TEMPLE, Texas (Dept. of Veterans Affairs & KWTX) - The Department of Veterans Affairs has named Baylor graduate Michael Kiefer as the new medical center director for the Central Texas Veterans Health Care System in Temple.
In a news release, Network Director Jeffery Milligan, VA Heart of Texas Health Care Network, said. “His (Kiefer's) sound leadership qualities and proven experience will be valuable assets for the health care system, the employees, volunteers and most importantly, the Veterans we are honored to serve.”
Kiefer is a retired Army Veteran with more than 28 years of service with an emphasis in health care leadership.
His previous VA health care experience includes serving as the medical center director of the Amarillo VA Health Care System, acting director of the VA Heart of Texas Health Care Network, and the medical center director of the West Texas VA Health Care System in Big Spring.
Kiefer’s also served as the regional chief of staff of the Northern Regional Medical Command in Fort Belvoir, Virginia; commander of the Weed Army Medical Center in Fort Irwin, California; regional chief of staff of the Pacific Regional Medical Command at Trippler Army Medical Center, Hawaii; and chief of staff of the Carl L. Darnall Army Medical Center in Fort Hood, Texas.
Certified through the American College of Healthcare Executives, Kiefer holds a master’s degree from Baylor University and a bachelor’s degree from Lehigh University in Pennsylvania.
“Michael has an exceptional background and possesses the leadership, knowledge, and skills necessary to successfully lead the Central Texas Veterans Health Care System into the future,” said Milligan.
Kiefer's appointment is effective July 21, 2019.
"Things need to change. The culture (at the VA) needs to change"
LAS VEGAS (KTNV) — Veterans hospitals are back under fire on the national level. And some of the issues coming to light in hearings in Washington, DC mirror the ones 13 Action News exposed here in Nevada.
The Department of Veterans Affairs clearly knows there's a problem. Just this week, the Office of Inspector General released this report , and the very first sentence highlights the VA's "...chronic healthcare professional shortages since at least 2015."
Congress is now learning more about problems with the VA's work culture as whistleblowers testified on Capitol Hill.
The problems were nearly identical to ones we've exposed here in Las Vegas.
"Things need to change. The culture there needs to change," said Dr. Brian Werner.
"Yes absolutely," said Dr. Victoria Smith. "The VA is a numbers company. There's no other way of looking at it."
Our investigation as recently as April detailed claims from more than a dozen current and past VA doctors and employees. People who describe a culture of fear at the Southern Nevada VA.
"Morale was terrible," said Dr. Smith. "People were unsure whether they were going to have a job."
And it isn't an isolated problem. Whistleblower hearings before the house Committee on Veterans Affairs show just how widespread it has become.
After Dr. Katherine Mitchel blew the whistle in 2014 about manipulation of patient wait lists, she received a federal employee of the year award. But she says that didn't mean real change.
"I've been described by the VA as a whistleblower success story and as definitive proof that the VA embraces whistleblowers," Mitchel told lawmakers. "However nothing could be further from the truth. Unfortunately VA administrators today still continue to retaliate."
Here in Las Vegas Dr. Brian Werner left the Southern Nevada VA earlier this year after he says instead of addressing problems he raised, VA leadership turned the tables and investigated him.
"We're supposed to be transparent," Werner said. "You're supposed to have these agencies and whistle-blowers and all these things you can file but the reality... it really doesn't work like that and people are afraid to come forward."
"I've had patients that I've taken care of that were discriminated against because they had somebody who was advocating for them," said Smith. "And it's a sad situation. I hate seeing our Veterans be short-shifted like this.
A psychologist from Maryland says she was pressured to reduce wait-list counts by scheduling fake appointments in an imaginary clinic. She was terminated the day before this hearing, where she tried to spotlight staff retaliation.
"After I started voicing my concerns about their improper wait list practices, the agency threatened to remove me as coordinator of the program and transfer me to a different area of the hospital," Minu Aghevli told lawmakers. "I have experienced constant harassment, scrutiny and frivolous investigations. Management has stripped me of authority in ways that have been humiliating. I am exhausted."
The dozens of current and former staffers we've spoken to say it's an ongoing problem here and the primary cause of turnover and staff shortages,which directly impacts patient care.
The Southern Nevada VA is approved for 3160 positions. That includes 400 new positions added in just under two years. The VA says 517 are "in various stages of hiring." 259 of those will start soon or are awaiting final clearance, including about 30 physicians . Which leaves 258 vacancies the VA is actively trying to fill in Las Vegas including more doctors.
In response to this investigation, the Southern Nevada VA provided the following statement:
VA posts all of its vacancy info publicly online
However, the best indicator of adequate staffing levels is not vacancies, but Veteran access to care and health care outcomes. By those standards, VA is doing well.
