The lone panelist at a Feb. 26 congressional hearing was the Department of Veterans Affairs (VA) Under Secretary for Health Dr. Robert Petzel. For more than an hour, he and four of his lieutenants defended VA’s responses to Capitol Hill concerns over accountability issues in the department.
The hearing was held by the House Veterans’ Affairs Subcommittee on Health, chaired by Rep. Dan Benishek, R-Mich. Backing up Petzel at the hearing were two of his deputy under secretaries, Robert Jesse and Madhulika Agarwal, and two assistant deputy under secretaries, Rajiv Jain and Philip Matkovsky.
In his opening statement, Benishek mentioned a bill he introduced into the House, the Demanding Accountability for Veterans Act (H.R. 2072). "The goal of this legislation is to create a culture of accountability within VA – a culture where problems are identified and immediately corrected, and leaders are held responsible for their actions."
The American Legion has been monitoring accountability issues in VA for quite some time, and has recently conducted quality reviews at three VA medical centers (Atlanta, Dallas and Pittsburgh) whose directors received bonuses after preventable deaths of patients had occurred on their watch. The reviews are part of The American Legion’s System Worth Saving program, which has been evaluating the quality of VA health care since 2003.
Recalling previous VA oversight hearings, Benishek said, "We heard example after example of VA failing to act swiftly to address important issues, or respond to the Subcommittee’s requests for information in a timely manner." A surgeon by trade, he lamented that – while large-scale changes often happen slowly in large government bureaucracies – "I think we can all agree that our veterans deserve more than what we have seen in the last year."
In his testimony, Petzel highlighted several VA improvements: enhanced screening and treatments for military sexual trauma, expanded use of community health-care providers, new productivity and staffing standards in place for all VA physicians by the end of fiscal 2014, and more comprehensive pain-management services that reduces the use of opioid therapy.
"VA will continue to ensure accountability," Petzel said. "And when adverse events do occur, we will learn from them, (and) improve our system to prevent these incidents from happening again."
Benishek asked what specific actions were taken against VA staff at facilities where preventable deaths of patients had occurred. Petzel said, at VA medical center in Memphis, two physicians were disciplined (one was removed from the hospital staff); at Columbia, S.C., three senior executives resigned under the threat of discipline; and, at Pittsburgh, an investigation done by VA and the Justice Department found no criminal activity. "In fact, they found that only one of those six patients had actually died from Legionella, and the others died from other illnesses.... We’re now in the process of evaluating disciplinary action for people at Pittsburgh."
Petzel explained the range of VA discipline for its employees "is anywhere from admonishment to removal. I would point out that, last year, VA removed 3,000 employees, approximately one percent of its workforce." Over the past two years, 14 of VA’s senior executives have either been removed or resigned under threat of discipline. "So we do discipline our workforce. We do hold our workforce accountable."
Rep. Brad Wenstrup, R-Ohio, asked Petzel and his staff if they had ever been in private medical practice; they had not. "If the VA hospitals and their providers operated under Medicare rates – or even 105 percent of Medicare rates – and providers were paid fee-for-service, do you think the VA hospitals would be ‘in the black’?"
"Yes, personally, I do," Petzel said. He referenced several studies that showed costs for VA services were typically 15 to 25 percent below those of the private sector. "I think we could survive very well on Medicare rates – very well.... I would match our efficiency and our cost of doing business against the private sector at any time."
A few minutes later, Benishek told Petzel that the answer he gave to Wenstrup was "completely ridiculous...that you think that the VA is as efficient as the private sector.... Motivating the staff at a VA hospital – to get things moving, and to use your time effectively, is a tremendous problem. And that answer...is a complete fabrication of what actually occurs at the VA. I worked at the VA for 20 years, okay? I know that’s just not true."
Benishek asked Petzel to provide the subcommittee, for the record, the circumstances surrounding the 14 senior executives at VA who were forced to step down in the past two years.
"I had the numbers wrong," Petzel said. "There were 14 serious disciplinary actions taken. Six SES (senior executive service) were dismissed over the last two fiscal years, three non-probationary and three first-year probationary, and we will provide whatever information you want related to that."
Rep. Tim Huelskamp, R-Kans., addressed accountability issues with employees linked to preventable deaths at VA facilities. He asked Petzel if any staff were held accountable for six preventable deaths that occurred at the Columbia, S.C., VA medical center. Petzel told him that three senior executives there had resigned "under threat of discipline."
The following exchange then took place:
Huelskamp: "But they were not disciplined?"
Petzel: "They left before they could be disciplined."
Huelskamp: "They were allowed to resign and move on...."
Petzel: "Allowed to resign? It is their right to retire or resign."
Huelskamp: "There’s no way to hold them accountable when people die because of their failures?"
Petzel: "If somebody wishes to retire or resign, we cannot prevent that from happening."
Huelskamp: "There is no way, no criminal investigation, nothing along that line, to hold these former VA employees accountable?"
Petzel: "There was no criminal charges or intent involved in any of these situations."
At VA facilities where preventable deaths had occurred, Petzel said that some senior staff had either retired or resigned, and that several individuals had been disciplined, but no one was held accountable for the deaths by VA. He noted that no criminal intent had been uncovered by any investigations.