Until now, the Department of Veterans Affairs has confronted its blunders one embarrassment at a time, as if the troubles plaguing America's largest health care system are anecdotal and unrelated.
But connect the dots, and one can reasonably ask whether abusive management practices, wasteful spending, bureaucratic intransigence and medical mistakes reflect systemic problems within the VA that compromise its ability to provide competent care to America's 26-million veterans.
The latest story appeared Sunday, when the Times' David Dahl reported the VA quietly paid more than $2-million to settle claims stemming from the unusual deaths of five cardiac patients who received care at the Gainesville VA Medical Center and its affiliated teaching hospital. Settlements are legal tools, imperfect for laying blame. But the Times found the VA was warned six years ago about unsupervised residents and fellows working at VA hospitals.
"The VA was run by residents and fellows, essentially," one former doctor-in-training at Gainesville, Dr. Jose Gonzalez, told a federal grand jury. "The residents and fellows liked to be at the VA because they are able to make decisions (on their own)."
The disclosures raise the agency's problems to a higher level, by showing how employees' behavior can affect the quality of care. Indeed, the two are inseparable. Last week, President Clinton's choice to head the VA, Hershel Gober of Arkansas, withdrew his nomination after allegations surfaced that he had made inappropriate sexual advances toward a woman in 1993. The allegation, which Gober denies, raised questions, but so did the in-house investigation that cleared Gober, then the VA's second-in-command. The initial complaint against Gober was fielded by the VA general counsel's office, headed by a woman who would later become Gober's wife.
The Gober case chips away further at the VA's credibility. The question for Congress is whether the agency has the wherewithal to deliver the promises made by Kenneth Kizer, the undersecretary for health, to improve peer-review procedures and the reporting of medical mistakes. Congress was right to focus its recent hearings on how the laxity of the VA's decisionmaking process could undermine patient care.
Congress should keep up the pressure, and President Clinton should nominate a VA secretary who exudes confidence and leadership. Veterans deserve a change, and so do the vast majority of VA employees. The agency cannot fix its troubles one mishap at a time.