A clash of agendas and legacies for vets
Republican Rep. Jeff Miller, the soon-to-retire chairman of the House Veterans Affairs Committee, is a former deputy sheriff of Gilchrist County, Fla., who despises wrongdoing by VA department employees.
Indeed his committee, through his six years as chairman, is perceived by veteran groups as having fixated on exposing fraud, waste and abuse inside the Obama administration's Department of Veterans Affairs.
While veteran service organizations largely praise VA Secretary Bob McDonald's actions and those of his deputy and former West Point classmate, Sloan Gibson, since they took charge amid a patient wait-time scandal in 2014 and began to reform a vast VA bureaucracy, Miller isn't a fan.
We asked for his reaction to McDonald's recent blasts, at Congress for failing to pass "essential" legislation to sustain VA's transformation into a high performance organization and at Miller for an "against leadership" bent toward VA. Miller released a blunt statement charging McDonald with breaking promises, allowing scandals to continue, and ignoring new authority to speed the firing of misbehaving employees. Miller also said much of what McDonald seeks is in 36 House-passed bills still awaiting Senate action.
"When Secretary (Bob) McDonald joined VA," Miller wrote, "he promised to transform the department and create a climate of accountability. More than two years later, I see little evidence of that happening, as underscored by the fact that VA is still an agency where whistleblower retaliation and (patient) wait-time manipulation are routinely tolerated."
As proof, a committee spokesman shared links to various local and national news reports over the last two years of incidents where VA was slow to fire wrongdoers and slow to defend whistleblowers. Many of the news reports were written for an online site created by a conservative pundit.
But Miller added that McDonald, despite only two years as secretary after a career in industry, has "a long history of abandoning and undermining the tools Congress has already given him to help reform the department."
The one "abandoned" tool he cited was the Choice Act's fast-track firing authority." Miller also claimed McDonald "threatened to shut down hospitals unless (VA) could raid $3 billion" of a $10 billion fund Congress set up to make more private sector care available to veterans, and that McDonald had "botched" the 2014 Choice Act's implementation.
We bounced the sharp critique off executives for two large veteran service organizations. Both said most of Miller's points were wrong or unfair.
On his charge that VA routinely tolerates whistleblower retaliation and wait-time manipulation, "No, we don't agree," said Garry Augustine, executive director for Disabled American Veterans in Washington D.C. "We think the VA is doing good work in trying to reform things."
Louis Celli, The American Legion's director of veterans' affairs and rehabilitation, said Legion staff visit 30 to 35 VA facilities yearly, speaking to patients, staff and other stakeholders to learn how VA, the government's second largest bureaucracy, is operating and caring for veterans.
"Based on our data and analysis," posted on www.legion.org under its "System Worth Saving" page, "the isolated employee behavior problems reported in recent media are the exception, definitely not the rule," Celli said.
Both Augustine and Celli, contacted separately, also challenged Miller's contention that McDonald had abandoned an effective fast-track firing tool.
"No," said Celli. "VA did use the expedited authority. But their use of the new law blew up in their faces after the Justice Department ruled that the law was unconstitutional and would not hold up to legal scrutiny."
VA confirmed and shared the Justice Department legal finding.
"Miller's big on this accountability thing. We're all for accountability," said Augustine. But "you just can't fire people, whether in government or private sector. You've got to do due diligence. You've got to counsel and document [because] everybody has an option to appeal. And if managers haven't done enough to make sure the firing will be upheld, it's going to be overturned. That's what happened to a number of them."
Augustine and Celli also took exception to Miller's claim that McDonald and his VA team botched implementation of the Choice Act.
"Absolutely not," said Celli. "The Choice Act was a temporary program that required massive infrastructure support."
Lacking such infrastructure, and given only 90 days by Congress to launch a massive Choice program, VA had to hire third-party contractors to build private sector healthcare provider networks and to coordinate their use. It took a long time to "work out the bugs," Celli said, and "it's still not right."
McDonald and Gibson have conceded mistakes in implementing Choice. One was VA ceded too much control to the contractors and has had to reclaim its care coordination duties to better serve Choice-eligible vets.
"A program that turns VA into a pass-through payer isn't working," Celli said. "VA is a healthcare provider, [and] being a third party administrator was never in their list of responsibilities. The community care programs they do have mastery over, they do well."
When Choice began, said Augustine, vets would go into a VA facility, be told they qualified for Choice because the wait for VA care exceeded 30 days or they lived more than 40 miles away. Then they'd go home to wait for the third-party administrator to contact them.
"Sometimes that didn't happen. When they finally got to the doctor, the doctor's reimbursement was dependent on getting the [medical] record back to the third-party administrator so it could send to the VA, get reimbursed and reimburse the doctor. Doctors got tired of waiting so they started billing patients. It was a mess, and it still has problems."
VA has worked to strengthen Choice scheduling and sped payments. As to the rocky start, Augustine said, "there's enough blame to go around."
Chairman Miller, said a committee spokesman, stands by his criticism of McDonald and also his committee's continuous focus on VA failings.
"The constitutional duty of an oversight committee is to provide oversight. That's what [the committee] has and will continue to do," he said. Otherwise, "it's possible they could be swept under the rug, as VA has a history of doing. We're not going to ignore serious problems at the department because you or anyone else feels we're being too 'negative.' "