Agency Spotlight-The Troubled History of the VA- Part 2

Jan 27, 2017


veterans (va)This two-part blog post will look at some of the issues that have plagued the Department of Veterans Affairs, including issues they face today. This post will focus on some of the headlines out of the VA in recent years.

Dentist Resigns After Possibly Infecting Vets

Last month, a story surfaced from Tomah VA Medical Center in Wisconsin of a dentist who resigned after possibly infecting almost 600 veterans. The dentist may have infected the veterans treated by him with Hepatitis B or C or HIV. The dentist failed to use proper sterilization procedures. Instead, he was using his own equipment-cleaning and reusing it which violates the VA’s regulations.

Those regulations call for the use of sterile and disposable equipment. The acting medical director of that hospital said, “During all of the orientation, he used all of our equipment. He used it appropriately, so it was very purposeful from what we found in our investigation that he knew exactly what he was doing, and preferred to use his own equipment against procedure.”

Hundreds of Vets Die Waiting for Care

A Department of Veterans Affairs hospital in Phoenix, AZ has been in the headlines of late. Two hundred veterans died while waiting for medical care. The VA’s Inspector General’s office (OIG) found 215 deceased patients had open specialist consultation appointments the day they died. The report also found that one veteran never received an appointment for a cardiology exam “that could’ve prompted further definitive testing and interventions that could have forestalled his death.”

This same facility was at the center of a national scandal in 2014 when VA internal affairs identified 35 veterans who died while awaiting care. There were also veterans on a secret waiting list that faced scheduling delays up to a year.

Despite reform efforts, the OIG report found that the Phoenix hospital still has a “high number of open consults because…staff had not scheduled patients’ appointments in a timely manner (or had not rescheduled canceled appointments), a clinic could not find lab results, and staff didn’t properly link completed appointment notes to corresponding consults.” Consults include appointments, lab tests, teleconferencing, and other planned patient contacts.

As of July 2016, there were 38,000 open consults in the Phoenix VA.

This report proved the work environment at this hospital “is marred by confusion and dysfunction” and won’t be solved “until there are consequences up and down the chain of command.”

veteransUnion Challenges Recent Recommendations on Care for Vets

Because of the scandals that have gripped the Department of Veterans Affairs over the recent months and years, Congress established the Commission on Care. This new commission examined veterans access to VA health care to examine how best to effectively organize the VHA and deliver health care to veterans during the next 20 years.

In their final report on healthcare they write, “The evidence shows that although care delivered by the VA is in many ways comparable or better in clinical quality to that generally available in the private sector, it is inconsistent from facility to facility, and can be substantially compromised by problems with access, service, and poorly functioning operational systems and processes. The Commissioners also agree that America’s veterans deserve much better, that many profound deficiencies in VHA operations require urgent reform, and that America’s veterans deserve a better, organized, high-performing healthcare system.”

The American Federation of Government Employees (AFGE) believes the VHA can best serve veterans by expanding access to services the VHA currently provides.

VHA Failed to Recoup Nearly $800K in Employee Recruitment and Relocation Debt in FY2014

The Veterans Health Administration (VHA) relies heavily on financial incentives to recruit and retain critical staff. A recent audit showed that the VHA didn’t try to recoup outstanding debts of nearly $800K in FY2014 from employees who should’ve reimbursed the government. The audit reviewed the departments’ use of recruiting, relocation, and retention (3 R’s) compensation and found that the VHA didn’t enforce payment for roughly 55 percent of the established 238 incentives for which employees didn’t fulfill their recruitment or relocation obligations.

During the audit timeframe, the IG found that the VA’s personnel system lacked the ability to issue alerts when employees, who received one the 3 R’s, changed jobs, making the HR staff possibly “unaware of unfulfilled incentive service agreements.”

The VA finished implementing a personnel system in July 2016 that alerts HR staff when employees have outstanding service obligations.

The report also found that the department overall didn’t properly oversee how the 3 R’s incentives were awarded, citing a failure to follow procedure. “VA’s inadequate controls over its 3R incentives represent an estimated $158.7 million in unsupported spending”, projected for fiscal years 2015-2019.

VA is Still in Need of Doctors and NursesVa in need of nurses

The VA’s largest staffing shortages are in 5 occupations: medical officer, nurse, physician assistant, physician therapist, and psychologist; their greatest need being medical officers and nurses. Medical technologist is also another occupation the department has had difficulty filling and retaining staff.

The VHA groups staffing losses into three categories—volunteer retirements, regrettable losses, and other losses. Regrettable losses are defined as “those individuals who resign from the VA or transfer to another government agency.”

Over the past few years, the VA has been on a hiring frenzy with doctors, nurses, and clinicians. They have used their Title 38 authority to offer more competitive pay to doctors and other healthcare professionals. Currently, they are trying to get authority from Congress to move other top management positions into Tittle 38. This would provide them with a greater hiring potential and more flexibility on pay.

New Legislation Could Make it easier to Fire VA Employees

Congressman Doug Lamborn (R-CO) has introduced the VA Accountability First and Appeals Modernization Act of 2017 (H.R. 611) to help make it easier to fire VA employees. This is a companion to a bill already introduced. This bill would increase the flexibility to make it easier to remove an employee for poor performance and misconduct as well as strengthening the protection for whistleblowers.

Lamborn made this statement:

“After 3 years of witnessing systemic abuse–including falsified waitlists, whistleblower retaliation, and abysmal patient care–this bill will provide real accountability and culture change at the VA. Too often, misbehaving and even criminal employees have continued to receive a salary at taxpayers’ expense. This strong piece of legislation expedites the discipline process to make it easier to demote or fire employees for misconduct. Although I recognize that the vast majority of VA employees are good people trying to serve our veterans, we cannot ignore the serious problems that result from employee misconduct. Eliminating the worst of the worst will send a clear message to all agency employees and will begin to change the culture of corruption that has become too prevalent at the VA.”

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