This spring marked the ten-year anniversary of whistleblowers shining light on long waits for veterans to get care at the Phoenix VA, as well as the existence of secret waiting lists aimed at hiding that information. Investigations revealed several veterans died as a result of this delayed care.
The scandal extended to other VA facilities beyond Phoenix, as well, and led to more oversight of the system, as well as a plan to allow veterans to see medical providers outside of the VA if it’d take too long to see their VA doctor.
There are differing opinions as to whether or not things have improved in the system over the last decade. So, The Show conducted interviews to bring two different perspectives to you.
We start with Darin Selnick, a retired Air Force officer and former VA employee, including as senior advisor to the VA secretary during the Trump Administration. He’s also senior advisor to the group Concerned Veterans for America. When The Show spoke with him earlier, he was asked where he thinks the VA is now, relative to where it was a decade ago, and where it’s been over the last ten years.
Full conversation with Darin Selnick
DARIN SELNICK: It's sad to see, but it's like deja vu — back in 2014 all over again. I was part of, as being senior advisor to the secretary, I was part of making up the Mission Act and implementing the Mission Act, and making sure that, through access standards — which are similar to DOD's — that no veteran would have to wait too long or drive too far to get care.
Unfortunately, what I've been seeing, as someone who wrote this stuff up, is we're seeing in Phoenix and other parts of the country where they don't actually follow the access standards and veterans are getting delayed care, denied care.
MARK BRODIE: Are you still finding that there are, for example, secret wait lists and things like that? Or is it — and I don't mean to minimize it by saying "just" — but is the problem mostly now that it's just taking too long for veterans to see a provider?
SELNICK: Yes, it is taking too long, and the problem is veterans are not being told that they are eligible or they're trying to meet the access standards by giving veterans employment before the access standard and then cancelling them or never telling them that they're eligible for community care. So, it goes on and on.
The wait times that they post on the website are incorrect wait times, because, by regulations, you're supposed to calculate wait times by date of request — it makes sense. I call up, I asked for an appointment. That's when the clock starts.
But they're still using the 2014 way of doing business, which is a patient-indicated date or a clinic date where they say, hey, you know, you don't need to be seen for a certain amount of time, so we're not going to start calculating it. And it's the delays that kill veterans for cancer and other things.
BRODIE: For veterans who are trying to get care through the VA, is it kind of like what we see in many cases, especially here in Phoenix and elsewhere — also in healthcare — there just aren't enough providers for the number of patients who need to see them?
SELNICK: No, that's not really the problem. The problem with the VA is that they're so inefficient in seeing people. So, to do a direct comparison, I use Camp Pendleton Hospital, military hospital. And on average, in the military, they see 19 patients a day.
Staff is telling me that they're down to as low as sometimes three to five patients or six patients a day. So, if you have the staff, but you are inept in your operation, that's the problem. But even if the VA didn't have enough staff — which they do, they have twice the ratio of staff that that like a Kaiser does — then that's why you have community care.
So, if there's a long wait time, the whole point of the access standards is that if you have mental health and primary care and there's a wait of more than 20 days, they're supposed to offer you community care. If you have more than a 28-day wait for specialty care, they're supposed to offer you community care.
Now you don't have to take community care if you like that doctor and you want to wait longer, but the point is you should not have three, four, five, six months — and a lot of doctors are getting in trouble because they are putting veterans in community care and they're getting in trouble for it and they're doing it because they have waits of three, four, five months.
BRODIE: When you talk about community care or seeing a physician in private practice, anybody who's called to try to make an appointment will tell you — any random person would tell you — that it can still sometimes take two, three, four months to see a provider depending on the specialty.
So, I wonder — yes, the VA should be according to the law and the standards, referring veterans to community care if the wait is too long at the VA, but does just referring them to community care guarantee they're gonna get it any sooner?
SELNICK: Well, you're right. In health care, there's no guarantees. But what's the difference between — because I get asked this question all the time, what's the difference between VA and the private sector, good and bad for both sides — the difference is choice.
So, if I have a long wait time at the VA, and therefore, it's a 40-day wait, and I go to the community, and the best I can find is 50 days, I don't have to use the community, I can use the VA. So, I have the choice of best of both worlds if I do. That's the whole point of choice.
The difference, though, is if the VA provider is 60 days out, there is no other choice in that VA to find a better choice. But in the community, you can shop around, you can shop around any provider that provides that in the network. And you can shop around and you can say, hey, I need to get this treatment.
My experience in the private sector is if a particular provider has a long wait time, normally practices will offer you another provider with a much shorter wait time, especially if you tell them hey, I need to be seen, because all doctor practices have holes in their schedule. So, you can literally shop around, and I've done that myself to go ahead and get the appointment that I want.
BRODIE: So, given the problems that you're describing that are still within the VA a decade after this initial scandal broke, do you think that there is still a place for the VA? Or do you think this country needs to sort of blow up the system of health care for military veterans and maybe start over?
SELNICK: Well, I think there's definitely a place for the VA. It just needs to be modernized. The VA is running like a 1990s health care system. And so, who did modernize? DOD did. And so, DOD has about two-thirds of its care in the community, because there's just not enough retired veterans and stuff like that who use a DOD that are close enough to the facilities.
And the same thing happens to the VA. The VA's mission is service connected. It needs to focus on that, and not try to do everything for everybody. When you try to do that, you don't do anything well for anybody if you try to do everything for anybody. So, it needs to modernize. Bad employees need to be held accountable, and it needs the competition. It needs to know that if veterans don't like it, they can go somewhere else, and that's how they're going to improve for their customers.
