Meet David Cox: Dr. “No” of VA Reform

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Meet J. David Cox, who many consider “Dr. No” of badly needed reforms within the Department of Veterans Affairs (“the VA’).

J. David Cox

J. David Cox

J. David Cox is President of the American Federation of Government Employees and is the person most likely to block any meaningful reform within the VA.  SFTT has had an eye on Mr. Cox who in the run-up to last year’s Presidential election, threatened the previous secretary of the VA with physical violence:

Cox was “prepared to whoop Bob McDonald’s a – -,” he said. “He’s going to start treating us as the labor partner … or we will whoop his a – -, I promise you,”

The new VA Secretary, Dr. David Shulkin, is rightly receiving favorable media coverage and support from both parties in Congress on his forceful new leadership.  In fact, the New York Times recently referred to Dr. Shulkin as a “Hands On, Risk-Taking ‘Standout.'”

The New York Times reports the following example of Dr. Shulkin’s responsiveness (and common sense):

After he first took the job, he grew concerned that the agency was not doing enough to prevent suicide after a news report showed high rates among young combat veterans. Suicide prevention leaders told him that they would put together a summit meeting to respond, adding that it would take 10 months.

Dr. Shulkin told them to get it done in one month. When his staff members pushed back, he pulled out a calculator and began quietly tapping, then showed them that during the delay, nearly 6,000 veterans would kill themselves. They got it done in a month.

“For me it was a very important day,” he said, remembering the meeting. “It taught our people you can act with urgency, and you can resist the temptation to say we work in a system that you can’t get to move faster. I think they learned that you can.”

Indeed, SFTT has greatly admired the decisiveness with which Dr. Shulkin has attacked two chronic problems with the VA:  A bloated infrastructure and the lack of authority to manage the VA’s large workforce.

While Congressional Republicans and Democrats have largely agreed on an “accountability” bill to support the firing of VA employees, J. David Cox argues that:

“Trampling on the rights of honest, hard-working public-sector employees is not the solution to holding bad employees accountable for their actions,” American Federation of Government Employees National President J. David Cox said. He said the bill would set up different standards for VA employees and other federal workers.

In fact, just recently it was reported that “a federal appellate court overturned the firing of Sharon Helman, who presided over a Phoenix VA Health Care System that left veterans waiting for weeks or even months for care while phony records were kept to show the agency was meeting its wait-time goals.”

Dr. David Shulkin, VA Secretary

While I hope that Dr. Shulkin has the fortitude to implement the bold changes he has outlined, the entrenched bureaucracy represented by David Cox and others, such as David Cifu, will continue to undermine his efforts.

The VA has simply grown too large to manage effectively.  Dr. Shulkin is right in arguing that the lives and well-being of Veterans are far more important than defending the rights of a few “bad apples” within the VA.  David Cox should embrace the vision of Dr. Shulkin and act in a manner which reflects well on the work ethic of the vast majority of VA employees.

Veterans, Veteran organizations and our elected officials should provide Dr. Shulkin with a clear mandate to bring about the much needed reform within the VA. Our Veterans, their family and friends and an appreciate public deserve no less.

J. David Cox would do well to join forces with Dr. Shulkin in this effort rather than taunt him.

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SFTT Military News: Week Ending May 12, 2017

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Found below are a few military news items that caught my attention this past week. I am hopeful that the titles and short commentary will encourage SFTT readers to click on the embedded links to read more on subjects that may be of interest to them.

If you have subjects of topical interest, please do not hesitate to reach out. Contact SFTT.

