Does the Next VA Secretary Face an Impossible Task?

Senators have a long To Do list for nominee Robert McDonald, expecting him to succeed where his predecessors have failed.

U.S. military veteran and amputee Lloyd Epps walks after doctors serviced his prosthetic leg at a Veterans Administration facility in New York in January. A bill that the House approved on Thursday would cut some controversial nuclear weapons spending in a bid to help veterans.
National Journal
Jordain Carney and Stacy Kaper
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Jordain Carney Stacy Kaper
July 22, 2014, 11:30 a.m.

As Pres­id­ent Obama’s pick to lead the em­battled Vet­er­ans Af­fairs De­part­ment out of its cur­rent crisis, Robert Mc­Don­ald faces a tall or­der from the sen­at­ors who will de­cide his fate.

Mem­bers of the Sen­ate Vet­er­ans’ Af­fairs Com­mit­tee in­sist that he will need to over­haul the VA at once if he is con­firmed. For law­makers, that in­cludes everything from in­stalling new lead­er­ship and trans­form­ing the de­part­ment’s cul­ture to restor­ing ac­count­ab­il­ity and en­sur­ing that vet­er­ans re­ceive prompt med­ic­al treat­ment.

Mc­Don­ald told law­makers that if he gets the job, he would take ac­tion on re­forms dur­ing his first 90 days in of­fice. 

“The No. 1 core value of the or­gan­iz­a­tion is in­teg­rity, so we’ve got to root out when that isn’t up­held,” he said.

Mc­Don­ald said on his first day he would lay out his lead­er­ship vis­ion to all VA em­ploy­ees and in­centiv­ize them to bring any con­cerns and prob­lems to his at­ten­tion so he has a full pic­ture of what’s wrong. He would also travel across the coun­try in the first few months to meet with em­ploy­ees, vet­er­ans, and oth­er stake­hold­ers.

He also plans to re­struc­ture met­rics for em­ploy­ees’ eval­u­ations. Vet­er­ans ser­vice or­gan­iz­a­tions and law­makers have long ques­tioned if link­ing per­form­ance met­rics to bo­nuses could en­cour­age data ma­nip­u­la­tion.

“How does the VA — among oth­er things — provide timely, qual­ity health care?” com­mit­tee Chair­man Bernie Sanders of Ver­mont said in an in­ter­view just ahead of Mc­Don­ald’s con­firm­a­tion hear­ing Tues­day. “How do we con­tin­ue … lower­ing the claims back­log? How do we make sure that the num­bers that are com­ing out are ac­cur­ate? How do we de­vel­op ac­count­ab­il­ity at the VA? … These are very dif­fi­cult is­sues.”

Mc­Don­ald’s con­firm­a­tion pro­cess could see quick turn around from the com­mit­tee. Sanders said com­mit­tee mem­bers hope to vote on his nom­in­a­tion Wed­nes­day.

The VA has been un­der fire in re­cent months after al­leg­a­tions of data ma­nip­u­la­tion at its med­ic­al fa­cil­ity in Phoenix that in­cluded re­ports of vet­er­ans dy­ing while wait­ing for care.

Act­ing Sec­ret­ary Sloan Gib­son told law­makers late last week that in­vest­ig­a­tions in­to roughly 70 VA fa­cil­it­ies are not ex­pec­ted to wrap up un­til mid-Au­gust.

Com­mit­tee rank­ing mem­ber Richard Burr of North Car­o­lina told Mc­Don­ald that if he is con­firmed, “it will be es­sen­tial that you em­brace the find­ings of these in­vest­ig­a­tions.”

The ma­jor hurdles Mc­Don­ald faces are prov­ing that the VA is be­ing held ac­count­able for its mis­deeds and can turn it­self around im­me­di­ately by tak­ing care of the mil­lions of vet­er­ans un­der its charge, com­mit­tee mem­bers stressed Tues­day.

