Why I Blew the Whistle on the V.A.

PHOENIX — MY decision to become a whistle-blower after 24 years as a physician in a Veterans Affairs hospital was, at first, an easy one. I knew about patients who were dying while waiting for appointments on the V.A.’s secret schedules, and I couldn’t stay silent.

But there was no response to the two letters I sent to the Veterans Affairs inspector general, one in late October 2013 and one in early February. Going public would damage an institution I gave more than two decades of my life to, trying to make a better place for veterans to get their care. But I had to be able to sleep at night.

I retired from the Phoenix V.A. medical center in December 2013. When there was no reply to my February letter, I contacted Eric Hannel, a staff director for the House Veterans Affairs Committee, and told him what I knew. I also contacted Dennis Wagner, a reporter at The Arizona Republic, who had already been reporting on the problems at the Phoenix V.A. hospital.

The inspector general for Veterans Affairs has opened an investigation, and after meeting with members of his team in Phoenix, I have faith in the job that they are doing. But I have very little in the internal V.A. inspection that Secretary of Veterans Affairs Eric Shinseki is conducting through the Veterans Integrated Service Network, the umbrella structure created when the V.A. radically decentralized its health care operations in 1995.

The difference is between trained investigators from the Department of Justice whose job it is to ferret out waste, fraud and abuse — lying to them can trigger criminal penalties — and V.I.S.N. office workers who ask a few questions of clinic staff members who may be afraid to speak the truth out of fear of retribution.

Here’s another idea: I would much prefer to have Debra A. Draper, the director of the Health Care Government Accountability Office, conduct an anonymous electronic survey of primary care providers, nurses and clerks at every V.A. hospital and clinic across the nation to find out what they think the real new and returning patient waiting times are. Then her team should give the hospital administrators a one-week amnesty period to report their own version of the waiting times. If the numbers match, then you have reliable data. If they don’t, then send the inspector general out to audit them. If the hospital administrators have fudged their data, fire them and prosecute them to the maximum extent under the law.

A full accounting is necessary in the narrow sense to punish those who engaged in improper or illegal conduct. In a larger sense, the accounting is needed because the V.A. must determine the magnitude of its problem in order to design a solution.

It is apparent to me that the scheduling scandal is a symptom of a much more serious disease — a mismatch between the V.A.’s mission and its resources. Today’s V.A. health care system in general does a very good job at providing chronic care, and it excels at things like blood pressure and diabetes control. It has an excellent computerized records system that is second to none in transferring clinical information from facility to facility across the nation.

Where it breaks down badly, especially out West and in other sparsely populated parts of the country, is in the provision of urgent and emergency care where the distance to any suitable hospital, let alone a V.A. hospital, can be great. We should think about giving veterans in these situations something like a Vetacare card, which could be used for urgent or emergency care, or both, and subsequent hospitalization if needed. This would allow for more immediate treatment, and the V.A. could be billed directly.

Congress and the V.A. need to decide whether to revert to the days of yesteryear, when the V.A. took care only of patients’ service-connected conditions, along with providing a safety net for our most impoverished veterans — or to try to re-establish a more universal program that utilizes the current system’s strengths while repairing its weaknesses. If so, it is likely that many medical centers would need more financial resources in addition to administrative reform.

Any scandal that befalls the V.A. necessarily lands on the party that is in the White House. As this is an election year, we can expect that there will be significant pushback to delay and limit the discovery of negative information — which is why I expect my suggestions to be vehemently opposed by the White House and the V.A.’s upper management.

I am worried about the patients whose care is entrusted to the V.A., and I am skeptical about our chances of creating real, long-lasting reform — but I hope that this time we will. It is easy, especially on Memorial Day weekend, to pay lip service to the need to “support our troops” and our veterans. But it is much harder to actually do it.

Sam Foote is an internist who was a Veterans Affairs outpatient clinic director for 19 years.

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