A Former Top VA Executive Offers His Perspective on What Went Wrong

Many factors have contributed to the Veterans Affairs waiting lists debacle, but the number of returning soldiers from Iraq and Afghanistan was hardly a major factor, said a former top VA official who believes the real problem is bad management that goes beyond the bureaucratic mess of the past.

HINES, IL - MAY 30: A sign marks the entrance to the Edward Hines Jr. VA Hospital on May 30, 2014 in Hines, Illinois. Located in suburban Chicago, hospital has been linked to allegations that administrators kept secret waiting lists at Veterans Administration hospitals so hospital executives could collect bonuses linked to meeting standards for rapid treatment. Today, as the scandal continued to grow, Veterans Affairs Secretary Eric Shinseki apologized in public and then resigned from his post. (Image source: Scott Olson/Getty Images)

Low productivity – such as some specialists seeing only two patients per day – and the decision to increase the number of non-service-related medical conditions treated also have significantly contributed to the problem, said Darin Selnick, the former special assistant to VA Secretary Anthony Principi from 2001 to 2004.

“The VA has all the funds it needs and all the staff it needs,” Selnick, a retired Air Force captain, told TheBlaze. “It's just bad management.”

The VA estimates there are 2.1 million veterans from Iraq and Afghanistan. Of that number, 616,487 had VA health care in 2013, according to the department. The VA estimates 689,974 will be treated in 2014. The percentage of post-9/11 veterans more than doubles the percentage of the 1991 Gulf War, but that doesn't mean it's insurmountable for VA's resources.

“It's smoke and mirrors. There has always been a continued rate of increase. You didn’t have two million dumped on the VA,” Selnick added. “About 11 percent of the veterans [enrolled for VA care] are post-9/11. That's not going to overwhelm the system.”

This hasn't stopped others from blaming the two wars of the past decade for what top government officials now admit is a systemic problem in the department's medical facilities across the country.

House Minority Leader Nancy Pelosi (D-Calif.) said President Barack Obama “sees the ramifications of some seeds that were sown a long time ago, when you have two wars over a long period of time and...millions more veterans.”

In a White House speech last month on the VA problems, Obama also implied the issues stem from the two wars. “We ended the war in Iraq and as our war in Afghanistan ends, and as our newest veterans are coming home, the demands on the VA are going to grow,” the president said.

“The greatest number is from Vietnam,” Selnick said. “The World War II generation is dying off. Vietnam veterans are in their 60s and 70s now.”

Veterans Affairs Secretary Eric Shinseki resigned Friday over the waiting lists scandal two days after a scathing report from the VA's inspector general said the problem was national in scope. The IG report stated 1,700 veterans were waiting for appointments at the Phoenix medical facility but were not on the official waiting list. It also found that some veterans had to wait for 115 days to get appointments. The report did not address reports of whether 40 veterans have died while waiting for care.

Selnick, now a senior VA advisor for Concerned Veterans for America, blamed Shinseki and political employees in the VA for allowing a culture of poor accountability and said a good secretary could have prevented some of these problems.

“There has always been a customer service problem and a problem with bureaucracy,” Selnick said. “It doesn't take much for an already shaky system to melt down.”

[sharequote align="center"]“It doesn't take much for an already shaky system to melt down.”[/sharequote]

The VA said 8.9 million are enrolled in the system. But Selnick said fewer than six million of those enrollees are veterans — the remainder are spouses and other family members.

The VA faced a heavy demand for benefits in 2002 after Congress expanded eligibility. Then-VA Secretary Anthony Principi froze new claims for non-service-related disabilities while existing claims were grandfathered. Selnick said this policy, implemented during his tenure, worked in ensuring that the most urgent cases, such as veterans wounded in combat, were treated first and not put on a waiting list.

But Shinseki increased that service for non-combat injuries by about about 30 percent, Selnick said.

A VA spokesperson deferred questions from TheBlaze to the inspector general report.

The department has faced some genuine problems, said Joe Davis, director of public affairs for Veterans of Foreign Wars and a former Air Force sergeant.

Asked whether the VA is facing an insurmountable case load or if the agency is just performing worse than before, Davis answered, “all of the above.”

“The influx of new veterans with three times to four times more claims per person than previous generations, not the least of which are (traumatic brain injuries) as the result of the enemy’s preferred use of IEDs, and (post-traumatic stress disorder) as the result of multiple tours and other exposures to abnormal events” contributed to the backup, Davis told TheBlaze in an e-mail.

Davis objected to “calling this a scandal.” He said it was instead a “crisis in care and confidence.”

[sharequote align="center"]A “crisis in care and confidence.”[/sharequote]

He added there were additional cases of veterans with Agent Orange from Vietnam and those with Gulf War syndrome straining the system.

The New York Times recently reported that in the last three years, VA primary care visits increased by 50 percent but the number of primary care doctors only increased by 9 percent.

That said, The Daily Beast recently reported that some VA doctors apparently aren't working that hard.

There are eight cardiologists at the VA facility in Albuquerque, Virginia; but some are seeing two patients each day, or about 36 patients per week. For perspective, the Daily Beast cites a 2013 survey of medical professionals that found 60 percent of private-practice cardiologists see 50 to 124 patients per week, more than the entire practice at the Virginia clinic in question sees in a week.

Selnick believes this is indicative of a larger problem of poor productivity by the department. He said the VA has 33 specialties, but there is no staffing plan for 31 of those specialities to determine how to address the anticipated patient load.

“It's not (that) there are not enough doctors, it's just that they are underutilized,” Selnick said. “It's not the amount of doctors; it's the amount of productivity.”