Report: VA falls short on mental health care despite hiring push (The Wall Street Journal)
The Department of Veterans Affairs lacks enough full-time psychiatrists to meet demand for services and those on staff aren’t being used efficiently, despite a multiyear, multibillion-dollar effort, says a report from the department’s internal watchdog. The VA hasn’t been “fully effective” in hiring psychiatrists or in using those it has, the VA’s Office of Inspector General reported Tuesday, adding that the department has focused on meeting overall hiring goals rather than on hiring personnel to fill gaps at specific facilities. The VA “did not effectively use psychiatrists in its efforts to improve veterans’ access to psychiatric care,” the inspector general said in the report, adding that poor “clinic management practices resulted in unused capacity of its psychiatrists.” In fiscal year 2014, the department spent nearly $4 billion on outpatient mental health services, the report says, yet the inspector general identified 94 of 140 facilities that year that needed additional psychiatrists to meet demand and found that 25% of psychiatrists’ time wasn’t used effectively. The report serves as a follow-on to a 2012 study that identified wait times of more than a month for psychiatrist appointments by veterans and a large number of vacant psychiatrist positions. In 2012, then-Secretary Eric Shinseki announced an initiative to hire 1,600 mental health professionals, bumping up pay scales to help recruit them. In 2014, Secretary Robert McDonald announced another hiring initiative as part of a broad reform package pushed through in the wake of a department-wide scandal that led to the resignation of top officials, including Mr. Shinseki. Since then, the VA hasn’t come up with effective hiring goals or an effective department-wide system for managing psychiatrists, leaving these determinations to local hospital networks that haven’t been fully effective,the report says. “This VA OIG report highlights some very important areas for improvement,” said the Iraq and Afghanistan Veterans of America, an advocacy group, in a statement. The group “continues to recommend the VA conduct regular analyses of staffing needs to continually track current and predict future needs for mental health clinicians, including psychiatrists,” it said. Sen. Johnny Isakson (R., Ga.), chairman of the Senate Committee on Veterans’ Affairs, said in a statement that the report “does not appear to reflect any sense of urgency to address the shortages or operational inadequacies.” He added that he will be asking the VA secretary “to reconsider addressing the recommendation in a more timely manner.”
The way vets file claims means there will always be a backlog, VA says (Military.com)
The Veterans Affairs Department’s backlog of disability claims has dropped below 100,000 but it won’t ever reach zero because of the way veterans seek care, says the head of the Veterans Benefits Administration. Future claims exceeding the 125 days set for on-time decisions will more than likely be because of veteran’s individual choices or outside agencies, not the VA’s system, according to Under Secretary Allison Hickey. “Zero for us is not an absolute zero,” she said on Monday. “I don’t want us to say, ‘Too bad, we want to hit our 125 days! The heck with you! We’re going!’ That’s not right and that’s not the kind of culture and core values that we hold.” Hickey spoke with reporters during a telephone roundtable, during which she announced that the backlog — once well over 600,000 claims — had finally been brought down to fewer than 100,000. She credited the reduction to increased digitation of records, a new application system that emphasize electronic filings, and employees pulling mandatory overtime hours for the past three years. But Hickey said the problem of claims going past 125 days without a decision won’t disappear entirely, though the numbers will be manageable at perhaps 11 percent of new claims. There are valid reasons that some claims will take longer than 125 days that have nothing to do with VA bureaucracy, Hickey said. Examples include a veteran amending a claim already nearing the 125-day point, a veteran’s preference for where or when to get a necessary physical, or a claim requiring information from the Defense Department. Many times, she said, VA will be nearing completing of a claim application when the veteran decides to add a new medical condition. “To the veteran, that means if they can get that on that [original] claim, they get the earlier effective date,” and with it compensation starting from that date, she said. If they file it as a new claim, they will get a later start date for compensation. So adding it onto a nearly finished existing claim means action on the claim is going to run past 125 days.
