on the claims.
Now come the reports that VA facilities in at least seven states may have been manipulating the data to make the wait lists disappear, on paper at least.
The most egregious case is in Phoenix, where the Justice Department is investigating allegations that veterans died while awaiting treatment, even as records understated the wait times.
Since the Phoenix case was publicized, others have followed. A nurse at a VA hospital in Wyoming was put on leave after an email surfaced from the nurse explaining to other employees how to alter records to hide long delays in treatment. A VA investigation has found similar efforts to hide the truth on waiting times in Fort Collins, Colo.
The list goes on and on. There have been allegations of misconduct in Washington state, Texas, Nevada and elsewhere, with more likely to come.
It’s not new, either. There were indications as early as 2008 that the data from VA facilities should not be trusted, and those concerns were relayed to both the Bush and Obama administrations. According to the Los Angeles Times, a 2010 memo by a VA undersecretary referred to as many as a dozen “inappropriate scheduling practices,” dating back to 2008.
That’s not to say that all VA facilities have acted inappropriately.
Maine’s Togus, for example, is among the fastest processors of disability claims in the VA system, and its wait times for doctor visits also have been among the best. The VA is not investigating Togus as part of the larger look into wait times, and there is no indication of any wrongdoing there.
And that’s not to say that veterans who are seen at VA facilities receive substandard care. In fact, patient surveys show a greater satisfaction with care at VA hospitals and clinics than in health care facilities in general.
But to leave so many veterans waiting for care is unacceptable, and to allow for a cover-up rather than address the problem is inexcusable.
The VA, at least in this aspect, is broken, and it is well past time for Shinseki to own it.