Military Code-Breaking Project Inadvertently Compromised
In early December 2016, an NYU student came across a server inside New York University’s famed Institute for Mathematics and Advanced Supercomputing, headed by the brilliant Chudnovsky brothers, David and Gregory. The server appeared to be an internet-connected backup drive. But instead of being filled with family photos and spreadsheets, this drive held confidential information on an advanced code-breaking machine that had never before been described in public. Dozens of documents spanning hundreds of pages detailed the project, a joint supercomputing initiative administered by NYU, the Department of Defense, and IBM. And they were available for the entire world to download.  Read more . . .

cyber warfare

Large Russian Military Exercise on Western Border with Latvia
The Russian exercise, known as Zapad, or West, occurs every four years and will take place this year in western Russia, including Belarus and the Russian enclave of Kaliningrad. The U.S. military estimates that 70,000 to 100,000 Russian troops could take part in the exercise, the officials said, adding that the Russian military could also take the opportunity to upgrade certain equipment permanently stationed in the region. Specifically, the officials said that they expect the Russian missile defenses in Kaliningrad to be permanently upgraded with nuclear-capable Iskander ballistic missile systems.  Read more . . .

Vet Groups Back Bill to Support VA Firings 
Major veterans service organizations have rallied behind proposed legislation to speed up the firing process at the Department of Veterans Affairs, but a government union charges it would be a gross violation of workers’ rights. “Trampling on the rights of honest, hard-working public-sector employees is not the solution to holding bad employees accountable for their actions,” American Federation of Government Employees National President J. David Cox said. He said the bill would set up different standards for VA employees and other federal workers.  Read more . . .

US Army Small-Arms Program Explained
U.S. Army small-arms experts recently laid out a blueprint of future small-arms goals that would equip infantry units with several new weapons, ranging from a new squad automatic rifle to a new shoulder-fired, anti-armor weapon. Four months after the Army selected a replacement for its M9 service pistol, the service has started to talk openly about plans to equip infantry squads with lighter, more effective small arms.  Read more . . .

Use of Antidepressants to Treat PTSD Linked to Dementia
Experiencing an exceptionally traumatic event can lead to mental health issues. It can result in flashbacks, nightmares, and severe anxiety that affects the quality of life of the individual and their overall well-being. The most serious of the trauma-inducing mental disorder is post-traumatic stress disorder (PTSD), which can last for months or even years after the inciting incident, interfering with day to day functioning. New research suggests that this disorder is a significant risk factor for developing dementia, a leading cause of serious illness, disability, and death.  Read more . . .

Psychedelic Drug and Therapy Show Promise in Treating PTSD
According to a story by Scientific American, researchers presented results from trial treatments that used psychotherapy and MDMA (3,4-Methylenedioxymethamphetamine otherwise known as ecstasy) as a means of combatting major side-effects of PTSD, such as frequent nightmares and heightened anxiety levels. It was found that 67% of patients who received two or three sessions of MDMA-assisted therapy had completely overcome the illness roughly a year later. This number, as compared to the 23% of patients who got the same result after receiving psychotherapy and a placebo drug, could be the catalyst for an increased number of trials involving psychedelic drugs in the future.  Read more . . .

Bipartisan Support in Senate for VA Accountability Bill?
Congressional Republicans and Democrats have reached agreement on a long-stalled bill to make it easier for the Department of Veterans Affairs to fire its employees, part of an accountability effort touted by President Donald Trump. The deal announced Thursday could smooth the way for final passage on an issue that had been in limbo since the 2014 wait-time scandal at the Phoenix VA medical center. As many as 40 veterans died while waiting months for appointments as VA employees created secret waiting lists and other falsehoods to cover up delays.  Read more . . .

Drop me an email at info@sftt.org if you believe that there are other subjects that are newsworthy.

Feel you should do more to help our brave men and women who wear the uniform or our Veterans? Consider donating to Stand For The Troops

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Whistleblowers and the Department of Veterans Affairs

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On April 27th, President Trump signed an Executive Order to create the Office of Accountability and Whistleblower Protection within the Department of Veterans Affairs (“the VA”).

According to the AP, VA Secretary David Shulkin said the office will help identify “barriers” that make it difficult for the department to fire or reassign bad employees. Another function of the office will be to help shield whistleblowers from retaliation.

To many, it may seem surprising that a new office within the VA is required to protect “whistleblowers,” since private and public whistleblowers have long been afforded protection under the Whistleblower Protection Act of 1989.

