The VA suffers from "significant and chronic systemic failures" that must be addressed by department leadership, according to a White House report delivered to President Obama on Friday, giving urgency to congressional legislation aimed at reducing veterans' wait times for healthcare and holding officials more accountable.
Among the problems cited are a "corrosive culture" that has led to personnel problems within the Department of Veterans Affairs, exacerbated by poor management and a history of retaliation toward employees raising issues.
The report is the latest stinging assessment of the VA, which operates 1,700 hospitals and clinics.
White House Deputy Chief of Staff Rob Nabors presented the findings to the president during a meeting also attended by acting VA Secretary Sloan Gibson.
In a statement afterward, Gibson acknowledged the "unacceptable, systemic problems and cultural issues within our health system" and pledged to "work to earn back the trust of veterans."
The White House report follows one by the VA inspector general that found a systemic problem in scheduling veterans for healthcare in a timely manner, including instances in which VA staffers falsified records to cover up long waits. The Office of the Special Counsel, which investigates whistle-blower complaints, assailed the VA this week for failing to acknowledge the "severity of systemic problems" that have put patients at risk.
With the VA inspector general now investigating 77 of the department's facilities, as noted in the report, this latest assessment is likely to give momentum to House-Senate negotiations to complete work swiftly on reform legislation.
Among other things, such legislation would allow veterans facing long waits at VA facilities to see private doctors and would expand the VA secretary's authority to fire senior managers for poor performance.
But one of the recommendations -- that the department needs additional resources -- is likely to run into resistance from some lawmakers who have argued that the VA, whose budget has been increased in recent years, has enough money. A Senate-approved bill would provide $500 million for expedited hiring of new VA doctors and nurses.
Rep. Jeff Miller (R-Fla.), chairman of the House Veterans' Affairs Committee, said, "It appears the White House has finally come to terms with the serious and systemic VA healthcare problems we've been investigating and documenting for years." He pledged to work to institute reform that would "improve services to America's veterans while bringing real accountability and efficiency to the department."
Sen. Bernie Sanders (I-Vt.), chairman of the Senate Veterans' Affairs Committee, said Nabors' recommendations would be considered as Congress works on VA reform legislation.
"As the report indicates, there is strong sentiment among many veterans and stakeholders that in general the VA provides high-quality healthcare once you get in the door and that the current system needs to be fixed, not abandoned or weakened," Sanders said.
But he added: "The VA must do a far better job in understanding what is taking place on the ground, and regional and local offices can no longer hide serious problems when they exist" and it must be "honest and straightforward about its needs in terms of additional doctors, nurses, other medical personnel and facilities that it needs to provide the high-quality care that it must provide."
Nabors, who has been visiting VA facilities, called for reform of the Veterans Health Administration, saying it is resistant to change.
The Veterans Health Administration is marked by an "inherent lack of responsiveness and a belief that any issues raised by the public, the VA leadership, or oversight entities are exaggerated, unimportant or 'will pass,'" according to the report.
Nabors called for "better structure and more accountability."
The report criticized the "unrealistic" goal of scheduling veterans within 14 days of their desired appointment. That goal has been cited as a reason for employees manipulating wait lists to conceal long wait times.
It also said technology used by the department is "cumbersome and outdated."
Among the sharpest criticism was the "corrosive culture" that Nabors said had led to personnel problems across the department that were "seriously impacting morale and, by extension, the timeliness of healthcare."
"There is a culture across much of the department that encourages discontent and backlash against employees. Whistle-blower complaints suggest poor management and reflect a palpable level of frustration at the local, regional and national levels," the report says, noting that the VA accounts for one-fourth of the cases under investigation by the Office of Special Counsel.
"The tone at the top should encourage employees to speak up about problems but also to think of and be a part of solutions," the report recommends.