Study: Servicemembers with bad discharges have higher homeless rates (The Los Angeles Times)
Veterans whose behavior got them kicked out of the military have dramatically higher rates of homelessness than those who left under normal circumstances, according to a new study by researchers from the Department of Veterans Affairs. Among VA patients who served in Iraq or Afghanistan between 2001 and 2011, 5.6% were discharged for misconduct. Yet these patients accounted for 28.1% of veterans who had been homeless within their first year out of the military, the analysis found. The type of misconduct that resulted in discharge typically involved drug or alcohol use. “This is one of the strongest — if not the strongest — risk factors for homelessness observed to date,” said Jamison Fargo, a research scientist with the VA’s National Center on Homelessness Among Veterans and co-leader of the study, published Tuesday in the Journal of the American Medical Assn. The analysis did not include former service members whose offenses were so egregious that they were disqualified from using the VA. More than 142,000 service members have been dismissed from the military since 2001 with discharges that usually make them ineligible for VA services, according to data from the Department of Defense. If the full population of service members discharged for misconduct had been included, the homeless tally would have been higher, said Bradford Adams, a lawyer for Swords to Plowshares, a veterans service group in San Francisco that has been pushing for more support for veterans with “bad discharges.” About 15% of the veterans in its short-term shelters are ineligible for VA services, he said. Fargo and his colleagues based their study on the 448,290 VA patients who served in the recent wars. They used Defense Department codes to separate them into five discharge categories and VA records to see who had experienced homelessness. The researchers could not track the roughly 40% of recent war veterans who choose not to use the VA. Overall, 1% of the VA patients had been homeless at some point within a year of leaving the military. But that figure was 5.4% for those discharged for misconduct. The new study “feels like a canary in a coal mine,” he said.
Unhappy with your VA visit? Tell the kiosk (Stars & Stripes)
If you’re angry with the Social Security clerk you dealt with, or happy with the airport security screener who rifled through your bags, you can now tap a button on a kiosk and let the government know. Federal agencies are now getting your feedback on how well they served you in seconds through a year-long pilot program designed to help them quickly address customer service complaints and other issues. “We’ve learned that the best place to start when diagnosing a citizen problem is data,” said Victoria McFadden, deputy chief customer officer with the General Services Administration’s Office of Customer Experience, which rolled out the Feedback USA program in late July. “This is the first time we’ve had a real-time effort to measure customer service,” McFadden said. “We want to see if there’s something agencies will react to if it’s real-time data.” The silver kiosks are stationed at 27 passport offices and 14 Social Security offices across the country. In the next few weeks, passengers at Reagan National, LaGuardia, Los Angeles International and San Francisco International airports will see them as they leave the Transportation Security Administration checkpoints. The Department of Veterans Affairs also plans to launch kiosks soon. The system for customers is pretty simple, even if the technology isn’t. You click on one of four emoji buttons: a happy face, a somewhat happy face, an angry face or a somewhat angry one. And someone in the agencies’ customer service offices will be watching for the data to stream in seconds through a computer. The responses, all anonymous, will be summarized hourly.
The killing fields of socialized health care (Watchdog.org)
The Department of Veterans Affairs is the perfect example of socialized healthcare. The federal government owns all the hospitals, employs all the staff, and leaves patients to languish and sometimes die on waitlists. A year after news broke that VA hospitals kept veterans waiting months to see a doctor, including in Wyoming, the VA still refuses to admit its methods endangered veterans. But new evidence reveals that the agency’s practices are disastrous for our wounded warriors. The Office of Special Council, the investigative arm of the federal government, recently reported that VA scheduling procedures directly resulted in the death of many patients. In 2010, former Veterans Affairs Secretary Eric Shinseki started issuing bonuses to administrators that kept patient wait times low. Administrators that kept patient wait times below 14 days could earn up to $15,000 in bonuses. Sounds great right? But to meet these goals, administrators used a slight of hand to conceal how many patients were waiting to see a doctor. Patients that could be seen within 14 days were submitted into the official electronic record. The rest were put on a secret paper log, hidden from official scrutiny. While VA hospitals looked like they were seeing patients in a timely manner, patients suffered for months in need of care. An internal audit discovered that over 90 percent of veteran hospital administrators, including some at the Cheyenne VA Medical Center, earned bonuses while abandoning patients on waiting lists. By 2014, over 270,000 veterans were waiting at least 125 days to see a doctor. VA administrators excused this obscene patient abuse by claiming they misunderstood the VA’s scheduling procedures. This couldn’t be further from the truth. Cheyenne’s VA staff were fully aware of VA procedures and knowingly disobeyed them under orders from supervisors. Emails sent by former Telehealth Coordinator David Newman explicitly instructed staff to falsify wait times: ”Yes, it is gaming the system a bit. But you have to know the rules of the game you are playing, and when we exceed the 14 day measure, the front office gets very upset.”
Isakson sees progress in VA system (Macon Telegraph)
U.S. Sen. Johnny Isakson, chairman of the Veterans’ Affairs Committee, said Tuesday the culture is changing in the VA healthcare system. In a town hall meeting in Dublin a year ago, the Georgia Republican promised that VA employees would be held accountable for a scandal in which secret records were kept to hide how long veterans were waiting for care. But when VA Secretary Robert McDonald came to Macon recently, McDonald acknowledged that only a few employees out of 314,000 nationwide had been fired as a result of the scandal. In a meeting with the Telegraph editorial board Tuesday in Macon, Isakson was asked whether his promise to hold VA employees accountable had been fulfilled. He suggested the number of people fired does not tell the whole story. He noted that the first criminal indictment from the scandal was of an employee at the Augusta VA. “You had a cultural problem in the VA prior to two years ago,” Isakson said. “It was an accepted practice amongst the employees that you could kind of cook the books to make your performance look better so that you would get a pay raise. … They now realize that type of activity is not going to be tolerated.” While he said things have improved in the VA system, he called it a “work in progress” and said more needs to be done. “Bob McDonald is a good man, and he is trying hard,” Isakson said. “It’s going to be an ongoing battle. We owe it to our veterans to do everything we can for them.” He noted that several investigations are still ongoing.