VA is seeing more patients than ever before, more quickly than ever before, it has more employees than ever before, its budget is bigger than ever before and Veterans are more satisfied with wait times than they have been previously. Consider the facts:
- VA completed more than 58 million internal appointments in FY 2018, a record and 623,000 more than the same timeframe the year prior.
All VA health care facilities now provide same-day services in primary and mental health for Veterans who need them.
- A 2018 Rand study found that the VA health care system “generally delivers higher-quality care than other health providers.”
- A 2018 Dartmouth study found that VA hospitals outperform private hospitals in most markets
- A recent study in the Journal of the American Medical Association (JAMA) shows that VA wait times are shorter than those in the private sector in primary care and two of three specialty care areas.
It also found that access to care at VA health centers improved from 2014 to 2017 and patient satisfaction with VA appointment wait times is improving.
VA staffing plans consider normal rates of workforce turnover, retirement, and growth, and the expectation that there will always be vacant positions.
Each year, VA hires more employees than it loses to replace turnover and keep up with the growth in demand for services.
- As stated in the original response “the best indicator of adequate staffing levels is not vacancies, but Veteran access to care and health care outcomes. By those standards, VA is doing well.” Locally, we served an all-time high of more than 63,400 Veterans in Fiscal 2018 and completed a record 910,600 outpatient appointment – an annual increase of 53,300 appointments from where we were just two years prior. We also provide same-day services in primary and mental health for Veterans who need them and offer a myriad of telehealth options to meet our Veterans needs.
- As of June 26, 2019, VASNHS had 3,160 approved positions with 517 in various stages of hiring. Of those, we have selected individuals for 259 positions and are either awaiting the new employees’ arrival or are working final clearances for onboarding. The remaining 258 positions are in various stages of recruitment (75 being prepared for advertisement, 80 currently being advertised on usajobs.gov , 42 announcements closed with applications being screened by human resources, and lists of qualified candidates for 61 positions with hiring managers to review and make selections).
- Of note, many of these positions are new. Since October 2017, the VA Southern Nevada Healthcare System has added nearly 400 new positions locally to meet the needs of the expanding Southern Nevada Veterans population. This includes approximately 70 new positions in behavioral health, 106 new positions in support of a new 20-bed inpatient ward and 20-bed psychosocial residential rehabilitation treatment program ward; and 40 new positions to coordinate Veteran’s care within the community as part of the VA MISSION Act.
- Recently, the VA Southern Nevada Healthcare System hosted its first-ever nursing career fair. Over two days, the facility interviewed 144 candidates for a myriad of open registered nurse positions and extended job offers to 53. The event was a huge success and VASNHS plans to conduct similar events in the future to attract candidates for other career fields and openings.
- Nevada ranks 47th for physicians, 48th for nurses and 50th for behavioral health specialists per capita, creating strong competition for health care professionals. Ensuring VASNHS is properly staffed to meet the needs of Southern Nevada’s growing Veterans population is a top priority, however we face many of the same common challenges as the rest of the health care industry locally and nationally. VASNHS is actively addressing these issues and will continue to recruit the best qualified candidates to care for our Veterans.
One of the pressing issues facing Veterans in rural communities is the lack of fast, reliable internet service, or any internet service at all. According to VHA’s Office of Rural Health, 42% of rural Veterans enrolled in VA do not have internet access that would support their use of VA telehealth and other online services.
Rural areas may be those that are sparsely populated, or that are not closely linked socio-economically to larger urban centers.
The lack of those rural Veterans’ access to reliable internet at home is known as “the digital divide.”
VHA, together with Microsoft, as well as with other nongovernmental partners such as national wireless service carriers, Walmart, and Philips, is helping bridge that digital divide. These partnerships aim to broaden Veterans’ access to learning, working, communicating, and accessing VA services and benefits online which in turn enhances Veterans’ digital inclusion and their ability to participate in their own health care.
Veterans in rural areas may face complex health care challenges that could be eased by having access to reliable internet and telemedicine according to the Office of Rural Health. For example, Veterans in rural areas may experience fewer transportation options or challenging journeys to receive care.
Eliminating 230-mile drive to VA medical center
Before a telemedicine clinic was established in Elko, Nevada, Veterans who lived in that rural area had to travel to VA medical centers located in other cities at least 230 miles away.
VHA has worked to address the digital inclusion challenges faced by Veterans in rural areas in many ways.
- VHA has partnered with T-Mobile to host the VA Video Connect application for Veterans (which connects Veterans to their health care providers on a secure line from any location) on all devices with T-Mobile service for free without using up their data.
- We have partnered with Walmart, Philips, and Veteran Service Organizations to set up remote clinics—known as Atlas sites—for Veterans to access telehealth services closer to their homes; and it has loaned internet-connected iPads to Veterans in need of a telehealth solution but who didn’t have a home computer or internet access.
