Health Care
1:25 pm
Thu May 22, 2014

Congresswoman And Veteran 'Appalled' By VA Scandal

Transcript

MICHEL MARTIN, HOST:

I'm Michel Martin, and this is TELL ME MORE from NPR news. We want to go back to a story we've been covering because it continues. It's about practices by healthcare facilities for veterans. More than two dozen healthcare facilities, run by the Department of Veterans Affairs, are being investigated for allegedly creating secret patient waiting lists as a way to hide how long veterans were really waiting for care. President Obama talked about the issue this week vowing to get answers. But he also said that if misconduct occurred it will be punished.

(SOUNDBITE OF SPEECH)

PRESIDENT BARACK OBAMA: My attitude is, for folks who have been fighting on the battlefield, they should not have to fight a bureaucracy at home to get the care that they've earned.

MARTIN: We've heard from reporters covering the story, but we wanted to hear from someone who's had a close connection with healthcare for service members. So we called Rep. Tammy Duckworth. She is an Iraq War veteran - a former Blackhawk helicopter pilot who lost both of her legs and partial use of her arm during an attack and spent a year recovering at Walter Reed Army Medical Center. She also formerly served as an assistant secretary of Veterans Affairs, where she worked on initiatives to improve communications and end homelessness and better serve Native American and women veterans. She is a congressman representing Illinois. And we reached her at her office on Capitol Hill. Congresswoman, thanks so much for joining us once again.

REPRESENTATIVE TAMMY DUCKWORTH: It's great to be on. Thank you.

MARTIN: So, as we mentioned, you formally worked for the Department of Veterans Affairs. When these allegations surfaced - I'm wondering if there had ever been scuttlebutt around this. You know, sometimes there's an issue - but there's kind of a whiff of an issue. And people have heard about it but there's been no proof, so that they don't know how seriously to take it. When you were serving at the agency, was there ever any suggestion that this was going on?

DUCKWORTH: Well, when I was serving at the agency, what happened was Sec. Shinseki helped put into place the new standard that veterans would not wait more than 14 days for an appointment. This was a new system with electronic record-keeping, and also the electronic scheduling system that was put into place. And so the new system was supposed to be one that was electronic - that would automatically send updates and then report as to how long patients were waiting for their appointments. And so this whole - people gaming the system to get around the system, especially at the expense of veterans - is absolutely news to me. And I'm just appalled by it.

MARTIN: I was going to ask you that. How did you hear about this and what was your reaction when you heard?

DUCKWORTH: I heard about it in the news like everyone else. You know, my reaction was twofold. One was just disgust. And I'm worried about veterans who are not getting the care that they need. And now - now, I'm worried about the veterans who, watching the news the last several weeks, think that they won't get the care they need from VA - so don't even bother going or don't even bother trying. And we simply can't have that.

Our veterans need the help and the services are there. But on the other hand, I have to say, having worked in the VA, it's a large bureaucracy. It's the second largest department in the United States government. And there are problems with bureaucracies that large. That's why we need to streamline them - cut them down, make them more efficient and more responsive to the customer. And in this case the customer is the veterans. So I wasn't surprised that it was happening - in a sense that when you run that many facilities, something is going to happen. But I was absolutely disgusted and appalled.

MARTIN: I was going to ask if you have an operating theory about how this could have happened. You've previously said that the VA is like - that there are silos. You know...

DUCKWORTH: There are.

MARTIN: There's two silos - there are two main elements - the Health Administration and the Benefits Administration, and that they don't effectively work together. Do you have a theory about how this happened or why this happened - just based on your knowledge of how the place works?

DUCKWORTH: Well, the VA is still very much siloed. There's actually three different administrations within the Department of Veterans Affairs. And the two that are most critical here - that have the problems - are the Benefits Administration, that provides the pension payments, the G.I. benefits, the VA home loan guaranty. And then, there is the Health Administration that does all of the hospitals and clinics. And they're very siloed. And they don't like to talk to each other and they don't even like to talk to the leadership at central office. And I was very frustrated because I got the sense that folks who were the heads of the regional offices - their loyalty was to their silo and not to the entire agency. And I really feel like their loyalty should be to the veterans first and foremost. And that means that they should be sharing information.

MARTIN: Is this a function of people in the field not being able to speak with or have any control over the circumstances that would make a difference 'cause you have to assume that people don't go to work every day trying to do a bad job? Right?

DUCKWORTH: Agreed.

MARTIN: So is it because they don't have any ability to be heard if they can't meet the workload - or what else? I mean, is it just bigness?

DUCKWORTH: I think it's more the resistance to change. I think it's mixed messages going out to people who are on the frontlines. So, in this case in Phoenix, it appears that it's the hospital leadership that's telling their middle managers and their schedulers to create this alternate record-keeping system so that they would not have to report the true wait times for veterans to the central office in Washington.

And I think it's - unfortunately and absolutely criminal - it's self-preservation. And those folks need to be punished. The answer should have been - gosh, we can't get veterans in within the 14 day period. Let's report that to headquarters so that they know we need more resources. Right? We need more doctors. We need more clinics. We need more facilities so that veterans don't have to wait the 14 days. Or we need to start approving some of the requests from veterans to get healthcare outside the VA - but paid for by VA if we can't get them in in the 14 days.

