WASHINGTON — Robert Wilkie is slated to appear before lawmakers this week for the first time since he took over as secretary of the Department of Veterans Affairs two months ago.
The Senate Veterans’ Affairs Committee scheduled a hearing, “State of the VA: a 60 Day Report,” for Wednesday afternoon, where senators are expected to ask Wilkie about his plans for implementing several major, congressionally mandated reforms.
Wilkie, a former Pentagon official, was sworn in June 30 after months of political infighting under former VA Secretary David Shulkin. His dismissal this spring led to an exodus of other VA leaders.
Veterans groups are looking to Wilkie to bring stability to the embattled agency, and they expect to hear Wednesday how he plans to do it.
“I think he’s really walked into a tough situation,” said Bob Wallace, executive director of Veterans of Foreign Wars. “He’s really got a full plate in front of him, but I think he’s capable of meeting the challenge. I think he’s the right person at the right time for the VA.”
Here are a few issues Wilkie is likely to be asked about.
Implementing the VA Mission Act
Chanin Nuntavong, a director with the American Legion, said Wilkie has “huge undertakings” to tackle at the VA. The biggest could be implementing the VA Mission Act, a $52 billion, far-reaching bill approved in June that overhauls the VA’s private-sector care system and extends benefits to more Veteran caregivers.
Most of what’s in the Mission Act is supposed to be implemented by June 2019, but there are already concerns about whether the VA will meet that goal.
The Mission Act outlined dozens of deadlines for the VA to submit progress reports to Congress. Three reports were due Sept. 4. Of those, two were several days late and one still hadn’t been submitted as of Tuesday, according to the office of Sen. Jon Tester, D-Mont., the ranking Democrat on the Senate Veterans’ Affairs Committee.
The missing report pertains to the VA’s progress with extending benefits to Veteran caregivers. The Mission Act mandates that the VA provide benefits, such as monthly stipends, health care and medical training, to caregivers of Veterans injured before May 7, 1975.
“VA needs to be hitting these early milestones if it’s going to meet the later ones,” Tester said at a Sept. 5 hearing. “It needs to do better.”
Concerned Veterans for America, a conservative advocacy group, has also expressed concern about the VA meeting the deadlines, particularly those regarding the new program for private-sector medical care.
“It’s important for the VA to meet these deadlines to show that one, they’re taking this seriously, and two, they’re going to be transparent about it and show they can be trusted,” said Dan Caldwell, executive director of CVA. “If they can’t meet a deadline on a report for Congress, how can they be trusted to run the whole program?”
The Mission Act does away with the Veterans Choice program, which was created in 2014 to allow some Veterans to receive medical care in the private sector, but only when they live more than 40 miles driving distance from a VA facility or their wait for a VA appointment would be more than 30 days.
Some claim the Choice program was implemented hastily, and many Veterans thought the rules were too rigid. Under the Mission Act, Choice expires in June, and a new system is supposed to take its place.
Since I am in Denver investigating fraud, waste, and abuse this week, I wanted to give readers additional insight into the outlandish waste VA engages in when no one is looking.
Case in point is the recent exposure by Fox 31 in busing employees between facilities, a total of 176 yards, over five years while the new over-budget Aurora VA was built.
I can’t wait to check that out now that the facility finally opened at a staggering $1 billion above budget. How many underground bunkers did the deep state secretly build into that budget? I hope they came equipped with caviar and some top-shelf champagne.
Apparently, the five-year project involved specialty airport-transport buses that shuttled VA employees 176 yards:
The Problem Solvers’ latest discovery is a nearly five-year program which provided a fleet of employee-only shuttle buses to drive staff between the North and South doors of the facility during the construction phase.
A FOX31 investigative team spent significant time over the summer recording empty buses which drove in short circles.
At times, three airport-passenger-type shuttles ran on 12-hour schedules. Each bus had an assigned driver. Based on our observations, the shuttle vehicles idled with engines running the entire day. Operators would sit and wait for about half an hour in one of two roundabouts before swapping positions at a different door. If a passenger did arrive to be transported, that bus would drive the staff person to the opposing door, while an empty shuttle would drive the 176 yards to swap positions with the prior shuttle.