Most recently, VHA has entered into a partnership with Microsoft aiming to improve rural Veterans’ online access to VA services and benefits. VHA’s offices of Community Engagement, Connected Care, Rural Health, Telehealth Services and VA’s Office of Information and Technology, will work with Microsoft in this partnership.
The partners will help identify opportunities to bring broadband internet access to rural areas of the country with large populations of Veterans who have limited internet access, and who might benefit from online VHA services and benefits.
The Microsoft Airband Initiative partners with internet service providers (ISPs) to identify and provide broadband access to rural communities across the U.S. who currently lack such access.
In alignment with the Microsoft Airband Initiative, Microsoft will work with its ISP partners to develop and grow Airband program offerings for the Veteran population as well.
Dr. Kevin Galpin: “VA has a goal of making all primary care and mental health teams available by video by the end of 2020. To access video technology in the home, Veterans must have reliable internet, and through partnerships like these, the digital divide can shrink.
“We really want Veterans to have the opportunities that come with being connected. There is lots of value in being able to maintain social relationships, conduct job searches online, and connect with VA. We know limited internet access is a problem and we’re exploring a multitude of options. We’re looking out for Veterans.”
The nation’s VA medical centers lack proper oversight says a new audit report from the Government Accountability Office (GAO).
With 1,200 medical facilities, regional offices called Veteran Integrated Service Networks (VISNs) are not properly monitoring staff levels. Setting business and finance strategies, the 1,000 employees working in the facilities lack clearly defined roles to oversee medical centers.
“It is important for an organization to have both individual and organizational-level performance measures to help monitor performance,” GAO said.
Lack Proper Performance Measures
But VA does not use appropriate performance measures.
Instead, VA has no policy to deal with poorly performing regions. So who is watching the watchers? No one, apparently.
Further, dubious VISN directors could easily obscure data revealing the VISN “has failed to meet its objectives.” Compounding matters these same directors are evaluated on metrics that have nothing to do with oversight of its medical facilities.
So how do you hold them accountable if their bonuses and performance metrics are not tied to the performance of the subordinate medical center?
Many VISNs fail to fill key oversight roles ensuring the circular process continues into infinity.
“By establishing a process for assessing the overall performance of VISNs in managing and overseeing medical centers, VHA would be better able to determine if a VISN’s performance is positive, if it is functioning poorly, or if it requires remediation,” GAO said.
Perhaps this explains why and how the system continues to maintain its broken ways.
One of my friends, Lauren Price at Veteran Warriors, wrote up the anatomy of whistleblower retaliation. When you think of the context of limited direct VISN accountability, the following makes a lot of sense, in italics below.
Life Cycle Of A VA Scandal
- Event(s) occur. Leadership notified.
- Leadership makes deliberate efforts to conceal event(s).
- Whistleblower(s) go public about event(s).
- Leadership removes whistleblower(s) from position(s).
- Leadership begins retaliatory actions against whistleblower(s)
- Event(s) facts are leaked to the media.
- Congress “demands action”.
- Leadership thanks Congress for oversight.
- Congress orders an investigation.
- Leadership concurs with investigation recommendations.
- Whistleblower(s) are/is fired.
- Wash, Rinse, Repeat.
- Pick a scandal, any scandal over the history of the agency.
Lauren is not wrong.
Without direct VISN accountability, the ability of leaders to retaliate will go on forever. And, Veterans will be at risk.
Wait List Scandals Continue
Wait list scandals are now commonplace at various VA facilities where agency leaders pressure clinicians to doctor wait lists to make the facility’s performance appear better than it is.
Today, Congress is holding hearings to address three new sets of whistleblower retaliation not unlike other stories exposed since 2014.
Veterans who need care are unable to access that care because of scheming agency leaders gaming the system. While the names sometimes change, as Lauren’s example explains, the strategies are the same.
Last week, I wrote about the Linda Loma VA cover-up of deadly Legionella outbreak where facility leaders tried to cover-up an outbreak.
That decision put Veterans and employees at risk of illness and death. Even though Congress is now demanding answers, will anything happen?
Without VISN accountability, there can be no ground level changes.
A Department of Veterans Affairs health care worker said she received a letter from the agency on Monday notifying her that she would be terminated, just one day before she was scheduled to testify at a congressional hearing about how the VA treats other whistleblowers.
Baltimore psychologist Minu Aghevli said she received the letter, which outlined the VA Maryland Health Care Center's proposal to terminate her employment, after working for the agency for nearly 20 years and raising concerns for years about the quality of patient care and manipulating wait lists in opioid treatment programs. In an earlier letter, the VA says she was facing disciplinary action for treating a patient at a non-VA hospital and violating the agency's code of conduct, but she and her lawyer argue the agency is retaliating against her for raising concerns about problems within the department.