Clearly, additional protection is needed if doctors like Dr. Dale Klein can be relegated to an empty room for bringing VA abuse to the attention of the Inspector General.  Found below is a report for Fox News:

Dr. Dale Klein may be the highest-paid U.S. government employee who literally does nothing while he’s on the clock. A highly rated pain management specialist at the Southeast Missouri John J. Pershing V.A., Klein is paid $250,000 a year to work with veterans, but instead of helping those who served their country, he sits in a small office and does nothing. All day. Every day.

“I sit in a chair and I look at the walls,” the doctor said of his typical workday. “It feels like solitary confinement.”

A double board certified physician and Yale University fellow, Klein said the Department of Veterans Affairs (V.A.) took away his patients and privileges almost a year ago after, he alleges, he blew the whistle on secret wait-lists and wait-time manipulation at the V.A. in Poplar Bluff, Mo., as well as his suspicion that some veterans were reselling their prescriptions on the black market.

While one would like to be optimistic that the new “Whistleblower Office” within the VA would help improved efficiency within the VA, I suspect that there are far too many institutional barriers to be overcome in this mammoth organization.

Department of Veterans Affairs

Size Matters at the Department of Veterans Affairs

The VA’s simple mission laid down by President Abraham Lincoln is “to care for him who shall have borne the battle, and for his widow, and his orphan.”

Needless to say, each person has his or her interpretation of what that VA mission entails, but over time the VA has laid on layers of responsibility to fulfill that mission.   In the military, we often refer to that as “mission creep.”

In effect, the VA – whether pressured by Congress, the President or their own Administration – have taken on responsibilities that may or may not be what was originally intended under President Lincoln’s promise.

More importantly, the VA has centralized most functions under its umbrella to administer to the needs of Veterans.

Employing some 350,000 people and many outside consultants, the VA administers health and benefit programs to millions of Veterans.  In economic terms, one might characterize the VA as a monopoly.

While many of the services provided by the VA are excellent, it would be unrealistic to expect that ALL services are effective.

In fact, the IG, internal VA audits and the IG have reported many irregularities at the VA.  Unmanned Crisis Call Centers, unacceptable patient “wait times” and the heavy reliance on prescription drugs all contribute to public wariness and distrust of the VA.   More importantly, many Veterans reject the services provided by the VA.

SFTT has long argued that the VA is far too large to succeed on every front without compromising their main mission.  Shortly after Dr. David Shulkin was appointed Secretary of the VA, we wrote:

NO AMOUNT OF MONEY or CHANGE IN LEADERSHIP or ENACTMENT OF NEW LEGISLATION will bring about A MORE RESPONSIVE VA.

The VA has become a bureaucracy that answers only to itself and is not responsive to the needs of Veterans.  Frankly, the VA has lost its way and very little will change unless the VA is broken down into far smaller manageable components.

While smaller components of the VA will invariably fail, A SMALLER AND LESS CENTRALIZED VA WON’T COMPROMISE THE FULL MISSION.  

VA Whistleblowers and David Cox

Dr. Shulkin and others clearly realize that there are serious problems of accountability within the VA.  The April 27, 2017 Executive Order is designed to help “weed out” waste and inefficiencies within the VA.

J. David Cox

J. David Cox

Despite much needed reform within the largely ungovernable VA, I suspect that  J. David Cox, President of the American Federation of Government Employees, will continue to run a destabilizing campaign to block any meaningful reform.

We admire the courage of “whistleblowers,” but Veterans shouldn’t expect great changes considering the entrenched positions of David Cox and his henchmen.

It is reassuring to see Dr. Shulkin take action to confront the serious problems within the VA.  We wish him success in his endeavors and hope that he receives much needed support from our elected leaders to bring radical reform to the VA.

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VA Secretary David Shulkin: Glass Half Full?

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Department of Veterans Affairs (“the VA”) Secretary, Dr. David Shulkin means well, but it is not surprising that his leadership is being undermined by the same chronic conditions that have plagued other VA Secretaries.