“The biggest chal­lenge is ob­vi­ously get­ting the sys­tem na­tion­ally to be able to de­liv­er much more rap­id-re­sponse health care to our vet­er­ans,” Demo­crat­ic Sen. Mark Be­gich of Alaska said in an in­ter­view shortly be­fore Mc­Don­ald’s hear­ing. “Second, I think he has a cul­ture with­in the VA that he has to move kind of in­to this 21st cen­tury of how to re­spond to this very com­plic­ated health care de­liv­ery sys­tem that we have.”

Be­gich ad­ded that Mc­Don­ald faces not just a budget is­sue, but a re­cruit­ment chal­lenge of hir­ing more doc­tors and oth­er es­sen­tial health care pro­fes­sion­als.

“He has to kind of re­build that im­age, re­build that trust, and be able to de­liv­er health care in a much more ex­ped­ited way to vet­er­ans across the coun­try.”

Get­ting the Amer­ic­an people — vet­er­ans in par­tic­u­lar — to trust the VA must be his first or­der of busi­ness, some sen­at­ors said. They ad­ded that this will re­quire a sig­ni­fic­ant house­clean­ing.

“First and fore­most, mak­ing sure the in­form­a­tion is ac­cur­ate and truth­ful, get­ting good in­form­a­tion” would be Mc­Don­ald’s top chal­lenge, said Demo­crat­ic Sen. Richard Blu­menth­al of Con­necti­c­ut. “Second, chan­ging the cul­ture. Bring­ing tough stand­ards to bear and mak­ing sure that they are met. And third, chan­ging the people — mak­ing sure that there is new lead­er­ship and that they are part of the new cul­ture.”

Des­pite the laun­dry list of de­mands, Mc­Don­ald is ex­pec­ted to have a smooth con­firm­a­tion pro­cess. A hand­ful of Re­pub­lic­an sen­at­ors — of­ten tough crit­ics of the VA — told Mc­Don­ald that his con­firm­a­tion is all but guar­an­teed. Law­makers are hope­ful that he can use the ma­na­geri­al skills he honed in the private sec­tor — in­clud­ing dur­ing a stint as the CEO of Procter & Gamble — to whip the de­part­ment in­to shape. 

If con­firmed, Mc­Don­ald will re­place Eric Shin­seki, who stepped down as sec­ret­ary in late May amid grow­ing al­leg­a­tions of mis­con­duct at VA of­fices across the coun­try. Sloan Gib­son has served as act­ing sec­ret­ary since then. 

But the scan­dal goes bey­ond the VA’s health ad­min­is­tra­tion. On the oth­er side of Cap­it­ol Hill, House Vet­er­ans’ Af­fairs Com­mit­tee mem­bers — led by Re­pub­lic­an Rep. Jeff Miller of Flor­ida — are look­ing in­to al­leg­a­tions that dis­ab­il­ity-claims work­ers cooked the books or des­troyed in­form­a­tion. Whistle-blowers across the VA have come for­ward and test­i­fied be­fore Con­gress about al­leg­a­tions of re­tali­ation. 

Linda Hal­l­i­day, the as­sist­ant in­spect­or gen­er­al for audits and eval­u­ations, told law­makers last week that the VA’s Of­fice of In­spect­or Gen­er­al is in­vest­ig­at­ing data-in­teg­rity com­plaints with VA claims at its of­fices in Bal­timore; Hou­s­ton; Little Rock, Ark.; Los Angeles; Oak­land, Cal­if.; and Phil­adelphia.

And though law­makers on both sides of the aisle have missed little op­por­tun­ity to cri­ti­cize the em­battled de­part­ment, le­gis­la­tion that would provide ex­tra fund­ing and al­low vet­er­ans great­er ac­cess to private health care is stuck in a con­fer­ence com­mit­tee, with no break in the lo­g­jam in sight.

In a bit of polit­ic­al foot­ball, Sen­ate Ma­jor­ity Lead­er Harry Re­id has blamed Re­pub­lic­ans on the con­fer­ence com­mit­tee, say­ing they are un­will­ing to provide ex­tra fund­ing for vet­er­ans, des­pite sup­port­ing the re­cent wars.

But with the month­long Au­gust re­cess loom­ing, Sanders and Miller have said they were still hope­ful an agree­ment could be reached, des­pite the “tough ne­go­ti­ations.”

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