The agency denies that the notice was related to her testimony.
The VA has faced dozens of complaints from whistleblowers who say they were retaliated against for raising concerns about the quality of medical care for Veterans or actions by agency officials, according to the agency that handles whistleblower complaints from federal employees. Aghevli and two other whistleblowers from the agency testified in front of the House Veterans' Affairs Committee on Tuesday saying the agency has a culture of trying to silence or punish people who report problems.
Aghevli called the termination proposal scary, because she said it appears to be a warning shot to ward off other potential whistleblowers.
"This feels obviously retaliatory, but worse than that I feel like I'm being used as a threat against other employees who might think about speaking up about patient care concerns and I resent that. I do not want to be used as a pawn," she testified on Tuesday.
Aghevli first reported concerns over hospital waitlists in 2014, just as a national scandal erupted over wait times, amid allegations patients had died waiting for care at a VA facility in Phoenix.
"In order to reduce the waitlist, I was instructed to improperly remove Veterans from the electronic waitlist by scheduling fake appointments for them in an imaginary clinic," Aghevli said in remarks she prepared to share with Congress on Tuesday. "This clinic was not tied to any provider or location, nor did it actually correspond to any real visits...The Veterans scheduled for these fictitious appointments were not actually receiving VA care.
"The VA also pressured me to artificially reduce the number of patients on the waitlist through other improper means," she added.
The VA's internal watchdog has investigated concerns about wait lists in opioid treatment facilities in Maryland, though it does not specify if it was prompted by Aghevli's complaint. The inspector general's inquiry published in 2018 confirmed that the VA's opioid program transferred Veterans waiting for treatment to another list where they essentially wouldn't be counted. In an earlier report, the agency said they would improve internal controls by 2017 to ensure that all patients receive treatment.
Aghevli said the VA has "engaged in continuous retaliation" against her in an apparent effort to oust her from the agency ever since she first reported her concerns, including being stripped of patient-care privileges and assigned to do "menial administrative tasks."
"Two months ago, I was told that my clinical privileges are being suspended. So since that time I have been forbidden from having any clinical contact with patients and I was assigned to pretty menial administrative tasks," she said. "It felt like I was put in a position where I would be especially visible to other staff to make it sort of a publicly humiliating situation."
A letter from her legal team to the Office of Special Counsel -- which aims to safeguard federal employees, especially whistleblowers -- says Aghevli received the "notice of proposed removal" on June 24.
"The notice of proposed removal was issued immediately after the Agency learned that Dr. Aghevli's disclosures would be the subject of a front-page story in USA Today and that she would be testifying before Congress," her legal team wrote in the letter to OSC.
"The reasons set forth by the Agency for proposing Dr. Aghevli's removal are without merit and cannot be the actual reasons for proposing her removal."
Aghevli did not send ABC News a copy of the letter because she said wanted to send her official response first.
Aghevli, who served as the former coordinator of the department's opioid addiction treatment program in Baltimore, said hospital officials cited in the letter an ongoing matter with a patient's follow-up care and gave her several business days to respond. In her testimony on Tuesday, she said her privileges were suspended in April because she visited a high-risk patient in a local hospital after he overdosed, and that the patient disclosed he attempted suicide after leaving the VA facility.
Aghevli declined to offer specific details about the April incident, citing potential patient privacy concerns, but she said it involved a "high risk Veteran" who had visited the hospital’s emergency room in the past.
"So basically, what they say is I shouldn't have followed up with this high risk Veteran in a community hospital, despite everything the VA says about following up with high risk Veterans," she said. "The VA says that we should engage them, keep them involved in care and provide proper mental health treatment."
In a statement, the VA Maryland Health Care System said the notice of proposed termination was not related to her scheduled testimony on Tuesday.
"Dr. Aghevli will have an opportunity to respond to the proposed action, and a regional VA leader will decide whether to uphold it or mitigate it after ensuring all procedural protections in the VA Accountability and Whistleblower Protection Act have been met," it said in a statement, adding "identifying as a whistleblower doesn’t shield someone from accountability when they have failed to uphold VA’s values and committed clear instances of misconduct."
Another VA whistleblower who testified Tuesday, Katherine Mitchell a physician and consultant for the VA in Arizona, said she has faced continued retaliation even after the concerns she raised were addressed. She was one of the first people to raise concerns in 2014 about officials manipulating wait lists and jeopardizing care for Veterans in Arizona.
She said she's seen a lot of improvement in patient care at the VA but that there's still a culture where some agency leaders make it difficult for people concerned about behavior that could be dangerous for patients to come forward.
"This has nothing to do with who’s in office. Things got worse two years ago because the media's attention turned off whistleblowers and turned on to politics and other things," she said Tuesday.