Dr. David Shulkin, VA Secretary

THE VA IS SIMPLY TOO LARGE TO SUCCEED IN ITS MISSION

This week brings yet three more examples of the chronic problems facing the VA:

The VA still can’t FIX the Suicide Hotline

Secretary Shulkin Needs Senate Approval to Fire VA Employees

VA Dropping Veteran Caregivers from Their Rolls

Indeed, this litany of weekly crises is not dissimilar from scandals that have surfaced under the leadership of other VA secretaries.

What follows is a well-choreographed skit designed to reassure the public and Veterans that all is well in the Music Man’s River City.

“New Crisis” at the VA attracts national media;

VA Secretary assures Congressional subcommittee that problem will be fixed;

Congressmen get public facetime preaching to the converted;

– VA Secretary Shulkin sulks back to his office to prepare for next week’s Congressional hearing;

VA Labor Union blocks any constructive legislation that would allow the Secretary Shulkin to implement much-needed change within the VA.    Why?  Just ask J. David Cox, President of the American Federation of Government Employees, who once threatened a VA Secretary with “physical violence” for suggesting a change to the status quo.

For those who have followed this same tragic charade for many years, it is clearly evident that the VA is too big to succeed.  In the words of Nassim Taleb, the VA is fragile.

In my opinion, NO AMOUNT OF MONEY or CHANGE IN LEADERSHIP or ENACTMENT OF NEW LEGISLATION will bring about A MORE RESPONSIVE VA.

The VA has become a bureaucracy that answers only to itself and is not responsive to the needs of Veterans.  Frankly, the VA has lost its way and very little will change unless the VA is broken down into far smaller manageable components.

While smaller components of the VA will invariably fail, A SMALLER AND LESS CENTRALIZED VA WON’T COMPROMISE THE FULL MISSION.  

Will “change you can believe in” actually take place?  I think not, considering the entrenched political interest in maintaining the status quo and the patronage of a large block of voters represented by J. David Cox.

As presently configured, there is no possible way that the VA can fulfill President Abraham Lincoln’s promise: “To care for him who shall have borne the battle, and for his widow, and his orphan” by serving and honoring the men and women who are America’s Veterans.

As argued on several other occasions, the VA should be reconfigured to concentrate on those Veteran functions which require centralization.  All other activities should be assigned to smaller VA components or outsourced (with supervision) to the private sector.

For instance, the VA centralized suicide crisis line makes little sense.   Aside from the fact that the crisis line is currently non-responsive (and has been for a long period of time), it seems evident that we should allocate responsive resources far closer to a high-risk Veteran.

Let’s face it, few jumpers have been talked down off the ledge by a Call Center.  If you want to deal with high-risk Veterans in urgent need of support, get human resources to them as quickly as possible.  THINK LOCAL and COMMUNITY-BASED SERVICES.

While this more decentralized approach may not resolve the current Crisis Center problems, it would be far easier to manage and control at a local level.  Better yet, high-risk Veterans will benefit from a far more responsive human touch by local communities that truly care.

For Veterans, BIG IS NOT BEAUTIFUL!   Many Veterans see a largely unresponsive institution that seems more preoccupied with statistical adherence to protocol than positive patient outcomes. Wouldn’t it be wonderful if we could turn that perception around?

From the perspective of the VA, it is a lot easier to say that “we need more resources to deal with current shortcomings,” rather than face the reality that the VA has become a dysfunctional bureaucracy.

The Titanic

The ability to turn around the “Titanic” VA was lost many years ago.  Going forward, we must chop down the VA into far smaller component “passenger ships”  with accountability and leadership that can truly effect meaningful change.

Sure, one or more of these smaller components may fail, but not ALL Veterans will be held hostage by the continued failure in leadership of an INSTITUTION THAT IS TOO BIG TO SUCCEED.

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Will the VA Provide Better Service to Veterans?

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With much fanfare, Dr. David Shulkin, the new Secretary for the Department of Veterans Affairs (“the VA”), has moved quickly to address some of the recurring problems at the VA.

Dr. David Shulkin, VA Secretary

As the first VA Secretary without a military background, Dr. Shulkin appears committed to resolve several pressing concerns:

– Speedier processing of Veteran benefit claims and,

– Eliminate unnecessary bureaucracy and artificial constraints on “out-of-network” support for Veterans (Choice Program).

