Void in VA leadership creates chaos
At first, it was one doctor quitting the tiny Ukiah Veterans Affairs Outpatient Clinic in Northern California. Then another left, and another, until of the five doctors there a year ago, only one remained.
The Veterans Choice Act, passed by Congress amid scandalous stories of hidden waiting lists at Veterans Affairs hospitals, allowed more veterans to get care from private providers, but it created an avalanche of paper at Veterans Affairs facilities as outside doctors sent in information on patients. Veterans Affairs doctors had to enter so many medical records manually into the aging department health records system that it crippled their ability to see patients.
“I was working nights and weekends, holidays, and I couldn’t keep up,” said Dr. Neal Elkin, a primary care physician who left the Ukiah clinic in January. “I was so stressed, I couldn’t sleep. My asthma started getting bad, and I just burned out.”
In Washington, the leadership of the department had been working to streamline private care and overhaul its computer system to cut paperwork. Then President Donald Trump plunged the department into turmoil. He fired the Veterans Affairs secretary, Dr. David J. Shulkin, by tweet in March after weeks of infighting. His hand-picked replacement, Dr. Ronny L. Jackson, saw his nomination collapse last week amid a barrage of accusations related to his work as the White House physician. Meanwhile, a string of departures at the highest level of the agency has left it adrift.
Unable to find replacement doctors, the Ukiah clinic conducted appointments using remote doctors and video screens.
“You’ve got a huge vacuum of leadership,” said Robert A. McDonald, a Republican tapped by President Barack Obama to lead the department in 2014 after the wait-time scandal brought down his first secretary. “Not only do you not have a secretary, but many of the experienced people who could provide continuity are leaving.”
Legislative efforts to fix the private care program, known as Veterans Choice, have been stalled, in part because of lawmakers’ own disagreements. The contract for a new $16 billion electronic health records system to replace the one built in-house decades ago was put on ice months ago. And lawmakers, veterans advocates, and current and former department leaders fear that sinking morale could erase the progress the department has made in recent years.
“The VA for months has been hemorrhaging career officials at an alarming rate as one after another is either pushed out or decides to run, not walk, for the door,” said John Hoellwarth, a spokesman for AMVETS. “I’ve never known the enthusiastic mass exodus of an organization’s most knowledgeable and experienced personnel to be an indication that all is well.”
Current and recently departed staff members describe the central office in Washington as eerily quiet. Political appointees hold meetings without career staff members and talk openly about purging anyone they see as friendly to the former secretary, according to one former official familiar with the comments.
The department’s No. 2, Deputy Secretary Thomas G. Bowman, has been isolated by Trump White House appointees who see him as too moderate and want to drive him out, current and former officials said. The acting secretary, Robert Wilkie, in charge since March, has been a quiet presence and has not met with key staff members overseeing issues like the Choice program.
Trump administration officials say the department is pushing ahead with a review of the electronic health records contract that should allow a final decision within weeks. The department is working with Congress, they said, to try again to pass long-awaited legislation to improve the private care programs.
An agency spokesman, Curt Cashour, argued that high staff turnover actually benefited the department, allowing the administration to replace high-level officials who were not fully committed to Trump’s policies.
“Under President Trump, VA has had its most productive year in decades,” Cashour said in a statement.
He continued, “This has understandably shaken up VA’s Washington bureaucracy, and in many cases employees who were wedded to the status quo and not on board with this administration’s policies have departed VA — some willingly, some against their will.”
Cashour said White House appointees have not been threatening to purge anyone. “Only one person talked about a purge,” he said, referring to Shulkin. “He no longer works at VA.”
Cashour noted that the department’s 33,000 vacancies — out of a workforce of more than 360,000 — had actually declined considerably since the beginning of the administration.
In a statement, Wilkie said that “all of us are committed to implementing the president’s agenda for veterans.”
Wilkie and Bowman declined to be interviewed.
Shulkin’s proposed replacement, Jackson, withdrew from consideration after senators publicized accusations that he drank on the job, misused prescription drugs and oversaw a hostile work environment.
In that void, current and former career officials and veterans advocates say, the political appointees who clashed with Shulkin have made it clear that disagreement with the White House’s private care agenda will not be tolerated. The instability and partisan rancor have prompted a number of experts to resign.
Scott Blackburn, a former partner at the consulting firm McKinsey and Co. who was overseeing the transformation of the department’s electronic health records system, quit in mid-April. Blackburn, a disabled veteran and a graduate of Harvard, was replaced by the former director of data operations for the Trump campaign, Camilo Sandoval.