Eric Shinseki resigned as secretary of the Department of Veterans Affairs on Friday, leaving behind a sprawling bureaucracy embroiled in scandal and burdened with a decades-old legacy of overwhelmed facilities and management failures that his successor must now confront.
President Barack Obama announced Shinseki's departure after a 45-minute Oval Office meeting between the two men that ended a week of mounting demands from both parties for the secretary to step down. Obama, who appeared pained at the turn of events, hailed Shinseki as having an unquestioned commitment to the nation's veterans, but he said the political storm had made Shinseki's continuing leadership untenable.
"We don't have time for distractions," Obama said. "We need to fix the problem."
Fixing the problem at the department now becomes an urgent political matter for the president, once again raising questions about whether the candidate who pledged in 2008 and 2012 to make government work efficiently has lost grasp of the government he now leads.
The department's troubles, however, remain a far more serious concern for the millions of veterans whose access to timely health care has been steadily eroding as waves of wounded soldiers from Iraq and Afghanistan have converged with those who returned from earlier wars.
Most of the veterans now seeking treatment at department facilities are aging Vietnam-era service members, many with chronic illnesses like diabetes that require long-term care or with cancer and cardiovascular disease that require complicated and expensive treatment. Veterans of Iraq and Afghanistan are further straining the system with mental health problems like post-traumatic stress disorder.
Veterans' demand for medical services is soaring. The number of outpatient visits to VA health care facilities has grown 26 percent over the past five years, to 94.6 million in the current fiscal year, according to the department. Over the same period, the number of staff doctors and nurses has grown 18 percent.
The effort to resolve the fundamental problems at the department will also play out in Congress, where Republicans say the problem is not a lack of money — the department's $154 billion annual budget has more than doubled since 2006 — but rather inefficiencies in the delivery of care. Democrats say the problem is a serious shortage of doctors and not enough hospitals.
One immediate question is whether the firing of Shinseki will have any real impact on the agency's deep-seated problems. Shinseki apologized in a speech Friday morning, before Obama accepted his resignation, saying that he was "too trusting" of some people working for him. He criticized a "systemic, totally unacceptable lack of integrity" at some veterans health care centers that he said he could not explain.
But the problems described Friday in an internal audit are remarkably similar to those documented six years ago in a report to the department by Booz Allen Hamilton, the management consulting company. The Booz Allen report found "chronic delays in care" at veterans hospitals and clinics, resulting in part from "the current shortage of nurses, nurse practitioners, primary care providers and specialty physicians."
Shinseki had been challenged by some of those problems during his five years at the department's helm. A year ago, he and Obama had what aides described as a "come to Jesus" meeting in which the president demanded that Shinseki deal with a huge backlog of disability claims that were delaying benefits to veterans.
But the recent allegations that officials manipulated waiting lists for thousands of veterans across the country exposed even bigger issues.
The department's internal audit, which Shinseki presented to the president Friday, attributed the scheduling scandal to the agency's "overarching environment and culture which allowed this state of practice to take root."
The audit said the department's culture "must be confronted head-on if it is to evolve to be more capable of adjusting systems, leadership and resources to meet the needs of veterans and families."
The seeds of Shinseki's departure may have been planted years ago, when he established standards that his supporters said were admirable but unrealistically high. He set 125 days as the goal for processing disability claims and was then blamed for the backlog that ensued. For new patients, he required that veterans to be seen within two weeks.
Among the names mentioned as Shinseki's possible successors by lawmakers and officials at veterans organizations are Kenneth W. Kizer, who was undersecretary of veterans affairs from 1994 to 1999; Rep. Tammy Duckworth, D-Ill., a veteran who served as assistant secretary at the department; Sen. Jon Tester, D-Mont.; and Jim Webb, a veteran who was a Democratic senator from Virginia and a secretary of the Navy.
The president may also face a difficult time getting Congress to agree on legislation and financing to make the necessary changes. Democratic and Republican lawmakers have demonstrated vastly different visions for reforming the department.
Speaker John Boehner, R-Ohio, said Friday that "until the president outlines a vision and an effective plan for addressing the broad dysfunction at the VA, today's announcement really changes nothing."