The VA spokesman provided the following explanation as to how the shuttling worked and why:
“Shuttle services began prior to construction of the Rocky Mountain Regional VA Medical Center. Building A (Clinic Building South) was the only building on the campus and an agreement between VA and USAF resulted in the Buckley AFB clinic being temporarily located on the 4th floor of Building A. The shuttle’s purpose was to ensure that Buckley AFB patients and VA employees had access to Building A during construction.”
When asked about cost, VA said they could not estimate the cost because there existed no line-item budget for the transportation program. This means, if VA wants to squirrel away money without oversight, they push the funds into something that lacks a line-item budget.
Luckily, Fox 31 investigated the matter to bring it into the light using a calculator and a little common sense:
The VA hired WG-6 employees to drive the shuttles. Based on pay scales, the average hourly wage for such employees is around $20 per hour.
FOX31 figured two full-time drivers worked approximately 1,462 days.
The VA said it “leased” the shuttles from General Services Administration over the final three years of the program at $768.30 a month per vehicle, plus $0.562 per mile.
Bottom line: the short bus route for VA employees cost at least $769,000 in tax funds.
Without an actual budget from the VA, the FOX31 Problem Solvers could not accurately or fairly calculate the cost of fuel, shuttle maintenance, mileage or the occasional use of a third shuttle and a third driver, so we did not include those. If added to the $769,000 known total, the cost of the transportation program could be several hundred thousand dollars more.
When it comes to the Aurora VA facility $1 billion over budget, you have to wonder how many other expenditures were unaccounted for and how many cronies or family members owned contracting companies that profited from the lack of oversight.
VA SAIL report scorecard shows majority of VA medical centers have improved over past year in quality of services provided to Veterans
Using a web-based report scorecard that measures, evaluates and benchmarks quality and efficiency at its medical centers, the U.S. Department of Veterans Affairs (VA) recently released data that showed significant improvements at the majority of its health care facilities.
Compared with data from the same period a year ago, the July 2018 release of VA’s Strategic Analytics for Improvement and Learning (SAIL) report showed 103 (71 percent) VA Medical Centers (VAMCs) have improved in overall quality — with the largest gains seen in areas where there were VA-wide improvement initiatives, such as mortality, length of stay and avoidable adverse events. Seven (5 percent) VAMCs had a small decrease in quality.
“This is a major step in the right direction to improving our quality of services for our Veterans,” said VA Secretary Robert Wilkie. “Over the past year, we were able to identify our problems and implement solutions to fixing the issues at 71 percent of our facilities. I’m extremely proud of our employees and the progress they have made to raise VA’s performance for our nation’s heroes.”
Additionally, of the 15 medical centers placed under the Strategic Action for Transformation program (StAT), an initiative that monitors high-risk medical centers and mobilizes resources to assist the facilities, 33 percent (five medical centers) are no longer considered high-risk and 73 percent (11 medical centers) show meaningful improvements since being placed under StAT in January 2018.
The quarterly SAIL report, which has been released publicly since 2015, assesses 25 quality metrics and two efficiency and productivity metrics in areas such as death rate, complications and patient satisfaction, as well as overall efficiency and physician capacity at 146 VAMCs. It is used as an internal learning tool for VA leaders and personnel to pinpoint and study VAMCs with high quality and efficiency scores, both within specific measured areas and overall. The data is also used to identify best practices and develop strategies to help troubled facilities improve.
Secretary of Veterans Affairs Robert L. Wilkie, visited the VA Southern Nevada Healthcare System Sept. 20 to meet with hospital administrators, speak with Veterans and employees, and talk about the way forward for the VA.
Since being sworn in, July 30, the new VA secretary has visited sites across the nation to learn and assure both Veterans and VA employees that his focus is on ensuring the department has the resources necessary to provide Veterans the care and benefits they’ve earned.