"It has nothing to do with who's in the president's office or who controls Congress. This is a malignant leadership culture that will outlast us all unless someone has the courage to break rank in leadership and finally change it."
Three employees at the Department of Veterans Affairs said in new interviews that they were sidelined at their jobs and stripped of responsibilities after they raised alarms about improper treatment of patients.
In interviews with USA Today the three staffers, physician Katherine Mitchell, CT technologist Jeffrey Dettbarn, and psychologist Minu Aghevli, Ph.D., said that they were removed from patient care positions to prevent them from learning of future or ongoing abuses at the agency.
The three are set to testify before Congress on a wide range of patient mistreatment this week.
"The VA is two-faced: What it says it does and what it actually does are two entirely different things," Mitchell told USA Today. "Whistleblowers who are brave enough to report problems serve as a vital safety net for Veterans. If people can't identify problems, Veterans will suffer and die. That's what it boils down to."
"As a physician, nurse, and basically as a human being, I will not back down if someone's health or safety is being threatened," she added in the interview.
Dettbarn, who said he hoped to return to patient care, added that a culture of fear at the agency had led to few staffers advocating on behalf of patients.
"There's nobody there to watch out for the Veterans," he told the newspaper. "They've got everybody else scared to say anything. Who's taking care of those patients?"
Sidelining those who speak out, she added, "jeopardizes the health and safety of every Veteran in the system."
A spokesman for the agency declined to comment to USA Today on the assertions from Mitchell and the others. In a statement to The Hill, an agency spokesperson stressed that the agency was working on implementing new improvements to protect whistleblowers.
"These include providing timelier resolutions, more responsive recommendations and enhancing communications with whistleblowers," the spokesperson said.
"VA does not tolerate retaliation against employees who have made a protected disclosure," the spokesperson continued. "Any employee who feels they have been retaliated against for making a protected disclosure is encouraged to contact VA's Office of Accountability and Whistleblower Protection (OAWP)."
Exclusive: 'The VA is two-faced.' Whistleblowers say managers are trying to silence them on Veteran care
WASHINGTON – Three Veterans Affairs health care professionals who reported patient care issues say the agency continues to try to silence them, jeopardizing Veterans and undercutting a key Trump promise of whistleblower protection.
They work at different sites – in the Phoenix area, Baltimore, and Iowa City, Iowa – yet the VA response has been similar. All were stripped of assigned patient-care and oversight duties, and they suspect VA managers are retaliating against them for speaking out, and sidelining them to prevent them from discovering or disclosing any more problems with Veteran health care.
In exclusive interviews with USA TODAY, their assertions contradict proclamations by agency leaders and President Donald Trump that VA employees who disclose wrongdoing at the agency are being celebrated and not scorned.
"The VA is two-faced: What it says it does and what it actually does are two entirely different things," said Katherine Mitchell, a physician who reported shortfalls in care at the Phoenix VA that earned her a federal "Public Servant of the Year Award" in 2014.
Mitchell is scheduled to testify at a congressional hearing Tuesday examining the treatment of whistleblowers at the VA. She will be joined by Iowa City CT technologist Jeffrey Dettbarn, who blew the whistle on mass-cancellations of diagnostic test orders, and Baltimore VA psychologist Minu Aghevli, who reported Veterans had been removed improperly from wait lists for opioid-addiction treatment.
Mitchell said the retaliation against her and others who speak out sends a signal to other employees to keep their mouths shut and "jeopardizes the health and safety of every Veteran in the system."
"Whistleblowers who are brave enough to report problems serve as a vital safety net for Veterans," she said. "If people can’t identify problems, Veterans will suffer and die. That’s what it boils down to."
Trump's accountability order
Trump signed an executive order creating a VA Office of Accountability and Whistleblower Protection and then a law making it permanent in 2017. Early reviews were promising – within several months, the office had delayed disciplinary actions against 70 VA employees who disclosed alleged wrongdoing.
But the VA inspector general has since launched a wide-ranging investigation of the office’s handling of whistleblower cases and reports of problems.
The Government Accountability Office issued a report last July that said the office allowed officials accused of wrongdoing or retaliation to be involved in investigations of the accusations – calling into question their independence and findings. And leadership at the office has turned over multiple times, causing confusion and disruption.
In response to inquiries from USA TODAY, VA spokesman Randall Noller issued a statement Wednesday saying the agency "welcomes the inspector general’s oversight."
"For the last several months, we’ve been cooperating closely with the IG on its assessment and encouraging the office to release its report as soon as possible," he said.
An assistant secretary who took over the office in January, Tamara Bonzanto, plans to use its findings as a "roadmap" for improving office operations, Noller said. In the meantime, she has been "working on a number of key improvements."
"These include providing timelier resolutions, more responsive recommendations and enhancing communications with whistleblowers," he said.
