Editorial: Changing the culture of the VA

  • Veterans Affairs Secretary David Shulkin speaks at the annual U.S. Conference of Mayors meeting on June 26. AP

Sunday, July 23, 2017

A flawed or failed culture often gets the blame when bad things happen not just once, but again and again.

A culture of silence made decades of abuse by Catholic clergy possible. A culture of blind obedience to an imperious CEO has been blamed for the diesel emissions scandal that cost Volkswagen its integrity and billions in fines and reparations. A medical culture of maximizing profit explained how a small Texas town once billed Medicare recipients more, on average, than any other place in the nation. A failed culture likely explains the alleged atrocities that led to last week’s hasty removal of the top two officials at the Manchester Veterans Affairs Medical Center.

Changing an institution’s culture, particularly one as large as the VA, is exceedingly difficult.

The 11 health care providers, led by Nashua Dr. William “Ed” Kois, who went public with their concerns about the substandard care of patients at Manchester’s VA hospital, are heroes in a battle that should have been unnecessary. America’s veterans deserve prompt, top-notch care, but that’s apparently not what many of them get.

An operating room closed because exterminators couldn’t get rid of flies that one nurse said have been there for at least 16 years is bad enough. Ditto for the surgical equipment that was either rusty or blood-stained. But the lack of care and caring for patients, as described by the Boston Globe’s Spotlight Team, was heartless and inexcusable.

Gilmanton Korean War veteran Robert McWhinnie, who had a tumor removed from his spine in 1995, lived in pain and could barely walk. Despite dozens of visits to the Manchester VA, doctors never ordered imaging to see if the tumor had grown back.

“They ignored him basically for 20 years and allowed this thing to grow and grow,” his wife, Janice McWhinnie, told the Globe.

McWhinnie was one of many spinal care patients, according to Kois, whose treatment at the hospital was substandard. Kois and fellow staffers complained but saw little or no change.

The problems afflicting the VA nationally are legion and longstanding: periodic underfunding, bad management, out-dated equipment and information systems, unfilled positions and an inability to predict demand for services and meet veterans’ needs in a timely fashion.

Last year, Robert McDonald, the business executive chosen by President Obama to shake up the VA, said that the organization suffered from “a culture of helplessness.” Expecting no improvement, employees stopped trying. Fearing reprisal, they failed to speak up.

Veterans, too, particularly the older ones, accepted delays, rarely complained and were grateful for what care they received.

McDonald’s replacement, Dr. David Shulkin, described the VA medical system as “in critical condition” and in need of intensive care.

Shulkin, who has led some of the nation’s major hospitals and health care organizations, has accelerated a reform effort that McDonald initiated. He wants to eliminate the VA’s needless bureaucracy and the delays it creates and increase veterans’ ability to access care outside the VA system. He expects transparency and accountability – every VA facility will be expected to post quality data and wait times. And he wants to make it easier to fire VA employees who don’t meet the agency’s standards.

A top to bottom investigation of the Manchester clinic is under way. The investigators, some of whom we hope will be independent of the VA, should interview not just the whistleblowers but the private physicians who treated patients referred to them by the VA.

Changing the culture of the VA will require a public that demands better care for its veterans. It will need members of Congress, who often speak of their respect and gratitude for veterans, to put their money where their mouths are. And it will need more people, like the Manchester VA staff members who spoke up, to keep the pressure on.