At VA, it's time for heads to roll

Whether they intend to or not, government investigations of government tend to steer clear of inflammatory language, of directly pointing fingers.

The Department of Veterans Affairs inspector general report on the conditions at the Phoenix VA Health Care System, released last week, gave non-judgmentalism a solid try.

And, in a way, that's fine. Maybe it is not the duty of government inspectors and fact-finders to draw conclusions about the culpability of deceptive, duplicitous hospital directors.

That is the job of the people at the top. The Obama administration. And it is now time they concluded that heads should start to roll.

In the 143-page report, the inspector general's team duly reported the "unacceptable lapses" and the "inappropriate scheduling practices."

But regarding the essential issue of the entire scandal — the revelations that dozens of ailing veterans died waiting and waiting and waiting to see a doctor — the investigators go soft.

At several points in the investigative review, the inspectors note that while veterans indisputably died while awaiting care on one of the Phoenix VA's "unofficial" wait lists, they could not conclusively determine that the patients died because of the lack of care during their long waits. Per the report:

"While the case reviews in this report document poor quality of care, we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans."

No one claims any direct cause-and-effect relationship, which would be nearly impossible to prove. Rather, the charge is that veterans experienced terribly long waiting periods — inappropriately long, to crib the VA inspector general's language — and that they died while awaiting care.

As the original whistle-blower to this scandal, former Phoenix VA physician Sam Foote, observed for The Republic last week, the issue is the standard of care: Would those patients more likely than not have survived, or at least enjoyed lengthier lives, if the VA had provided an acceptable and timely level of care?

"Without question, their statement was worded such that the reader will assume that no harm came to the patient due to the delay in care," said Foote. "That is unlikely to be true."

Still, the inspector general's investigation is by no means a whitewash. The report is especially critical of Sharon Helman, the former director of the Phoenix VA, whose false claims of wait-list improvements "resulted in a misleading portrayal of veterans' access to patient care."

At an American Legion convention the day the report was released, President Barack Obama was direct.

"What we've come to learn is that the misconduct we've seen at too many facilities — with long wait times, and veterans not receiving care, and folks cooking the books — is outrageous and inexcusable," the president said.

In almost the same breath, the president arrived at the essential bottom line: "VA employees who engaged in misconduct should be, and will be, fired."

We have yet to see that happen. The most notorious (but far, far from the only) embodiment of duplicitous VA management is the suspended Phoenix director, Helman, who to this day remains on paid leave.

Just a portion of the report's findings regarding Helman:

"(W)e found her accomplishments related to primary care wait times and the third-next available appointment were inaccurate or unsupported."

It is time for the administration to move past the rhetoric about how awful the situation in Phoenix was. We know it was bad. The VA inspector general's investigation confirms what we already knew.

It is time, finally, to act. The VA will never reform unless management changes.

Mr. President, you're right. It is time to fire some people. Roll some heads.

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