“In five weeks in office, this is the 10th hospital I’ve been to,” Secretary Wilkie said. “Part of my job, is getting outside of the nation’s capital, walking the post, listening, and trying to learn as much as I can so I can be a better advocate for our Veterans and employees.”
During his inaugural visit, Secretary Wilkie remarked on the positive things he saw – both within the VA and the Southern Nevada military and Veterans community as a whole. “Here in Las Vegas we see what the VA will become,” the secretary said. “The growth here is astounding. More than 1,000 Veterans come in to our VA facilities for care here every day. We also have a relationship between the VA and Nellis Air Force Base and I believe it’s a model for the future as we need to be better joined at the hip with the Department of Defense. [The community] is also moving forward with getting a new medical school here, which I think is the other prong of the VA’s future — being tied to academic and research institutions.”
While at the North Las Vegas VA Medical Center, Secretary Wilkie visited a prosthetics laboratory and wheelchair repair, and also had the opportunity to tour a Mobile Vet Center. He also met with several Veterans, including Red Coat Ambassadors as well as state and local Veterans service leaders. “What I saw are volunteers who are excited to be here,” the secretary said. “That’s an unsung part of the VA experience… Veterans want to be around people who speak their language. And it’s a unique language… It’s the language of service.”
Since taking office, one of Secretary Wilkie’s most important objectives is ensuring that each Veteran’s visit is a positive experience. “When a Veteran comes to the VA, nine times out of 10, he or she is very happy with the care,” he said. “What I emphasize is importance of every encounter or experience, which really is customer service.”
Part of improving the experience comes with funding and the secretary’s trip is part of a two-day visit that will see President Donald J. Trump sign the 2019 Veteran Affairs appropriation. “It’s the largest bill in the history of the VA, but it also reflects a change in the direction of the department,” Secretary Wilkie said, adding that one of the biggest changes within the VA going forward will involve an expansion of stipends for family home care. “We recognize family caregivers as the coming trend in health,” he said. “The greatest number of Veterans in this area are from the Vietnam era…and for those who served prior to May 7, 1975, this provides their families with stipends to provide care at home for their Veterans.”
As an Air Force officer, Secretary Wilkie wrapped up his visit stating that he appreciates the dedication of America’s service members. “I am soldier’s son. My military service, compared to my ancestors’, is modest. But being a part of an organization of folks whose very existence ensures that their fellow citizens sleep soundly at night is as great an honor as I can have. I am proud to be part of America’s obligation to those who have sacrificed so much.”
LAS VEGAS (KSNV) — It’s Veterans like Daniel Kaminski who United States Secretary of Veterans Affairs Robert Wilkie got to know Thursday.
Kaminski is a United States Navy Veteran. He’s a well-known wheelchair athlete who’s not letting his spinal cord injury stop him from enjoying life.
“The growth here in this part of Nevada is astounding,” Secretary Wilkie said.
He says the Veteran population is getting bigger and younger.
“It is astounding seeing the growth of this place. As an Air Force officer watching Nellis grow and then seeing the growth outside the gate and the changes in the population of Veterans in America,” Secretary Wilkie said.
He says big changes are coming to the Department of Veterans Affairs.
At the VA Southern Nevada Healthcare System in North Las Vegas, President Donald Trump will make history Friday, signing an $86.5 billion appropriations bill that will provide funding for the Department of Veterans Affairs.
“It also reflects the change in the direction of the department we are opening up the aperture for Veteran’s choice we are keeping the VA at the center of that Veteran’s experience,” Secretary Wilkie said.
White House officials are calling it the largest dollar amount ever for Veterans with $8.6 billion set aside for mental health services and $400 million towards preventing opioid abuse.
Thursday's visit has Secretary Wilkie excited for what the future holds for Veterans and their families.
“Veterans want to be around people who speak their language and it's a unique language the language of service and being around people who understand those specific those particular experiences,” Secretary Wilkie said.