Noller declined to say what policies are in place to ensure the office doesn’t allow managers accused of wrongdoing or retaliation to be involved in investigating the accusations. Noller also declined to comment on assertions made by Aghevli, Dettbarn and Mitchell, citing federal privacy laws.
Whistleblower advocates say they haven’t seen much difference in recent years. Jacqueline Garrick, founder of non-profit peer-support group Whistleblowers of America, said more than 190 VA employees have contacted her since 2017, complaining about retaliation for speaking out about problems at the agency, most about how Veterans are treated.
She said those who have gone to the Trump-created whistleblower protection office for help said the office's employees turned around and investigated them instead, launching "counter accusations and further retaliation."
She said Bonzanto told her in February she planned to "reset" the office’s operations. Still, Garrick said, "I haven’t seen any real sign of that."
She and other advocates also are slated to testify before Congress Tuesday at the hearing before the House VA Committee’s Subcommittee on Oversight and Investigations examining whistleblower concerns.
Backlogs and lists
In Iowa City, Dettbarn noticed something was awry in 2017 when patients showed up to get CT scans but orders for the tests had been cancelled in the computer system.
He reported the problems to administrators, who later admitted they had been mass-cancelling diagnostic test orders as part of a national effort to clear out a backlog of out-dated or duplicate orders.
Weeks after Dettbarn reported his concerns that orders had been cancelled without contacting patients or a medical review to determine if Veterans still needed the tests, he was removed from his job and then transferred to another position, pending an investigation – of him.
He said he has been spending all day every day making copies and doing other paperwork ever since, nearly two years later. Dettbarn went to the whistleblower protection office for help, but said he didn't hear back for months on end. "As far as I know, I'm still under investigation," he said.
He wants to go back to caring for patients, and he worries about being away from the diagnostic clinic for so long.
"There's nobody there to watch out for the Veterans," he said. "They've got everybody else scared to say anything. Who's taking care of those patients?"
In Baltimore, Aghevli began reporting problems with wait lists five years ago, at the same time a national scandal unfolded about VA wait times following revelations that Veterans died while they waited for care at the VA hospital in Phoenix.
Aghevli, coordinator of the opioid-addiction treatment program at the VA Maryland Health Care System, reported being pressured by supervisors to remove Veterans from a wait list for treatment and schedule them in an "imaginary clinic" so the list would appear shorter.
"Suddenly our wait list went from being well over 100 to being minimal, I mean, well under 20," she said.
A review of her allegations by the VA inspector general later concluded Veterans were removed from the list and placed in "non-count" status, even though they still wanted opioid-addiction treatment at the Baltimore VA.
But Aghevli said she quickly became "unpopular" with supervisors who turned around in the ensuing years and investigated her repeatedly, tried to transfer her, and threatened to shut down her program – which serves roughly 400 Veterans. She said they excluded her from meetings, changed her hours, and at one point, detailed her to clerical duties.
Through it all, she continued to report patient care problems when she came across them – including improper discharges, short-staffing and medication issues – to her supervisors, to the inspector general and to members of Congress.
"If I see somebody not getting adequate treatment, or not getting treatment that's clinically indicated, I will speak up about it," Aghevli said.
But she said she is still being retaliated against. In April, Baltimore VA officials once again moved her out of her job to a data entry post and stripped her of her clinical privileges, pending investigation. Aghevli said the reason they gave was that she had visited a Veteran patient in a non-VA hospital after he had suffered a health crisis, a situation that ostensibly could give rise to charges she was practicing at a hospital where she didn't work.
Aghevli called the explanation "nonsensical." She is going public with her story for the first time. "I just am not sure what else to do," she said.
She wants protections for whistleblowers expanded and strengthened. "I would like other people to not go through this," she said. "It's been really awful."
Noller, the VA spokesman, declined to comment on her case as well as Dettbarn's and Mitchell's unless they signed waivers of their rights under federal privacy laws. Mitchell and Dettbarn declined, fearing further retaliation.
Aghevli's lawyer, Kevin Owen, agreed on the condition the waiver be negotiated with VA general counsel. He said Friday that agency lawyers had not contacted him.
'I will not back down'
In Gilbert, Arizona, Mitchell has endured more subtle retaliation.
After she reported poor training and inadequate triage at the emergency room at the Phoenix VA, she reached an agreement with VA officials to move to a new job assessing health care quality and efficiency at facilities in the region.
"I was hoping to improve patient care on a wider scale," said Mitchell, who was a nurse before becoming a doctor.
But she said that, with very few exceptions, she hasn’t been allowed to perform those oversight duties. Mitchell has had to resort to helping Veterans "under the table" – in some cases, receiving reports confidentially from VA employees, taking it upon herself to investigate, and then writing reports to regional administrators.
