At the VA, concerns increasing about top leadership and outside meddling

RobertWilkieVA-150x150One of the nation’s largest health systems faces yet more serious questions about its leadership and external meddling in the quality and safety of its care. So, once again taxpayers may be asking themselves, with anger, What the heck is going on now at the top of the Department of Veterans Affairs?

Internal watchdogs have formally opened an investigation of Roger Wilkie, the VA’s chief, over allegations that he used his office and authority to dig up dirt on a Democratic aide who complained that she had been propositioned and groped by a man in the main lobby of the Medical Center here in the District of Columbia.

The claims were investigated, and authorities declined to pursue it further, including with the filing of any charges.

But Democrats in Congress have complained about how Wilkie reacted to the complaints. Preliminary scrutiny by the VA’s inspector general indicate that he may have inquired in U.S. Navy records as to whether the aide involved had made sexual harassment claims before while in the military. He discussed his purported findings with his staff, including suggesting — a notion not followed up — that VA public affairs staff use information he had dug up to discredit the woman and her complaints.

He has been rebuked for commenting at all about the case by veteran groups, including the American Legion and AMVETS. In the #Metoo era, his unusual intervention in the case, critics say, raises leadership and ethical issues in the VA, which is charged with making good on the nation’s high pledge to provide quality care to almost 9 million qualified service personnel and their families. As the Washington Post reported:

“With a growing population of female veterans returning from the wars in Iraq and Afghanistan, VA has struggled to address their health-care needs and ensure they do not face harassment in its sprawling health-care system. Sexual harassment remains a significant problem at hospitals and clinics, leading to campaigns to stop misconduct in the health system. But the latest one, which calls for bystander training for employees, does not make the training mandatory. Advocates say agency leaders have not publicly embraced the effort, which varies in intensity among facilities. The health-care system has long struggled to hire primary and specialty care physicians who are equipped to meet the unique health care needs of women returning from service.”

The newspaper describes other agency priorities where Wilkie is under fire, reporting:

“The agency’s signature policy under Trump, an aggressive expansion of private health care for veterans known as the Mission Act, is facing ballooning costs since it launched last June, officials told lawmakers this month. They acknowledged they do not know how many veterans are participating and whether patients are waiting shorter times to be seen by private doctors when compared with the VA system. Wilkie has delayed a planned rollout in Washington state in March of a $16 billion overhaul of its aging medical records system amid technical problems. And an office formed early in Trump’s tenure to encourage whistleblowers to come forward with reports of misconduct by senior officials remains in disarray months after a scathing inspector general report said it was failing in its most basic mission. ‘We’re definitely concerned about the turmoil,’ said Randy Reese, executive director of Disabled American Veterans. ‘They have culture issues and leadership challenges they need to get a hold of.’”

Wilkie also has raised concerns in Congress by firing his agency’s No. 2 official without explanation. Lawmakers say top appointees should be free to choose their executive teams. But the abrupt dismissal has created more questions than is good for the VA, critics say.

The VA’s problems at the top may trace not just to agency personnel but all the way to the White House, according to reports from ProPublica, a Pulitzer Prize-winning investigative site.

The news organization earlier had reported a head-scratching investigation on how President Trump allowed three pals from his Mar-a-Lago country club —Marvel Entertainment chairman Ike Perlmutter, physician Bruce Moskowitz and lawyer Marc Sherman —  to intrude into top aspects of VA operations: “As revealed by ProPublica in 2018, Trump gave the three men sweeping influence over the VA despite their lack of any relevant experience, such as having served in the U.S. military or government.”

ProPublica said that agency officials and lawmakers alike were puzzled and frustrated that, with the power of the White House seemingly behind them, the three called top VA officials and demanded discussion and accounting on agency work, including multi-billion-dollar projects in which none of the men had any expertise.

The House veterans affairs and oversight committees, led by Democrats, have followed up the ProPublica reporting. Lawmakers have started to dig into the three men’s activities, focusing on what if any ties they may have with Big Pharma and the drug making titan Johnson and Johnson. Did Perlmutter, Moskowitz, and Sherman have a role in Trump’s public enthusiasm for the J&J drug Spravato, a nasal spray that can be prescribed for treatment-resistant depression. The president has touted the drug as needed to help deal with the veteran suicides.

This is a serious problem, as the Military Times has reported:

“In the last four years, the official government estimate on the number of veterans who die by suicide has gone from 22 a day to 17 a day in the latest Veterans Affairs report. But the rate of suicides among veterans didn’t decrease over that span. Instead, the way the figures are sorted and presented did. Instead, outside experts note that by many markers the problem has grown even worse. The total number of suicides among veterans has increased four of the last five years on record. From 2007 to 2017, the rate of suicide among veterans jumped almost 50%. Veterans are 1.5 times more likely to die by suicide than Americans who never served in the military. For female veterans, the risk factor is 2.2 times more likely.”

Although research offers cautions about Spravato, particularly as a wider treatment for the suicidal, J&J has targeted the VA as a potentially large buyer of its product, ProPublica reported. And the House committees have taken note of this:

“In 2017, the Mar-a-Lago advisers worked with the VA and Johnson & Johnson on a suicide-prevention awareness campaign that culminated in an appearance at the New York Stock Exchange. The event put the VA secretary alongside Johnson & Johnson representatives and superhero characters from Perlmutter’s company, Marvel, and its parent, Disney.”

The president’s friends have not decided whether to comply with the House’s now-voluntary requests for information. The VA, whose spokespeople have defended Wilkie, has said its dealings with J&J about Spravato have been routine. J&J also has defended its pitching of Spravato.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the ordeals that service personnel and their families must endure if they or their loved ones are seriously hurt by negligent medical care at a hospital or clinic run by one of the armed services or the VA. Congress and the president recently gave this important group of Americans half a loaf when it comes to a fundamental constitutional right — their chance to seek justice in the civil courts if they suffer harms while receiving medical services in noncombat situations.

They now have a little more leeway to pursue malpractice claims, still in a military system and not in the civil justice system that protects civilians.

But what will shield them from the president’s haphazard dealings at the top of the VA? Several men have headed the agency during Trump’s time (including interim chiefs Robert Snyder and Peter O’Rourke). Trump fired his first pick, David Shulkin, after a tempestuous run and controversies over whether the White House had pushed too hard to privatize to many VA functions and services. The president then sought to elevate Dr. Ronny Jackson, his personal physician, to run the VA. Jackson withdrew from consideration from the post after a barrage of claims about his misconduct and major questions as to whether he lacked the experience to run “a massive health care operation of more than 370,000 employees … and has a budget of nearly $200 billion,” NPR reported.

Wilkie emerged as a VA leader after Trump elevated him temporarily to run the agency after the bungled Jackson nomination. Wilkie, a reserve Air Force officer, had worked as a less-known official for decades on the Hill and with Pentagon, including for former Defense Secretary Jim Mattis. Wilkie’s long labors for conservative lawmakers like Trent Lott and Jesse Helms gave him a leg-up when the president decided to turn his interim appointment permanent. He has upset some administration officials, though, by lobbying to leave the VA and to land in other posts, perhaps back at the Pentagon.

Perhaps the president should consider letting him out of his post, in favor of an official who not only can quell the unacceptable and unwanted top-level hijinks at the agency but also who wants to ensure that the VA, which wins many praises for the overall quality and safety of hits medical care, serves vets and their families — not political interests of careerists or ill-informed meddlers.

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