ATLANTA -- In another blow to Marietta-based MiMedx, the Veterans Affairs Medical Center in Minneapolis has parted ways with four podiatrists and a dermatologist over improprieties with the company's bio-pharma products, a VA spokesman confirmed for The Atlanta Journal-Constitution.
The company is under fire amid accusations of "channel stuffing" by ex-employees -- lobbying friendly doctors and medical staffers to overstock and over-use products, thereby inflating revenue reports and driving up stocks.
In May, three South Carolina VA workers were indicted on federal health care fraud charges, accused of excessive use of MiMedx products on Veterans after accepting gift cards, meals and other inducements from a company representative. Two of the three workers were also charged with accepting bribes.
The company has launched an internal investigation, and in June, MiMedx announced that it will revise more than five years of financial statements. In July, prominent Atlanta businessman Parker "Pete" Petit stepped down as the company's CEO and chairman. The company remains under scrutiny from the U.S. Department of Justice, the U.S. Securities and Exchange Commission, the Food and Drug Administration and the Department of Veterans Affairs.
Details behind the Minneapolis doctors' departures aren't clear. The spokesman, Ralph Heussner, said the VA proposed terminating all five, but each opted to resign or retire. He confirmed that the proposed terminations involved issues with MiMedx products.
Huessner explained in an email that the doctors "engaged in behavior that is not in line with the norms and values of the department.
"VA has made clear that it will hold employees accountable when they to fail to live up to the high standards taxpayers expect from us," the email said, "and that's exactly what we're doing in this case."
After several years of uncertainty, the Department of Veterans Affairs has decided on a location for a permanent medical clinic.
According to an announcement from U.S. Rep. John Rutherford’s office, the VA has awarded a contract to build a St. Augustine Community Based Outpatient Clinic at 207 Stratton Rd. in St. Augustine — off of State Road 207.
The clinic will offer primary care, mental health services and specialty care to the more than 9,000 Veterans in St. Johns County who currently receive services at the interim clinic. The facility, which will be leased for 20 years at the outset, will be 16,595 square feet and is set to begin construction this winter with an estimated completion date of spring 2020.
“This is welcome news for Veterans in St. Johns County,” Rutherford said in an email statement. “We must always ensure that our nation’s Veterans receive access to timely and quality medical care, so I am pleased that this facility will expand services in Northeast Florida.”
It’s been a long wait securing a permanent home. The VA used to have its clinic at 1955 U.S. 1 South, but that property, which also housed the county health department, was purchased by Lowe’s for a new store.
After that, the VA built a temporary clinic at Southpark Boulevard and Old Moultrie Road that opened in 2015. VA spokesman Daniel Henry said that clinic will remain open as long as needed to accommodate patients.
“At no point will we ever stop serving Veterans,” Henry said. “We’ve been working very closely with the community to upgrade our ability to take care of Veterans there.”
According to St. Johns County Veterans Council chairman Bill Dudley, it’s good for Veterans to know they are going to have a place to go for care for years to come.
“We’re happy that we finally have a location for a permanent home for our Veterans’ health care services,” Dudley said.
The location itself is not exactly what Dudley was pushing for when he met with VA representatives during the bidding process. He said he advocated for a site close to the relocated health department facility on San Sebastian View. That’s also close to the other county administration offices, including the Veterans Services office.
Dudley said that might have made things easier for Veterans because so many services would have been clustered together.
In the end, the site near S.R. 207 was chosen. It’s close to the current clinic and also fairly close to Flagler Hospital.
“The bottom line is that, for the most part, the Veterans were anxious to just get a permanent home location selected, so that has now been achieved,” Dudley said.
It’s unclear what will happen with the temporary clinic since it will remain operational for about another year and a half. Henry said there are no definite plans yet.
Dudley and others in the Veteran community obviously would have preferred a permanent solution right after the previous location was sold. However, he said the temporary clinic was a much better option than having to travel out of town for care.
“We did not want to see any interruption in our health care services for our Veterans in the county,” Dudley said. “In that respect, we were happy with the interim solution.”