Bush calls Colorado VA hospital a disaster, but argues for completion (The Denver Post)
Republican presidential candidate Jeb Bush told veterans at a metro town hall Tuesday that he supports finishing the Aurora VA hospital despite huge cost overruns. “We need to finish up, we can’t just can’t waste hundreds of millions of dollars,” Bush said, during the event at VFW Post 9644 in Sheridan. More than 100 people turned out at the event, where Bush highlighted a plan to revamp veteran services. Bush called the construction project, and its projected $1.73 billion cost “an unmitigated disaster.” He would take the VA out of the construction business and leave that to the U.S. Army Corps of Engineers, he said. The former Florida governor said the U.S. Department of Veterans Affairs needs to be modernized to focus on today’s challenges. During the last three or four years, he said, the VA’s budget has increased 73 percent, but the agency hasn’t modernized. “It is insular,” the former Florida governor said, and doesn’t accept responsibility. The agency is a bureaucracy that needs reform across the board, he said. “Longevity of service shouldn’t be why you get a raise, it should be, ‘Do you have a heart for people?’ ” Bush said he supported a system in which veterans would be able to choose to go to their own doctor. “Everybody does better when you empower the vet rather than empower the system.”
Veterans’ grave markers used to make patio are removed (Military.com)
The mystery of a patio in far southern Missouri that was built with national cemetery gravestones has been solved to the satisfaction of the local sheriff and the veteran who raised the alarm. Ed Harkreader, a Navy veteran, took pictures of the patio and staircase and posted them on Facebook last week. Some of the stones were installed face up, showing the names and dates of death of veterans and spouses. His postings created an outcry on social media. The patio was at an isolated residence in Ozark County, Mo., near Lake Norfork and the Arkansas border. Harkreader, who lives 15 miles away in Mountain Home, Ark., said he posted the photos because he considered the arrangement offensive to veterans and families. The federal National Cemetery Administration in Washington announced it would investigate. On Monday, Ozark County Sheriff Darrin Reed said the stones had been cut by a local monument company and, because of spelling errors or blemishes, tossed into a landfill. Reed said a local man admitted to taking them and using them on his property. Reed said he sought no charges because Chaney Monument Co., which cut them, never billed the federal government for the defective headstones, and because the local man hadn’t realized the significance of his pilfering. “The guy used poor judgment and taste,” Reed said. “He kept apologizing to us. He’s a very simple sort, and he told me he didn’t think the thing through.” Reed said sheriff’s deputies and members of a local fire department removed the stones on Sunday. He said they will be buried Tuesday afternoon on county property in a ceremony that will include a veterans’ honor guard from nearby West Plains, Mo., and local Cub Scouts. A spokeswoman for Chaney Monument said the company had a contract from 1982 to 2007 with the Department of Veterans Affairs to cut headstones for national cemeteries. The work ended with the death of the former owner, W.D. Collins. Reed said the company made about 7,000 stones that were delivered across the country, which explains why three of them in Harkreader’s photos were intended for graves in California, Texas and Alabama. “The defective ones never left the county,” he said.
Couple plead to VA benefits theft, conspiracy (Military Times)
A former Concordia Parish, La., couple has pleaded guilty in a scheme to steal veterans’ benefits, federal prosecutors say. U.S. Attorney Stephanie Finley said Tuesday that Alfred Lewis Jr., 67, of Ferriday, Louisiana, pleaded guilty Friday to one count of theft of government funds: $197,780 in veterans’ benefits received over 10 years. She said in a news release that Rose Lewis, 36, of Natchez, Mississippi, pleaded guilty to one count of conspiracy to steal the money. Alfred Lewis, who served in the Air Force, applied for veterans’ benefits in July 2003 and received them until November 2013. Prosecutors say Rose Lewis was earning more than $50,000 a year, but both Lewises sent Veterans Affairs written statements denying that she was working. Alfred Lewis could get up to 10 years in prison, and Rose Lewis up to five. Each also could be fined $250,000 and ordered to repay the money. U.S. District Judge Dee Drell scheduled sentencing Nov. 23 in Alexandria.