“The State of VA Health Care”
May 15, 2014
RYAN M. GALLUCCI, DEPUTY DIRECTOR
NATIONAL VETERANS SERVICE
VETERANS OF FOREIGN WARS OF THE UNITED STATES
VETERANS’ AFFAIRS COMMITTEE
UNITED STATES SENATE
WITH RESPECT TO
State of VA Health Care”
WASHINGTON, D.C. May
MR. CHAIRMAN AND MEMBERS OF THE COMMITTEE:
Chairman Sanders, Ranking Member Burr and members of the
committee, I wish I did not have to be here today, but I want to thank you for
the opportunity to share the Veterans of Foreign Wars’ concerns on the
Department of Veterans Affairs’ (VA) health care delivery.
Simply put, the VFW is outraged over the allegations that
have surfaced in recent weeks that VA denies care to veterans. What is more
frustrating is that nearly a month after these allegations surfaced, we still
do not have all the facts. We do not know who the veterans are who died waiting
for care in Phoenix. We do not know if other hospitals are cooking the books in
appointment scheduling to keep up appearances, while veterans either wait for
care, or pay for it out of their own pockets.
Regardless of the forensic facts in Phoenix, Wyoming,
Atlanta, Chicago, or Jackson, Mississippi, the VFW knows that veterans have
died waiting for care. This in and of itself is inexcusable. VA is supposed to
have protocols in place to make sure this never happens. So, what happened?
VA tells us the situation is improving, but to the veterans’
community, this is not good enough. VA’s obligation is to provide our veterans
with the best health care our nation has to offer. Over the last month, we can
clearly see that VA is not living up to this obligation.
Veterans want and deserve the truth, but instead we are fed
vague platitudes about quotas, wait times, waiting lists, and ongoing
investigations. The VFW has been vocally frustrated at the situation, but we
have been reticent to condemn individuals because of these “ongoing
investigations.” We are here today to
say that enough is enough. Whistleblowers first brought the problems in Phoenix
to the attention of VA and Congress as early as 2010. CNN broke the doors off
this story in April. Why are we still waiting?
Last week, the VFW grew tired of waiting and told veterans
to call our help line, 1-800-VFW-1899, to voice their concerns about VA health
care, and connect with our service officers for help. While some said they were
satisfied, or acknowledged improvements, most veterans painted a picture of a
VA health care system that is overburdened, under-resourced, and many times
In Durham, North Carolina, an Iraq veteran told us that he
can see his primary care doctor only once a year, and that he has sought care
elsewhere after 10 years of misdiagnoses.
In Denver, a veteran told us that when he moved to the city
in 2011, it took a year and a half to book an appointment, and now he cannot
get in for treatment of his service-connected conditions.
In Florida, a veteran who was diagnosed with prostate cancer
told us that he had to wait five months to see his primary care doctor.
In Nevada, a veteran who was diagnosed with skin cancer
tells us he is waiting eight months for an appointment after the hospital’s
And finally, in Phoenix, a veteran told us that he has been
waiting three years for a surgical consult, and was told that if his condition
gives him problems, he should just come to the emergency room.
If one veteran is not receiving the care he or she needs, it
is one too many. This is only a small sample of the hundreds of concerns we
heard from veterans at VA facilities from coast to coast, but the outpouring of
concerns was alarming, and seemingly systemic. So, what is causing this failure?
Is it a lack of resources? Is it personnel? Is it leadership?
As a result, the VFW will also conduct a series of veterans’
Town Hall meetings, talking to veterans face-to-face, allowing them to voice
their concerns. Once we have finalized locations and dates, we invite this
committee to attend and observe, hearing directly from the veterans about VA
Although we are still waiting for the full reports to be
issued on the latest allegations, recent preventable deaths at other VA
facilities have already been confirmed. In South Carolina and Georgia, we
learned that 23 veterans died due to recent consultation errors. Last year, VA’s
Inspector General released a report detailing the improper handling of an
outbreak of Legionella at the Pittsburgh Veterans Affairs Medical Center (VAMC)
which took the lives of at least five veterans.
Another report revealed the mismanagement of inpatient mental health
care at the Atlanta VAMC, costing at least four veterans their lives. The Jackson, Mississippi VAMC has been
plagued by multiple problems which endangered veterans’ safety and lead to
preventable deaths, including chronic understaffing, failure to sterilize
instruments, and thousands of unread radiology images leading to missed
diagnoses. Most recently, the VFW
learned that as many as 19 veterans died nationwide in 2010 and 2011 due to
unacceptably long wait times for routine cancer screening procedures.
