Julio Cortez/AP Photo
Clarence Shields, an Army veteran, pickets outside the Baltimore VA Medical Center, April 22, 2020, in Maryland. The VA has been struggling with shortages of workers and equipment at its health care facilities during the coronavirus outbreak.
Amid the tidal wave of media reports on personal protective equipment (PPE) shortages in private hospitals throughout the country, some press coverage has highlighted worker complaints about the same problem at the Department of Veterans Affairs (VA).
Like health care workers everywhere, concerned VA caregivers have blown the whistle on top administrators, who have downplayed the extent of PPE rationing. The double-talk and evasion of Trump appointees and their flacks at the VA has been a staple of recent Rachel Maddow episodes, plus news stories in The New York Times and Wall Street Journal.
These complaints triggered an angry letter sent last week to Vice President Mike Pence by Senate Veterans’ Affairs Committee member Jon Tester (D-MT) and 15 of his colleagues, including former committee chair Bernie Sanders, Elizabeth Warren, and Tammy Duckworth, a disabled Iraq War veteran.
The Senate Democrats questioned why the VA “can no longer rely on its prime vendors to properly supply its hospitals,” and must depend instead on a Supply Chain Task Force controlled by the Federal Emergency Management Agency (FEMA). They note that FEMA has failed to prioritize and quickly respond to VA requests for supplies, despite its expanded patient population of non-veterans from overwhelmed private hospitals. Meanwhile, frontline caregivers are told to reuse or bring in homemade PPE, despite the hazards of working in facilities where infectious diseases are present. The letter blames the dysfunction on “the broken procurement and distribution system developed by this Administration,” which has interfered with the VA’s “sacred mission” (which Congress has just given the VA $20 billion more to carry out).
As with any VA-related controversy, a little context and history is helpful. Not all bureaucratic problems and obstacles at the VA were created by the Trump administration, or its Republican allies on Capitol Hill, though both have certainly weakened it through partial privatization measures.
In both his handling of VA preparedness and outsourcing of veterans’ care, Trump is actually continuing, rather than repudiating, policies put in place by other administrations and supported by most signers of the April 23 letter to Pence, as well as other presidents like George Herbert Walker Bush.
As one current VA official with a long history in emergency preparedness told the Prospect, “The slow march of VA’s increasing inability to rapidly respond to a systemwide supply crisis started in 1991 with the penny-wise, pound-foolish decision to eliminate VA’s robust and resilient internal depot and medical warehouse system.” These depots, strategically located around the country, gave VA greater control over the purchase, distribution, and allocation of critical supplies across the system. “Back then, unlike now, VA wasn’t dependent on for-profit prime vendors and just-in-time supply systems favored in private medicine,” the official explained.
Several VA sources point out that the Supply Chain Task Force Senate Democrats are now complaining about was once managed directly by the VA itself. As a prominent VA observer explained, “Under Bush and Obama, the VA’s role in managing the stockpiles atrophied, which basically cut them out of the preferential role they once had. When you hold the cookie, you get the first bite. When you don’t hold it, you’re no longer in a preferential position.”
Emergency preparedness at the VA “was not a priority,” a VA official explained. “The VA undersecretary for health, David Shulkin, and VA staff were so overwhelmed and beleaguered by negative media and congressional acrimony—much of it coming from Democrats like Congressman Seth Moulton—that they viewed spending time and money on high-consequence/low-probability scenarios as a luxury.”
One casualty of this ramp-down of preparedness was a Washington, D.C., operation dedicated to fulfilling the agency’s “fourth mission”—acting as a backup medical system during national emergency situations.
The little-known Healthcare Operations Center (HOC) at VA’s central office was unique in the American health care system. Stocked with state-of-the art equipment, the HOC gave the VA the ability to coordinate rapid response in crisis situations. “In a room in VA headquarters we could watch the entire VA system in real time,” the VA official said. “We could track the evolution of a pandemic not only in the VA but state by state, county by county, monitoring the civilian and veteran population, and determining how many diagnoses there were as well as bed capacity, and burn rate of PPE and supplies.” While undersecretary, Shulkin, who worked for Obama and later Trump, shut it down.
Fortunately, Dr. Richard Stone, acting undersecretary for health, or executive in charge, at the VHA, had the foresight to restore the HOC last year. On April 23, just as Senate Democrats wrote to Pence, Stone issued a memo to VA staff describing its current emergency response and coordinating role.
In both his handling of VA preparedness and outsourcing of veterans’ care, Trump is actually continuing policies put in place by other administrations.
Other organizational chart changes made by Stone’s boss, VA Secretary Robert Wilkie, have been less helpful. For example, the VA’s Office of Operations, Security, and Preparedness has been put under the assistant secretary in charge of the Human Resources and Administration Office. This means the top official responsible for managing a workforce of 300,000—and, hopefully, speeding up emergency VA hiring—also has overall responsibility for emergency preparedness.
As they demand that the Trump administration speed up the production and delivery of necessary supplies for frontline VA caregivers, Senate Democrats might well ponder—and take some responsibility for—their own contribution to VA preparedness problems. Many of the Tester letter signers voted for the VA Accountability Act, which opened the door for stepped-up administration attacks on outspoken in-house critics of top VA political appointees, and put hundreds of other workers at risk of unfair discipline, after stripping them of past due-process protections when disciplined.
Fourteen of the 16 signers voted for the VA MISSION Act of 2018, which Tester himself co-sponsored. With only Bernie Sanders among them dissenting (and Tammy Duckworth missing the vote), this bipartisan legislation undermined the VA’s own direct care for veterans and its emergency response capacity. When Congress gave Trump the green light to outsource billions of dollars in VA services, it also provided him with a rationale for imposing a VA hiring freeze, which has, over the past three years, left the agency with 50,000 vacant positions.
Imploring the administration “to recognize VA’s unique role as the country’s largest health care system”—as Tester and his colleagues did—is like asking Trump to have a change of heart about gutting the Environmental Protection Agency. It’s not going to happen. And nine million VA patients can’t afford to wait for a former member of the Obama administration to get elected and, hopefully, start fixing things either. Given the record of Democrats under Obama, even if Joe Biden is president, a lot of pressure will have to be applied if VA policy is to be changed for the better.