They included flagging poor care provided by a neurologist who was later removed, a facility’s failure to biopsy a potentially cancerous skin lesion and radiation oncology treatments delayed by short-staffing.
"They were not happy,” she said of administrators, but they didn’t stop her and facilities appeared to take actions to address the problems. Still, she said, VA employees told her they were "actively being discouraged from talking" to her.
Since 2018, Mitchell has been in charge of implementing an initiative to complement medical care with yoga, acupuncture and other methods to improve Veterans’ health.
"They don’t want me involved in any patient safety problems – any problem of any significance, they want to keep me away from it," she said.
Mitchell has asked another federal agency that helps whistleblowers for help, the Office of Special Counsel, and is speaking out again about problems in the meantime that she says are jeopardizing Veterans.
"As a physician, nurse, and basically as a human being, I will not back down if someone’s health or safety is being threatened," she said.
The name “Procopio” now represents a major victory for tens of thousands of Vietnam War Veterans thanks to the case, Procopio v. Wilkie.
WASHINGTON – Alfred Procopio Jr. said he learned perseverance from his parents, who “never took no for an answer.”
“He was very tenacious,” Procopio said of his father. “He didn’t give up. My mother, she was a fighter, too. I was raised that way — to stand up for what you believe.”
House Speaker Nancy Pelosi, D-Calif., signs the Blue Water Navy Vietnam Veterans Act of 2019, during a ceremony on Capitol Hill in Washington on Tuesday, June 18, 2019. At right looking on are Rep. Mark Takano, D-Calif., the chairman of the House Committee on Veterans' Affairs, and the committee's Ranking Member Rep. Phil Roe, R-Tenn.CARLOS BONGIOANNI/STARS AND STRIPES
It’s that spirit that kept Procopio pursuing his case, through years of rejection, to prove to the federal government that his chronic illnesses were caused by exposure to Agent Orange during his service in the Vietnam War. Procopio, a so-called Blue Water Navy Veteran, worked aboard the USS Intrepid, an aircraft carrier that went into the territorial seas off the coast of Vietnam.
Blue Water Veterans — who served on open sea ships off the shore of Vietnam but did not step foot on land — have been blocked for decades from the same Department of Veterans Affairs benefits afforded those who served in Vietnam or its inland waterways. The government argued there wasn’t enough evidence that poisonous herbicides contaminated the water used on their ships.
That changed in January, when Procopio won his case.
The Department of Justice decided in May to not challenge the Federal Circuit Court of Appeals ruling in favor of Blue Water Veterans. Congress approved legislation last week clarifying that those Veterans are eligible for VA disability benefits. Lawmakers sent the bill to the White House on Tuesday, where it’s awaiting President Donald Trump’s signature.
The name “Procopio” now represents a major victory for tens of thousands of Vietnam War Veterans thanks to the case, Procopio v. Wilkie.
The man himself is happy about the court decision but unsure whether he’ll be around long enough to witness much of its payoff. He was 61 when this process began. Next month, he’ll be 74.
“They appealed it so many times, I thought, ‘How long are they going to deny it? Until we’re all gone?’” Procopio said. “There were a lot of guys who I served with who were older than me, and I know they’re not around.”
Recently, the battle over the future of Veterans healthcare increased in intensity because arguably the two most prominent politicians in the country weighed in on the issue, Rep. Alexandria Ocasio-Cortez, D-N.Y., and President Trump.
At a town hall in April, Ocasio-Cortez criticized the Trump administration’s efforts to expand healthcare choice for Veterans through the Department of Veterans Affairs and said in regards to the VA that “if it ain’t broke, don’t fix it.” It isn’t surprising that Ocasio-Cortez would vigorously defend the VA while attacking reforms meant to give Veterans more private healthcare options. Many of her ideological partners, such as Sen. Bernie Sanders, I-Vt., consider the VA a model government-run healthcare system and a positive example of “socialism in action.”
A week later, Trump responded to Ocasio-Cortez with a tweet that seemingly agreed with her assertion that the VA is performing well. Underlying his tweet was the implication that the uptick in performance is due to legislation he signed into law that increased choice for Veterans and accountability for VA employees — bills Ocasio-Cortez and her allies have criticized.
This exchange between the president and AOC predictably set off a debate about who was right and who was wrong about the VA. Unfortunately, in a world of 280-character tweets and cable news segments that are clipped and shared without context, it is difficult to convey a nuanced position about any public policy issue, including the future of the VA. The reality is the VA is neither completely fixed nor completely broken but is instead an institution at a crossroads with an opportunity to break the cycle of reform and failure that has plagued it since its inception. This is especially true with the recent launch of the Veterans Community Care Program which, if properly implemented, will substantially increase healthcare freedom for Veterans through the VA and improve access to medical services.
