Almost a year after ordering a massive shake-up of the Veterans Affairs Department, President
In a trip to the
"We've brought in a new team that has been tackling these issues to make sure that wait times for scheduling, access to providers, is greatly improved," the president told reporters. "But what we know is there is still more work to do.
"Trust," he said, "is one of those things that you lose real quick, and then it takes some time to build."
Aides to the president say the Phoenix center has shown progress since the revelations last April, as has the rest of the agency's division charged with providing healthcare to American veterans.
Promising accountability, new VA Secretary Bob McDonald fired or disciplined hundreds of employees and hired a net increase of more than 8,000 doctors, nurses and other healthcare workers, according to administration figures.
But change hasn't come quickly or thoroughly enough for some veterans advocates who hope Obama will see the job as only half done during his review.
The conservative Concerned Veterans for America warned the president publicly against the perils of a "whitewashed tour" by hospital administrators who were part of the problem. A whistle-blower who helped bring attention to the problems said she had seen signs of improvement but also expressed hope that Obama would get an unvarnished view, not just a meeting with senior executives.
“The person that he should be meeting with is the person that works the night shift on the psychiatric floor or who works the busiest shifts in the ER or the housekeeper that is struggling to clean all these really important places,” said Katherine Mitchell, a physician who testified before
"If they want to find out what's going on in the hospital, they need to speak with the people on the front lines," Mitchell said in an interview before Obama's tour.
While at the center, Obama met with executives of the healthcare system and members of Congress as well as with two nurses, a mental health practitioner, a scheduler and a labor representative, according to the
The overhaul at the VA came after a CNN report said that at least 40 veterans died waiting for appointments at the Phoenix VA Health Care System, many of them after being placed on a secret waiting list designed to hide their months-long delays in getting healthcare.
Other reviews showed long patient wait times at hospitals and clinics across the country with data manipulated to downplay the delays.
The White House responded by dismissing the VA secretary and bringing in McDonald, and pushing a reform law that included a new program to help veterans get appointments with private doctors when needed.
According to a report last week from the Veterans of Foreign Wars, 8.6 million veterans had signed up for the new program, Veterans Choice, in its first three months. Of that number, 26,662 had requested healthcare services from non-VA facilities, the overwhelming majority of whom received appointments.
But fewer than 1 in 5 veterans who qualified to get care outside the VA were offered that option, according to a survey conducted by the VFW. Local VA staff members were not sufficiently familiar with the program, the VFW found, but acknowledged that such problems were to be expected with the rollout of an "ambitious" program.
As part of Obama's visit, the VA announced a new advisory committee of experts to make more recommendations for change.
Sen. John McCain (R-Ariz.) was dismissive of the committee, calling it a "high-profile but empty gesture."
During a round-table discussion with the president Friday, McCain said, he questioned Obama about his administration's "foot-dragging" on fully funding and implementing the reform law.
Noting that no one had been fired at the Phoenix hospital, Miller said a "dearth of accountability also exists at VA facilities across the nation, as evidenced by the fact that VA has not fired a single senior executive for wait time manipulation."
"It's becoming quite evident that this administration is either unwilling or unable to take accountability at VA seriously," said Miller.
Mitchell, the whistle-blower, said hiring and access to care had improved significantly. But she said she still had concerns that potential informants fear retaliation if they report problems.
"I get calls every week describing problems and asking for help," said Mitchell, who still works for the VA as the special care medicine coordinator for the VA Southwest Health Care Network. "At the Phoenix VA, even just in the last three weeks, I've had serious patient care issues that were brought to me. ... People are just afraid to speak up."
Though some high-profile officials have been disciplined, Mitchell said the retaliation employees fear most is at lower levels.
"What I don't understand is why there is so few people being held accountable," she said. "They really, really need to emphasize holding supervisors accountable for retaliation because that essentially drags the employee and prevents them from speaking out."
Obama said he saw room for improvement but thought it was possible.
"Just the fact that there have been a few bad apples, mistakes that have been made, systems that aren't designed to get the job done," he said, "I don't want that to detract from the outstanding work being done."