The White House released a scathing report Friday on the Department of Veterans Affairs, calling for its health branch to be "restructured and reformed" and warning that a "corrosive culture" has led to problems of veterans obtaining timely health care.
A summary of the report by President Barack Obama's deputy chief of staff, Rob Nabors, paints an alarming picture of an entrenched and unresponsive bureaucracy that hides problems and targets whistleblowers.
The White House said Obama met Friday with Nabors, who he had asked to review the department amid a growing scandal over nationwide gaming of treatment numbers at its hospitals. The president asked Nabors to stay at the VA temporarily "to continue to assist the department during this time of transition."
Nabors and Acting VA Secretary Sloan Gibson found that the "vast majority of VA employees are dedicated, hardworking, and committed to the veterans they serve." But the White House said they agreed that "significant further action is needed to address systemic problems in the VA health care system."
The VA's inspector general has found inappropriate scheduling practices have compromised care for patients at VA medical centers and clinics nationwide. Nabors' report said a 14-day goal for scheduling appointments was "arbitrary, ill-defined and misunderstood" and "may have incentivized inappropriate actions."
The report calls for the Veterans Health Administration to be overhauled, saying that it "currently acts with little transparency or accountability" and that its leadership structure is marked by "a lack of responsiveness and an inability to effectively manage or communicate to employees or veterans."
In a statement, Gibson said: "We know that unacceptable, systemic problems and cultural issues within our health system prevent veterans from receiving timely care. We can and must solve these problems as we work to earn back the trust of veterans."
Gibson took over the department after former VA Secretary Eric Shinseki resigned last month as the waiting times scandal unfolded.
Nabors found that a "corrosive culture" has created personnel problems affecting morale "and, by extension, the timeliness of health care." The system treats nearly 9 million veterans a year. Nabors said the problems of a large and sprawling agency are made worse by poor management, "distrust between some VA employees and management, a history of retaliation toward employees raising issues, and a lack of accountability."
He talked of a culture that "encourages discontent and backlash against employees," noting that one-quarter of all whistleblower cases the Office of Special Counsel, the agency that investigates whistleblower complaints in the federal government, is currently reviewing are VA cases.
"There is a tendency to transfer problems rather than solve problems," the report says. "This is in part due to the difficulty of hiring and firing in the federal government."
The House of Representatives and the Senate are working on compromise legislation that would, in part, give the VA secretary the power to immediately fire poor-performing employees.
Nabors' report describes an agency behind the times technologically, even as its clientele and responsibilities broaden. He said its technology for scheduling is "cumbersome and outdated" _ some of it predates the Internet _ and that the agency, the country's largest integrated health care system with more than 1,700 sites, has shown an inability to spell out its budgetary needs.
He also warned that the VA needed to better plan for new veteran demographics, including an increased number of female and older veterans, as well as an increase in the special needs of younger veterans returning from Iraq and Afghanistan.
Nabors said the department plans to establish a panel of health care experts and industry leaders to make recommendations on scheduling. The agency in 2011 shortened its goal for scheduling appointments from 30 days to 14 and included the measure in performance contracts for directors.
He said the standard, which has since been removed, "creates an unrealistic comparison between VHA and the private sector."
The VA is also under scrutiny by its own inspector general, federal investigators and congressional committees.
Paul Rieckhoff, founder and CEO of Iraq and Afghanistan Veterans of America, a New York-based advocacy group, called the report "nothing new" and said it "only confirms the failures our members have been experiencing for years."
Noting the timing of the release, Rieckhoff said via Twitter: "Want to make sure nobody pays attention to your lack of real action on #VAScandal? Release a White House statement at 5PM on a summer Fri."
By Lesley Clark
McClatchy Washington Bureau