Even as someone who has been highly critical of the agency for years, I have to admit the VA has made some improvement since the deadly 2014 waitlist scandal.
Between 2014 and 2017, according to a study by the JAMA network, wait times across the VA have generally gone down. However, this decrease occurred while the VA increased the number of private sector appointments by over 50%, demonstrating better use of non-VA providers and the introduction of the albeit imperfect Veterans Choice Program helped improve wait times for Veterans.
Despite this good news, the VA still faces many systemic issues that need to be dealt with. Too many VA hospitals are delivering sub-standard care and hundreds of thousands of Veterans are still waiting long periods of time for appointments. Additionally, most of the VA’s healthcare facilities are over 50 years old, meaning not only are the buildings increasingly aged but they are not in locations best suited to serve the more dispersed Veterans population of the future.
The VA MISSION Act, signed into law last year by Trump, was designed to address these issues. Over the next few years the VA will continue implementing the law, and it faces its first major test with the rollout of the Veterans Community Care Program.
It is critical for the future of Veterans healthcare that the VA properly implement all the major components of the VA MISSION Act. Failure to do so will undermine the Trump administration’s VA reform agenda and compromise healthcare for millions of Veterans. In addition, any attempts to roll back the VA MISSION Act by members of Congress who oppose giving Veterans more healthcare choice — like Ocasio-Cortez — should be strongly resisted.
Finally, as more Veterans get care from outside of the VA, elected officials at the state and federal levels must explore ways to eliminate barriers standing in the way of Veterans making full use of their new private sector healthcare options. Critical reforms include expanded use of telehealth (as Virginia did) and repealing certificate-of-need laws (as Florida did this year). These and other patient-centered reforms, expand access to health care for both Veterans and non-Veterans while encouraging innovation.
The VA has improved since 2014, but challenges remain. We all want Veterans to get the care they need and deserve. To achieve that, everyone needs to acknowledge that VA healthcare still needs some major improvements and to commit ourselves to ensuring the necessary reforms are made.
Last week, VA implemented changes to community care under the VA MISSION Act. The changes included expanded eligibility for community care and a new urgent care benefit. As part of our outreach and engagement efforts, we collected the top questions received from Veterans and provided answers to each one below. Our goal is to make it easier to access the care you have earned.
General health care
- When can I receive community care? Eligibility for community care depends on your individual health care needs or circumstances. You should discuss community care eligibility with your VA care team to determine if you are eligible. This video provides a quick overview of Veteran community care.
- Can I get dental care through the MISSION Act? Eligibility for dental services has not changed under the MISSION Act. You should talk to your VA care team about eligibility for dental services. Click here for more information about dental care.
- How does a community provider know I am eligible to receive community care? If your VA care team has determined that you are eligible for community care and you chose a community provider, VA will send the provider a referral and authorization prior to you receiving care. You must receive approval from VA prior to obtaining care from a community provider in most circumstances.
- I was authorized for community care under the Choice program. What happens now? The Choice program expired on June 6, 2019, and specific Choice eligibility for community care is no longer being used. If you were eligible for community care under Choice, you should speak with your VA care team or a VA staff member at your local VA medical facility about updated eligibility for community care. This video also provides a quick primer regarding community care eligibility under the new Veteran community care program.
- How do I become eligible for the urgent care benefit? You must be enrolled in VA health care and have received care through VA from either a VA or community provider within the past 24 months to be eligible for the urgent care benefit.
- How can I find an urgent care provider? To find an urgent care location in VA’s contracted network, use the VA facility locator at https://www.va.gov/find-locations/. Select the link entitled “Find VA approved urgent care locations and pharmacies near you”.
- What is the difference between urgent care and emergency care? Urgent care consists of medical services provided for minor illnesses or injuries that are not life-threatening such as strep throat, pink eye, or influenza. Emergency care consists of inpatient or outpatient hospital services that are necessary to prevent death or serious impairment of health such as severe chest pain, seizures or loss of awareness, heavy uncontrollable bleeding, or moderate to severe burns.
- Do I have to pay a copayment if I receive urgent care that relates to my service-connected condition? Copayments for urgent care are different from other VA medical copayments. Copayments for urgent care depend on your assigned priority group and the number of times you visit any urgent care provider in a calendar year. Visit the Urgent Care webpage for more information about copayments.
- How do I get prescription medication related to an urgent care visit? VA will pay for or fill prescriptions for urgent care. For urgent care prescription medication longer than a 14-day supply, the prescription must be submitted to VA to be filled. For urgent prescriptions written by an urgent care provider, you can fill a 14-day supply of medication at a contracted pharmacy within the VA network, in VA, or at a noncontracted pharmacy. If a noncontracted pharmacy is used, you must pay for the prescription and then file a claim for reimbursement with your local VA medical facility.
Click here for detailed information on community care and urgent care.