In the past three weeks, whistleblowers in Phoenix,
Colorado, Wyoming, Texas and North Carolina have alleged that these locations
have “gamed” their patient appointment schedules to make it appear these
facilities are achieving their appointment wait times. VA’s assertion that wait
times for primary care appointments in Phoenix have decreased from more than a
year to 55 days on average is unacceptable. Mental health access also continues
to be an issue. VA has hired more than 1,000 mental health care providers, but
they still are not sure how many providers they need to fulfill the current
The lack of timely care for veterans is unacceptable. The
VFW certainly hopes that VA would never intentionally deny care to veterans,
but there have to be reasons why care takes so long to be delivered. We know
capacity is an issue. The VFW, in partnership with the Independent Budget, has
highlighted for years the need to increase VA medical facility capacity. Even
VA’s own 10-year Strategic Capital Investment Plan (SCIP) identifies capacity
as an issue. In 2004, VA’s medical center capacity was 80 percent. It peaked at
122 percent capacity in 2010, and in 2013 capacity remained unacceptably high
at 119 percent. Since FY 2010, appropriations for major construction projects
have decreased from $1.2 billion annually to an FY 2014 appropriation of less
than $350 million for the same account. Access to care can be directly linked
to capacity. VA’s major lease authority is also placing a burden on capacity,
which directly effects access. Since FY 2012, Congress has not authorized VA
major medical lease authority. That is 27 facilities in 18 states, most of
which should be providing direct care to veterans.
These allegations are causing veterans and their family
members to lose faith and confidence in a system that is supposed to care for them.
VFW members and their families are outraged. They want answers, and they want
those responsible for any substantiated allegations held accountable from the
lowest to the highest level of leadership. With this in mind, it may be time to
commission an independent review of VA’s health care system. We must all work
together to ensure that the culture across VA is one of placing veterans’ needs
first, and when veterans’ care suffers because of one of these reasons, those
responsible must be held accountable to the fullest extent of the law.
To provide timely access to care, VA must use all available
tools, including purchasing non-VA care when necessary. Ideally, VA would have the capacity to
provide timely, quality direct care to all those who need it, but it has become
apparent to the VFW that they do not.
Although we support expanding VA infrastructure and hiring enough health
care professionals to meet demand at VA facilities, we recognize that this will
not happen overnight. In the meantime,
it is absolutely unacceptable for veterans to suffer. Non-VA care must be used
as a bridge between full access to direct care and where we are now.
If it appears that certain facilities are not making proper outside
referrals due to improper training, lack of standards, or institutional
resistance, VA must move swiftly to correct those problems. If VA’s new fee
basis care model, PC3, is not being used to its full potential due to
insufficient funding at the local level, we will call on VA and Congress to give
them the resources they need.
When there is a lack of resources, there is a tendency to
make trade-offs, whether it is delaying care or manipulating scheduling systems
to satisfy quotas.
It appears that the culture of leadership, management and
accountability is focused on making the funding fit at every level. If this is
the case, this culture must change. Leadership at every level must have the
confidence that if they have a need, they can ask for that need to be addressed.
VA, the Administration and Congress must resolve to make the true need the
priority, not the need to make budget lines fit.
There is no question that the Veterans Health Administration
(VHA) faces significant challenges in efficiently and effectively running the
largest health care system in the United States. Successfully executing its
four major missions of providing care to veterans, conducting medical and
prosthetic research, training this nation’s physicians, and providing medical
support to the public during domestic emergencies is a massive undertaking. When
failures are identified, it must be the responsibility of VA, Congress, veterans
service organizations, and all of America to swiftly correct those problems with
better oversight, sufficient funding, and accountability of those
In doing so, however, we must resist any suggestion that VHA
is a fundamental failure which should be dismantled in favor of an alternative
model. Such suggestions not only serve to relieve VA of its responsibilities,
but fail to take into account the contributions that VHA makes to veterans,
their families, and the medical community as a whole.
The VA health care system was commissioned to care for those
who served and bled for our nation. The men and women who are chosen as
stewards of the VA health care system have been entrusted with a mission that
cannot fail under any circumstances. If the system is failing, it is their duty
to fix it. It is their duty to hold underperforming employees accountable. Most importantly, if they are unwilling to
perform this mission, it is their duty to either ask for help or step aside.
Last year, when the President met with then-VFW
Commander-in-Chief John Hamilton at the White House, he promised that he would
not leave the problems within VA for his successor to deal with. Today we ask
not only the President to live up to his word, but we implore Congress to do
We absolutely cannot sit on our hands and wait for the
system to slowly improve. Every day we hear of new allegations in another VA
facility. The situation that is unfolding in VA facilities across the country
demands immediate, decisive action. The mission of the VA health care system is
far too important, and as a society that cares for the men and women who
volunteer to defend our way of life, we cannot allow it to fail.
Mr. Chairman, this concludes my testimony, and I am prepared
to take any questions you or the committee members may have.
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