Indeed, Secretary Shulkin recently unveiled a 10 Point Plan to modernize the VA:

1. Firing bad employees

2. Extending the Choice program

3. Choice 2.0

4. Improving VA infrastructure

5. ‘World-class’ services

6. Better VA-DoD partnerships

7. Better electronic records

8. Stopping suicide

9. Appeals modernization

10. Internal improvements 

While there is little in these Powerpoint presentation bullet points that anyone would quibble with, implementing these broad goals tends to be far more complicated than listing the goals.   Unless there are rigorous benchmarks to assess progress toward achieving these goals, then this “goal-setting” exercise is rather fruitless.

In fact, it is difficult to reconcile the need for increased hiring within the VA unless one sees clear and conclusive evidence that “bad employees” are being fired.  In fact, the VA is recommending a hiring surge to deal with a backlog of benefit claims, a situation that has persisted for 4 years.

Are more employees needed or does the VA lack the “right” mix of employees to implement Shulkin’s 10 point plan?

For instance, State and Local VA coverage varies radically across the US.  For example, NPR reported in 2015 “that spending is nearly $30,000 per patient in San Francisco, and less than $7,000 per patient in Lubbock, Texas. Nationally, the average is just under $10,000. In places where more veterans are enrolled in VA health benefit plans, spending per veteran did tend to be higher.”   Why?  This is a huge variance that is not well explained.

Aligning the VA to Achieve Measurable Goals

As one looks at Shulkin’s proposed goals, it would be useful to determine their priority and the level of commitment (personnel and capital expenditure) that is required to attain them.  Furthermore, what are the benchmarks to chart progress toward achieving those goals.

For instance, “stopping Veteran suicides” is a goal that would find few naysayers.  Nevertheless, it is difficult to reconcile that goal with the sad fact that 30% of suicide watch calls are not currently attended by the Veteran Crisis Center.  Indeed, I find it disturbing that the Suicide Crisis Line has been centralized under the VA in the name of “efficiency.”

Perhaps, Dr. Shulkin and his staff have some measurable goals.  If so, they should be made public and both the Executive Body and Congressional Oversight Committees should receive regular updates from the VA on progress to date in achieving mutually agreeable goals.

Is this likely to happen?  Most certainly not!  This is an anathema to Big Government.

Is Firing Bad Employees Really Going to Occur?

With 365,000 employees, there are certainly going to be a few “bad eggs.”  While Dr. Shulkin praised the vast majority of VA employees, he told a cheering crowd  that “We’re going to make sure that the secretary has the authority to make sure that those (sic “bad”) employees … are leaving the VA system.”

J. David Cox

J. David Cox

Really?  It seems to anyone who has taken more than a cursory look at staffing within the VA, that David Cox, the President of the American Federation of Government Employees, will be calling the shots rather than Dr. Shulkin.

In most cases, distinguishing between a “bad” employee and an inefficient one is largely subjective.  Given the protection afforded by employees at the VA, it is highly unlikely that both the bad and inefficient employees will be “leaving the VA system” anytime soon.

In effect, this places a greater burden on both ” the good” and the many efficient and competent employees within the VA.  With little say or control on managing the workforce, I find it highly unlikely that Dr. Shulkin will be able to fulfill his promise to fire “bad” employees.

More importantly, it is unlikely that he will be able to realign staffing levels to implement his 10-point plan.

And Speaking of Bad Apples:  How About Dr. David Cifu?

If Secretary Shulkin is really serious about dealing with “Veteran suicides” and providing Veterans with alternative treatment for Veterans with PTSD, he would do well to question the credentials of Dr. David Cifu and others within the VA who continue to block Veteran access to better treatment alternatives.

When one looks at Secretary Shulkin’s complex agenda, one should focus on the signs that change is actually occurring.  Personally, I don’t expect to see much change over the next couple of years, unless there are clear bookmarks to measure that change.  Sadly, it seems likely that we will be looking at the same litany of complaints a couple years down the road.

