Tuesday, August 26, 2014

Hair-Splitting at its Finest

Sadly, this should come as no surprise.

The Veterans' Administration watchdog agency "has been unable to substantiate allegations that 40 veterans may have died because of delays in care at the department's medical center in Phoenix.  That "finding" was contained in a letter from the new VA Secretary, Robert McDonald, to the Office of the Inspector General, acknowledging a soon-to-be-released report on problems at the Phoenix facility.

More from The New York Times:

"A report by the department’s office of inspector general is expected to be released this week that will describe findings from its investigation into Phoenix. Officials from the inspector general’s office have declined to comment on what the report will say.
However, a letter sent from the new Veterans Affairs secretary, Robert A. McDonald, to the inspector general responding to the report’s findings states that the investigation was unable to prove a link between the deaths of 40 veterans and delays in care.
'It is important to note that while O.I.G.’s case reviews in the report document substantial delays in care, and quality of care concerns, O.I.G. was unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans,” says the letter from Mr. McDonald and the interim under secretary for health, Dr. Carolyn M. Clancy."
In other words, the VA acknowledges that veterans in the Phoenix area spent months--sometimes years--waiting for an appointment.  And the department knows that some of those vets died while awaiting diagnosis and treatment.  But the bureaucrats in the Office of the Inspector General cannot say definitively that the "absence" of care caused the deaths of dozens of veterans. 
Give me a break.  This is governmental parsing at its absolute worst.  Obviously, you can't say that waiting to see a doctor was responsible for someone's death.  And of course, the letter misses the logical assumption: waiting to see a doctor for chronic or even life-threatening conditions doesn't exactly improve your health.  Put another way: the vets died from a variety of different diseases and afflictions while the VA played games with the appointment schedule; the bureaucratic chicanery wasn't the direct cause of death but it was a contributing factor--a major factor. 
I wonder how this "explanation" will sit with the families of veterans who died awaiting care?  Consider again the case of Thomas Breen, the Navy vet who passed away from cancer while trying to see a doctor at the Phoenix VA:
"We had noticed that he started to have bleeding in his urine," said Teddy Barnes-Breen, his son. "So I was like, 'Listen, we gotta get you to the doctor.' "
Teddy says his Brooklyn-raised father was so proud of his military service that he would go nowhere but the VA for treatment. On September 28, 2013, with blood in his urine and a history of cancer, Teddy and his wife, Sally, rushed his father to the Phoenix VA emergency room, where he was examined and sent home to wait.
"They wrote on his chart that it was urgent," said Sally, her father-in-law's main caretaker. The family has obtained the chart from the VA that clearly states the "urgency" as "one week" for Breen to see a primary care doctor or at least a urologist, for the concerns about the blood in the urine.
"And they sent him home," says Teddy, incredulously.
Sally and Teddy say Thomas Breen was given an appointment with a rheumatologist to look at his prosthetic leg but was given no appointment for the main reason he went in.
No one called from the VA with a primary care appointment. Sally says she and her father-in-law called "numerous times" in an effort to try to get an urgent appointment for him. She says the response they got was less than helpful.
"Well, you know, we have other patients that are critical as well," Sally says she was told. "It's a seven-month waiting list. And you're gonna have to have patience."
Sally says she kept calling, day after day, from late September to October. She kept up the calls through November. But then she no longer had reason to call.
Thomas Breen died on November 30. The death certificate shows that he died from Stage 4 bladder cancer. Months after the initial visit, Sally says she finally did get a call.
"They called me December 6. He's dead already." 
And, as we subsequently learned, what happened to Mr. Breen was repeated over and over again in the VA medical system.  But now, thanks to investigatory gymnastics by the O.I.G., the department can claim that excessive "wait times" weren't directly responsible for the deaths of scores of veterans. 
Why would the VA issue such a convoluted pile of nonsense?  The answer lies in expected litigation; in recent years, the department has paid out millions of dollars in claims to veterans (and their families) because of shoddy or insufficient care.  The appointment scandal will likely cost the agency billions more.  The IG gives VA lawyers some potential wiggle room, though we don't believe that many juries will buy that argument.  However, the report might be enough to limit the size of projected payouts, and perhaps (in the hands of a friendly judge) reverse some cases on appeal. 
Readers will also note a rather curious angle to the story's handling by the Times and other media outlets.  So far, I haven't seen any comments from Dr. Sam Foote, the retired Phoenix VA physician who blew the whistle on the department's unconscionable practices, or the families of veterans who died.  In fact, the closest thing you'll find to an admission of guilt by the department was this comment by Assistant VA Secretary Sloan Gibson, who was conveniently available for the Times:
“I’m relieved that they didn’t attribute deaths to delays in care, but it doesn’t excuse what was happening,” Mr. Gibson said. “It’s still patently clear that the fundamental issue here is that veterans were waiting too long for care, and there was misbehavior masking how long veterans were waiting for care.”  
"Misbehavior."  Just like the Fort Hood shooting was an example of "workplace violence," and the IRS scandal was the work of "rogue" agents in a field office.  Then again, the MSM is nevery shy about helping the administration advance its narrative.  
ADDENDUM:  And if you need more proof that much of the VA is in permanent denial, consider this gem from the Philadelphia Inquirer (h/t Ed Morrissey at Hot Air).  The paper obtained a copy of a training guide for VA employees, in preparation for upcoming "Town Hall" meetings, hosted by the benefits section at the Philadelphia VA office.  The training document depicts veterans--the men and women the VA is supposed to serve--as "Oscar the Grouch:"   

The cranky Sesame Street character who lives in a garbage can was used in reference to veterans who will attend town-hall events Wednesday in Philadelphia.

"There is no time or place to make light of the current crisis that the VA is in," said Joe Davis, a national spokesman for the VFW. "And especially to insult the VA's primary customer."

The 18-page slide show on how to help veterans with their claims, presented to VA employees Friday and obtained by The Inquirer, also says veterans might be demanding and unrealistic and tells VA staffers to apologize for the "perception" of the agency.


The slide show, "What to Say to Oscar the Grouch - Dealing with Veterans During Town Hall Claims Clinics," was shown to employees who will staff those events.

Most slides touch on routine instructions, including dressing professionally, being polite, showing empathy, and maintaining eye contact.

But the "grouch" theme is maintained throughout.

About a dozen slides include pictures of the misanthropic Muppet in the can he calls home. In one, a sign reading "CRANKY" hangs from the rim. In another, Oscar's face is flanked by the words "100% GROUCHY, DEAL WITH IT."

The presentation includes tips on how to tell if a claimant is nearing an "outburst," including being accusatory, agitated, demanding, or unfocused. One section on dealing with angry claimants is titled "Don't Get in the Swamp With the Alligator."

In response, the VA claimed the powerpoint was an "old, internal document," pulled out for a recent training session.  A spokesperson for the department didn't know if the "grouch" presentation was created locally, or at the national level.  One VA employee in Philly--an Army veteran of the Bosnia conflict--said he was "stunned" at the content. 

Sadly, the tone of the slideshow is anything but surprising.  After all, dozens (perhaps hundreds) of VA employees were willing to alter and falsify appointment waiting lists to make it look like the department was providing timely healthcare--while thousands of veterans waited.  Scores died awaiting treatment, or because the care they actually received came too late.

Given that corrosive culture, it's completely predictable that VA employees would refer to their clients as "grouches" (or worst). 



1 comment:

Poor Richard said...

The VA should be dismantled as a cabinet-level agency and moved into the DoD, with positions being on the normal career path. Nobody is going to take care of veterans than people who are going to be vets someday themselves.