The new clinic will be entirely a VA project. The county government has no financial obligation in the new clinic.
System works to identify drugs to ‘deprescribe,’ better aid person, save money
By the time Dr. Sara Swathy Battar sees patients at the Veterans Affairs hospital in North Little Rock, they often have long lists of medications.
It struck Battar, the associate chief of staff for geriatrics and extended care for the Central Arkansas Veterans Health Care System, that there was no standardized medical tool for taking patients off their medications.
After some time, the same drugs that once saved someone's life are no longer needed and can have unpleasant or dangerous consequences.
"Every medicine is a poison with a desirable side effect," Battar said.
In 2016, Battar and her team developed a "deprescribing" method, which has saved the central Arkansas VA millions in cost avoidance and is now beginning to be implemented across the country.
The tool, called VIONE, uses five categories to help health care providers, patients and families work together to identify medications that are necessary and helpful and those that are not needed, which should be "deprescribed" -- stopped or decreased.
Battar's collaborators on the project were academic detail pharmacist Kim Dickerson and Tim Cmelik, chief of pharmacy for the central Arkansas VA.
The V in VIONE stands for vital, lifesaving medications that a patient should continue taking, such as diabetes medication. The I stands for important -- quality-of-life medications that improve the way a patient feels, such as those that treat pain and constipation. Those should also be continued, Battar says.
The O stands for optional, representing medications that don't make any difference in how a patient feels and could be discontinued.
"It's a chemical in your body," Battar said.
The N is for not indicated -- medications that do more harm than good and should be stopped.
Every medication has a reason to be taken -- that's the E, and one of Battar's mantras. If a patient or his family isn't sure why the patient is taking something, he should consider getting off it, Battar says.
Since VIONE was implemented at the central Arkansas VA about 2½ years ago, the method has saved the system an annualized cost of about $2.5 million. The team reviewed more than 8,000 Veterans' medical regimens and "deprescribed" more than 14,000 medications -- an average of 1.7 medications per person reviewed, Battar said.
It's a simple approach, but it's something patients and families often don't think about, Battar said. Hot Springs resident Kim McCraw said she hadn't.
McCraw had cared for her husband, Tom, by herself for eight years. The Air Force Veteran had been diagnosed with early-onset Alzheimer's disease at age 55. The disease had transformed "a man who had the patience of Job" into someone who was constantly agitated and unable to communicate, she said.
He was prescribed low doses of antipsychotic drugs, then hospitalized. The illness, along with the four medications he was taking, eventually put him in a fog, nearly sedating him, she said.
Then Battar proposed taking him off one drug at a time to see if it would make a difference.
"The same medication that helped fix this man -- maybe he didn't need it anymore," McCraw said.
Later, when VA staff members called her to say that her husband was up and walking, she thought they were talking about the wrong patient. Her husband hadn't walked in months.
As the Alzheimer's took its toll, McCraw said her husband wasn't always verbal, but going off some of his medications during his last months of life returned the "spark" of who he was previously. He died in April.
Because of that, she said, her memories of the visit the day before he died are ones where he was mentally present and loving. She remembers his joy while listening to music, him telling her that her purple shirt looked beautiful, him telling her that he loved her.
"It didn't save his life, but it gave him a quality of life in his last months that he would not have had otherwise," McCraw said. "They brought a piece of him back."
Many of her patients are elderly or frail, Battar said. They can have a plethora of ailments, ranging from long-term illnesses to past injuries, with prescriptions to match.
The thought of someone on so many medications toward the end of his life makes her squirm, Battar said.
Some might have seen a private specialist for aches, pains and other complaints, while others might have a health condition such as diabetes. Some might get over-the-counter medications for constipation, headaches, stomachaches, coughs, colds and other conditions that go away in a few days.
"They do not realize that all of those medicines can fight with each other," Battar said.
Additionally, some patients may not consistently take all of the medications they are prescribed, but get refills anyway, which is costly for the VA. Lots of prescriptions can also result in opioid addiction and abuse, Battar said, which is something else her system can address.