Dr. Shulkin, I admire your bravado and enthusiasm, but question whether you have the right tools and authority at your disposal to bring about a much needed reform within the VA.

Veterans should be hopeful, but not too optimistic.

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Will Much Change at the VA with David Shulkin as Secretary?

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Much was made during the election campaign over the failings of the Department of Veterans Affairs (“the VA”) to serve our Veterans effectively.  While President-elect Trump had vowed to overhaul the VA, his selection of Dr. David Shulkin, an Obama administration holdover, as his nominee raises questions over what may change within the VA.

Dr. David Shulkin, VA Secretary

Indeed, the initial Senate confirmation hearings suggest a “love fest” according to Quil Lawrence of NPR.  Found below is the complete Senate confirmation hearing of the VA secretary-nominee’s testimony to the Senate committee:

Personally, I would like to think that Dr. Shulkin is the right person for the job – and he may well be – but I find it curious that not one of the questions at the confirmation hearing directly addressed the implementation of the Commission on Care recommendations. While some of these issues were addressed obliquely at the hearing, it seems to me that there should be a regular status report to the respective Congressional committees on how (or whether) these programs are currently being implemented.

While a good deal of the confirmation hearing was an opportunity for Senators to showcase their “genuine” concern for Veterans and pontificate on the silly rumors of “privatizing the VA,”  the hearing covered many of the same issues that continue to plague the VA.

Nevertheless, I am encouraged by some of the remarks by Dr. Shulkin at his confirmation hearing which are summarized below:

– Commitment to moving care into the community were it makes sense for the Veteran.  Currently, some 31% of health services are provided by local communities compared to 21% when Dr. Shulkin joined the VA.

– Expand Choice Program to ensure that Veterans are able to seek care in their community.

– Work to eliminate disability claims backlog (already significantly reduced) and seek legislation to reform the “outdated appeals process.”

– Need to address “infrastructure issues” . . . and explore expansion of public/private partnerships rather that build medical centers that have “large cost overruns and take too long to build.”

The Veteran’s Choice Program (“the VCP”) is the result of the Veteran’s Choice Act that was enacted to address chronic wait times for Veterans seeking care at VA facilities.  To a large extent, “the VCP” is the brainchild of Dr. Shulkin.

During the confirmation hearings, Dr. Shulkin agreed that the “mileage” requirement to access private medical services (currently 40 miles from a VA facility) shouldn’t be a deciding factor.  In Dr. Shulkin’s opinion, wait times should be the determining criteria.  Couldn’t agree more.

Furthermore, Dr. Shulkin acknowledged that there was far “too much bureaucratic” red tape involved when a Veteran received the green light to seek private care and the required VA approvals to actually receive it.

While praising the work ethic and dedication of nearly all VA employees, he admitted that he was frustrated by current legal constraints to shed the VA of a few bad apples.  Perhaps, he should enlist the support of government labor leader, David Fox, to join him in helping streamline the VA for the benefit of Veterans.

With 314,000 employees and a VA budget of $180 billion (of which only $76 billion is discretionary), SFTT has long believed that the VA is “too big” to succeed in its mission to provide adequate and responsive care to Veterans in need.

The issue is not the “quality of care” provided by the VA, which according to a recent Rand Corporation study compares favorably with private institutions.   The question remains, who gets access to these quality VA services and when?

During his confirmation hearing, Dr. Shulkin stated that only 61% of interviewed Veterans “trust” the VA (up from 41%).   I am quite sure that as the new VA Secretary, Dr. Shulkin, will seek to improve trust levels among Veterans, but ease of access to urgent medical services – whether at the VA or private facilities – is critical.

Furthermore, Veterans should be provided with a wider range of choices in determining the type of treatment they feel is appropriate for their medical condition.  Specifically, it is simply not acceptable that “gatekeepers” at the VA should determine ALL “eligible” treatment procedures.

Certainly, Dr. Shulkin appears to have the “right” temperament for the job, but in my opinion, far more is needed to turn around this largely non-responsive ship that is currently adrift and aloof from meeting the needs of Veterans.

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