So, it's definitely a role. But veterans are not going to want to use the VA if the VA provides bad customer service and bad access. No matter how good the quality is, if you can't get it, it doesn't matter.
I'm not someone who advertises to get rid of the VA. What I support — what Concerned Veterans for American supported — is the Veterans Health Care Freedom Act, which was a commission on care recommendation that I was on that says veterans at all time should have the ability to pick between the VA facilities and the community care and be able to make the decision based on what's best for them.
Not everyone, though, shares Selnick's opinions. David Lucier, for one, has a much better view of the VA ten years since the scandal.
Lucier served in the U.S. Army Special Forces and is a member of the Arizona Veterans Hall of Fame; he’s also active in a number of veterans groups, and established a nonprofit called the Arizona Veterans and Military Leadership Alliance. When The Show spoke with him earlier, he was asked the same question — where does he think the VA is now, relative to where it’s been over the last decade?
Full conversation with David Lucier
DAVID LUCIER: We are much, much better off. The VA today is operationally much, much better than it was, say, 10, 12 years ago.
MARK BRODIE: What's changed?
LUCIER: Well, for one, leadership. The other thing is, is that all the stakeholders — many of the stakeholders — are involved. We got the veterans community involved. We got our elected leaders involved. We got administrators at our local VA, and we also went to Washington and talked to the Secretary of the VA about the condition and operation of our Phoenix VA.
BRODIE: Would you say that that scandal sort of was the impetus for these changes? Like was that — did that happening lead to these changes specifically, do you think?
LUCIER: Absolutely. They absolutely did. No doubt about it. We got to a low point. It's just like when you need treatment for drug addiction or alcohol, you got to hit a rock bottom. And I think that's kind of where we were.
There was a lot of problems there. And so, again, stakeholders got together, hammered out what was wrong, identified those problems, and then came up with solutions to fix them. And, of course, that was mostly on the VA. It wasn't an easy journey. But it was certainly a successful one.
BRODIE: I'm curious a little bit about that journey. I mean, was it a straight line? It sounds like it wasn't from rock bottom to the improvement that you're citing now. I mean, was it kind of a zigzag and a lot of, maybe, not consensus about what the right solutions would be? That kind of thing?
LUCIER: I mean, projects and initiatives and programs, they're like cash flows. They're uneven. They always are. But I think that we kept our eye on the ball, and we kept our eyes on the mission and the objective. And the objective was to bring our VA up to a standard that that we could all be proud of. And I think that we've we've reached that, and we've been able to maintain it for several years.
BRODIE: So what is your experience now? You're a military veteran, when you call the VA to get an appointment or to see a provider, what is your experience typically like?
LUCIER: Well, typically, you will tell the appointment person or your medical team. I generally go online and I say I'd like an appointment for this, that or the other. Then, I get a phone call back. "We understand you want an appointment," they confirm I want an appointment for XYZ, and then they say, well, listen, we can get you in on 20 days hence. Okay, so you go for it.
But the rule is that if— there's a time and distance rule. So, if you're far enough away, or the appointment that you're being scheduled for, is more than, I believe, 28 or 30 days out, then you have the option to go into the community for that care.
BRODIE: To see like a private practice doctor.
LUCIER: See a private practice doctor. And that is just the standard — I'll call it a script — because they're very strict about that these days. And so they will say, hey, I can fit you in, in 45 days at the VA, or we can put you out in the community and it's your option.
BRODIE: Well, it's interesting that you refer to it as sort of a script and that they're strict about mentioning that under certain conditions you are free to go and see a community provider, because there have been concerns — and people have expressed them — that the VA is not doing a good enough job of telling veterans that. That if they have to wait X number of days to see a provider at the VA, that they do have the option of seeing a community provider. It sounds like that has not been the case for you.
LUCIER: No, my experience, and folks that I engage with during the normal course of my business, basically have have said the same thing. Now, I'm sure that it's not 100%. No system is perfect, and trying to reach perfection in this life is a bit of a folly. But if we do come across those kinds of things, those are the kinds of things that everybody wants to know about because they want to fix it.
BRODIE: When you see a VA provider, you're offered an appointment, does it tend to be within a reasonable amount of time? Because that was one of the big problems, again, a decade ago, that the wait times were months and months, it was really, really a long time. Have those wait times come down to see particular providers?
LUCIER: My experience is that, not only has the wait times in the VA been reduced — and I'll tell you about some limitations on that, but generally, that's true — and the private sector medical, non-VA involvement. I mean, I'm the second of 11 siblings, and so I've got a lot of siblings that do use those services, and in between just getting an appointment and then the billing is just, I mean, I have sisters who spend a lot of time tracking down billing and correct billing, and getting appointments out in the community is not an easy thing to do.
But I think that, across the board, the VA has done better at getting their appointments filled. But, again, we've got a system, a backup system, where if that's not available, then immediately go to the community.
BRODIE: So, you are active in a number of veterans groups. I'm curious what you hear from other military veterans about their experiences with the VA — both positive and negative. What are people saying right now?
LUCIER: I think, across the board, people are very positive about it. Folks like myself — now, I've been there for several years. In fact, I was there when things weren't so good. And so, I've seen remarkable improvement.
But veterans, especially when you get them in a group, can be pretty vocal, and they can be sarcastic, but they're about hitting that nail on the head. And so, if they have a bad experience, they'll say so. And I just don't hear very many bad experiences.
It doesn't appear to be anything, right now, systemic. I think we've addressed those problems pretty well. Again, it's not perfect. I get that. But it is way better than what we've experienced a decade ago.