Nationally, about 40 percent of adults aged 65 and older were taking five or more medications in 2010, compared with about 13 percent in 1998, according to a 2010 study from researchers at Oregon State University.
VIONE was identified as a "gold status" practice in a Shark Tank-style competition encouraging innovative practices in the national VA system in 2017. It was selected for national dissemination in May by the U.S. Department of Veterans Affairs Diffusion of Excellence office.
Battar has shared the method with 26 other VA hospitals across the nation, at their request, she said. Some have already started implementing it. She said she hopes VIONE will become a household name in the medicine world.
"We have created some small ripples, and now we are seeing some huge tidal waves," Battar said.
LAKE CHARLES, LA (KPLC) -There are allegations of patient neglect, fraud, and other corruption concerning home health care provided to Veterans in Jennings.
In addition to this clinic in Jennings, frail Veterans who are home bound are provided with home health services. According to complaints filed by two former employees the system is fraught with corruption.
One former employee says there was patient neglect, falsification of Veterans’ medical records, fraudulent billing, misuse of government vehicles, tampering with vehicle tracking systems and more.
Local Veteran and advocate for others, Jim Jackson, has no first-hand knowledge of the situation, but he says he’s not shocked or surprised.
"Where there's this much smoke, we better look for the fire, we better put it out. And it goes back to supervision. Without the supervision, quality supervision, quality people throughout, we don't have anything. The VA doesn't have anything."
Another part of the complaint describes nurses allegedly documenting home visits, miles traveled and serves when logs show the cars never moved.
"It's a paper trail. So, these people who drove three and four hundred miles in a half a day and saw nine patients, but their paperwork was straight. Did they see anybody or do anything? Probably not."
There is even one allegation about fraudulent visits after a patient had passed away.
Jackson says the VA needs more employees who care about Veterans.
"We have so many people who are there for the insurance, for the paycheck, for whatever and so few there for God and country to be responsive to the needs of that Veteran."
A spokesman says the VA takes the allegations seriously and that their office of accountability and whistle-blower protection is looking into them.
Both former employees say they have suffered retaliation and have filed complaints seeking whistle blower protection.
VA critics say other reports back up complaints
A draft report from an internal investigation into the Manchester VA Medical Center states that most claims made by whistleblowers about the care there are unfounded, but the report is being criticized as biased.
The 62-page report obtained by News 9 is from the Office of the Medical Inspector, which is an office in the Department of Veterans Affairs. It details the office's findings regarding claims made by 12 former Manchester VA staff members.
Among the complaints were that operating rooms weren't properly cleaned or cared for, that blood and rust were present on surgical instruments and that patients with cervical myelopathy were victims of malpractice.
According to the OMI, those claims were unfounded.
The report also addresses the whistleblowers, saying they became "distrustful and frustrated when they felt as if their clinical concerns were not addressed by their leadership."
But critics of the VA said the motivations behind the writers of the report are clear.
"It's a PR move. It's pure and simple," said Andrea Amodeo-Vickery, a lawyer for the whistleblowers. "The other three reports weren't publicized yet. They substantiated these same claims that this new report didn't substantiate."
“Oh, I think they have it terribly wrong,” said Dr. Stewart Levenson, former chair of the department of medicine at the Manchester VA and one of the whistleblowers. “There are several incidents that are truly tragic, where they say there are no problems because they followed VA protocols, which are blatantly wrong.”
Levenson said the VA system needs faster, safer patient care.
“The patients, the Veterans, suffer the most,” he said. “Several suffered horrible complications, maybe even death, because they didn't get their care on a timely basis.”
U.S. Rep. Annie Kuster, D-N.H., who is on the House Veterans Affairs Committee, also questioned the findings.
"I have spoken with highly regarded physicians that have serious concerns about the quality of care, and thus, I question the outcome of this particular investigation," she said.
Kuster said she's pleased with the current leadership at the Manchester VA and has asked the U.S. Office of Special Counsel for an independent investigation into the VA's previous practices.