VA Healthcare Crisis: Veteran Wait Times and Systemic Failures

Introduction: VA Enrollment and the Scale of the Problem

One key factor to consider when evaluating the healthcare structure of the U.S. Department of Veterans Affairs (VA) is the number of veterans actually availing themselves of VA medical services. Over 9.1 million, out of a total of more than 21.6 million U.S. veterans, are registered with the VA healthcare system (Coburn, n.d.). Moreover, not every enrollee necessarily receives medical attention. The Congressional Budget Office (CBO), in 2013, established that terminating enrollment of Priority Group 7 and 8 veterans could help reduce the federal deficit. These veteran groups, who gained VA healthcare access only during the mid-1990s, include higher-income veterans not requiring any service-related medical assistance (Options for Reducing the Deficit, 2013).

History of Delayed Care and Veteran Deaths

By the year 2003, the VA found it nearly impossible to appropriately cater to the needs of every veteran enrollee, with wait lists for healthcare growing larger and longer, ultimately leading to a cut-off in new enrollments of Priority Group 8 veterans (Coburn, n.d.). A Navy veteran died of complications from Stage 4 bladder cancer after awaiting VA medical care for months. He was rushed to a VA emergency facility in Phoenix in September 2013, only to be sent back home, despite his medical report identifying the situation as "critical" (Coburn, n.d.). VA authorities reportedly never contacted the family for a follow-up, so the family called several times to schedule an urgent appointment. The veteran's daughter-in-law stated that she contacted authorities daily for months, with no results. After suffering through months of agony, he passed away on November 30, 2013. She states that authorities finally contacted them on December 6 — a week after the patient's death (Coburn, n.d.).

No fewer than 82 veterans died or suffered severe injuries due to delayed endoscopies or colonoscopies at VA centers, resulting in late diagnoses or missed care. CNN, after investigating these cases, could not determine whether any employee at the corresponding VA facilities had been fired or even suspended for their failures. As a matter of fact, some individuals implicated in the delays may have even received workplace bonuses (Coburn, n.d.). Three veterans lost their lives at a Georgia VA center because of delayed medical attention. A total of 5,100 veterans — including 340 diagnostic, 2,860 screening, and 1,300 surveillance endoscopy patients — who required gastrointestinal procedures could not access medical consultation in 2011–12 in Georgia (Coburn, n.d.). The VA failed to disclose, or deliberately attempted to conceal, information about some of the veterans who died while awaiting care.

No fewer than 40 veterans died while awaiting appointments at the Phoenix VA healthcare facility and, according to a CNN investigation, many of those names appeared on a classified waiting list. A retired healthcare provider who worked 24 years at the Phoenix VA facility asserted that when any veteran on the list passed away, the individual's name was simply removed from the records. Official records showed no evidence that the person had, in fact, ever sought medical attention.

After these deaths were disclosed, no fewer than 18 veteran deaths linked to the Phoenix facility were confirmed. The FBI began criminal investigations into VA scheduling procedures on June 11, 2014, seeking to determine whether hospital authorities had deliberately falsified veteran wait times to receive performance bonuses (Coburn, n.d.). The issue clearly depicts an uneven distribution of money and power between those who need medical assistance and those who hold the authority to grant it. The problem came to light through an independent criminal investigation that exposed high mortality rates and numerous suspicious deaths at Lexington's VA facility in Kentucky (Coburn, n.d.).

The VA system's failure impacts veterans most acutely. The VA's Inspector General conducted an analysis of circumstances surrounding a patient's sudden death at the Miami VA facility, where the patient had been enrolled in the Substance Abuse Residential Rehabilitation Treatment Program (SARRTP). The analysis revealed that the facility's healthcare environment was not sufficiently safe, and that techniques for examining SARRTP patients for illicit drug use could be improved (Coburn, n.d.).

For veterans who have served their country, returning home from long deployments is welcome news. When they come home, they expect the nation to support them as they return to civilian life. However, many veterans face serious financial and medical challenges upon their return. Veterans look to the Department of Veterans Affairs for necessities such as medical assistance, education, housing, and healthcare — yet they frequently do not receive the full support they deserve. Many veterans have responded by speaking openly about the misconduct within the VA. One veteran, McShan, stated that he had been using VA services since 2009 and had repeatedly encountered problems with long wait times, including waiting a year for a single appointment. Numerous other allegations from veterans were reported during subsequent investigations (Gaitan, 2014). Another veteran noted that a single negative experience with the VA created a lasting impression that permanently damaged his view of the institution.