MARTIN: Yeah. Well, why didn't they do that? I mean, are there incentives to lie because, as you pointed out, there is that option of referring people outside of the system? But they didn't seem to do that, at least according to the facts as we know them now. So why wouldn't they?

DUCKWORTH: Well, this is what I want to find out because in the vast majority of VA facilities, they do refer them. I, for example, go to VA for my women's health clinic and the amputee clinic, but my VA can't meet on a timely basis and to the level of sophistication - my needs for the type of high-tech prosthesis of artificial legs. So I actually receive my artificial limbs from a healthcare provider that is connected to the University of Illinois in Chicago, and they do some cutting edge research. And the VA pays for it.

So I'm sort of one of those people that are hybrid. I go there - to VA - for most everything else, but when it comes to my limbs because they can't meet my need on a timely basis, they pay for me to go outside. And that's the way it should be. And it seems like, in some of these hospitals, that they were not willing to do that. And we need to figure out why. And if it was a matter of a hospital director who wanted to protect her end of year bonus because she wanted to report the very best numbers, even though they were not true, then that's criminal because - especially we found out that veterans died or were harmed in any way. And I'm going to make sure that we continue to put the pressure on and end this type of practice.

MARTIN: I do have to say, just in the spirit of fairness, that the reporting doesn't yet indicate or confirm that the 40 veterans who died while on waiting lists that the fact that they died was due to the wait. So I think that is one of those issues that does remain open for clarification.

But on the whole question of accountability, there are those who have said that the Sec. Shinseki should resign - former four-star general - that he should be held accountable, not because he started the problem, but because he's been in office so long that he now owns the problem. Do you have an opinion about that?

DUCKWORTH: I think he does own the problem, and I think now that he knows that there is a problem, in this case, that he needs to fix it. I want to find out from the audits, first and foremost, how many hospitals, how many clinics are doing this? How widespread is it? First it was one clinic, then it was seven. Now it seems to be maybe over a dozen. And I want to know exactly how widespread it is.

MARTIN: But it sounds to me as though you're saying you don't think that Sec. Shinseki should resign at this point.

DUCKWORTH: Not at this time.

MARTIN: Is there a tipping point at which you feel that he should? Is there something that would cause you to lose confidence in his ability to fix this?

DUCKWORTH: Well, if he knew about the delays and the duplicate records keeping system and did nothing, then I would - that would give me great pause. But right now I want to know who knew and how widespread is it?

MARTIN: Well, the VA said yesterday that it was 26 facilities where this practice seems to have occurred. Do you have a reaction to that number? I mean obviously one is too many, but what do you feel about that?

DUCKWORTH: That's 20 percent of the major facilities. That's unacceptable.

MARTIN: If you're just joining us, we're talking about this whole issue involving the allegedly secret patient waiting lists involving Veterans Affairs healthcare facilities. I'm speaking with Congresswoman Tammy Duckworth. She's a Democrat who represents a district in Illinois, but she's a former Blackhawk helicopter pilot who's been served by the VA when she lost her legs while serving as an Army helicopter pilot during the war in Iraq - and is a former Veterans Administration official.

Before we let you go, I just wanted to ask about a couple of other projects that you were involved in while you were at the VA which was to better address the needs of women service members and veterans. And also, you're currently working on legislation to extend maternity leave for women currently serving in the military from 6 weeks to 12 weeks. How are those projects going? I mean do you feel confident that you're making progress there or is all this being overshadowed by this current issue?

DUCKWORTH: Well, we are making progress on both. By the time I - when I first got to VA, there was not a woman's coordinator, women's representative at every VA facility. And I made sure before I left that there were, especially at all of the major hospitals. And then my next push while I was there - every time I visited a hospital, and I said I want to see your woman's health coordinator, and then when I went to that particular office, I asked how many of these women who work here are veterans themselves?

So my next push was not only to have them - a woman's center - in every hospital but to make sure there was at least one female veteran working there. As far as the Mom Act, I'm so proud of that because we, in just a few days since I introduced it, have had over 70 cosponsors, both Republicans and Democrats. And what this bill would do would be to give military women six additional weeks of maternity leave. Right now, they only get six. Civilian women and federal employees get 12 weeks under Family Medical Leave Act, but the...

MARTIN: Those are unpaid though, are they not?

DUCKWORTH: They're not paid, right. But the FMLA does not apply to military women, so the additional six weeks that I would - that this bill would give military women would also be unpaid. And unfortunately that was a consideration that had to be put into place. I would rather it was paid, but under the current budget constraints, at least having the option for the six additional weeks will make a big difference for women in the military.

And this is, you know, so that they can choose to use it. If they choose to go back to work at six weeks, then that's fine. But if their family and their child and they need more time, then they should be able to do that. And, frankly, military commanders were getting frustrated because many of the commanders wanted to give their female service members more time after having a child, especially if they'd had a cesarean section, for example. But the way the regulations were set up, they didn't even have that option.

MARTIN: Congresswoman Tammy Duckworth is a Democrat. She represents Illinois. She is an Iraq war veteran, a Lieutenant Colonel in the Illinois Army National Guard. So thank you for your continued service, Congresswoman, on all levels. And we reached her at her office in Washington, D.C. Thank you again, and we'd hope we'll speak again.

DUCKWORTH: Thank you. I look forward to it. Transcript provided by NPR, Copyright NPR.