Organizational Culpability and Scheduling Manipulation

Dr. Margaret Moxness, formerly a physician at Charleston's Huntington VA facility in West Virginia, claims that while working there, her superiors directed her to delay care, even for patients requiring immediate mental healthcare. She witnessed no fewer than two patients take their own lives while waiting for therapy between appointments. She believes that VA authorities failed to recognize the genuine suffering of veterans and demonstrated little empathy toward these patients. Meaningful treatment of mental health issues is not possible when patients must wait 10 months between two consecutive appointments. When Moxness raised these concerns with her superiors — arguing that some veterans were in dire need of assistance — they ceased communicating with her (Coburn, n.d.).

At the Manchester VA center in New Hampshire, administrators used deliberate tactics to conceal the real extent of their appointment backlog. A former facility official stated that performance measures required veterans seeking treatment to be scheduled for psychiatric appointments within two weeks of their "desired appointment date." He identified several factors that made providing the necessary number of appointments practically impossible. Even when veterans and their clinicians agreed that a follow-up was needed within the following week, appointments were simply unavailable. Despite this, the facility allegedly met the performance measure by preventing veterans from stating their preferred date. Patients were instead told the next available date — which often fell weeks or months later — and that date was then recorded as the "desired" appointment date (Coburn, n.d.).

Southern Nevada's VA facility — a one-million-square-foot, $600 million structure equipped with advanced technology and designed as a regional hub for specialized treatments — was praised by local and national leaders as a major advance in regional healthcare delivery. The center was anticipated to improve care quality for veterans, with capacity for up to 60,000 patients. However, a critical problem faces the facility: there are not enough physicians to handle such a large patient population. Nevada has long struggled with a shortage of healthcare providers and consistently records some of the lowest doctor-to-patient ratios in the country (Coburn, n.d.).

After the VA's misconduct became public, officials began taking action, starting with the suspension of key personnel. The VA suspended its assistant director and the head of the Pension Management Center, along with other officials found guilty of misconduct (Yen, 2015). President Obama also publicly stated that he would not tolerate any misconduct from the VA. At the height of the scandal, approximately 26 VA facilities and hospitals were under investigation to determine whether a correlation existed between the number of deaths and the lengthy delays in appointments. VA authorities, however, responded defensively to the claims and indicated they were waiting for investigations to conclude before taking additional action (BBC.com, n.d.).

Conclusion

The VA department is already empowered to enable veterans to access healthcare outside of the VA system; however, that decision currently rests not with patients, but with VA administrators. Veterans — not bureaucrats — must be granted the authority to make decisions about their own care. Veterans should be permitted, if they choose, to schedule appointments with local physicians rather than driving long distances to the nearest VA center or waiting months for a VA appointment (Coburn, n.d.).

Non-VA healthcare providers should be paid at Medicare rates for their services. Where patients carry Medicare or private insurance coverage, the VA must ensure that other insurers appropriately pay their portion of the costs, while avoiding duplicative payments. The VA Inspector General must conduct regular reviews to verify that data is not being manipulated, fabricated, or omitted. Doubtful or inaccurate data must be reported immediately to VA oversight committees, the VA Secretary, Congress, and, if necessary, the Department of Justice (Coburn, n.d.).

Information gathered as described above will enable veteran patients to make informed choices about where and when to seek medical care, while holding the VA accountable for delivering timely, high-quality healthcare at all facilities. This approach would also allow the VA to improve its healthcare system through quicker identification of emerging problems and more informed decisions about resource allocation and staffing (Coburn, n.d.).

Congress and the Administration must also prioritize veteran care processes to ensure that no further lives are lost unnecessarily due to systemic failure to provide timely healthcare access. It is not enough to merely pass legislation. Congress has historically been too eager to make promises to veterans without examining whether earlier commitments were fulfilled. The Senate Veterans' Affairs Committee must specifically take up its supervisory role and serve as an advocate for veterans and taxpayers alike. The VA's problems were known to Congress for decades, yet they were ignored or worsened. Experience has shown that even when legislation is passed, sustained oversight is required — without it, the benefits of new laws go unrealized and new problems emerge undetected (Coburn, n.d.).

It is important to note that, while this paper offers a broad summary of the VA's numerous shortcomings and challenges, it is not exhaustive. Many aspects remain that deserve further congressional investigation, including the need to reorganize and strengthen the VA's medical administration functions, failures in IT development and contracting, and questions about the cost-effectiveness of community outpatient clinics (Coburn, n.d.).