CONDITIONS LESS THAN HONORABLE
Perry, Mark
Conditions Less than Honorable When veterans come knocking, the VA bars the door BY MARK PERRY In the lobby of the Veterans Administration headquarters in downtown Washington, an impressive...
...There is just a lack of accountability," says Tom Sherwood, former director of a VA outpatient clinic...
...three cemetery area offices...
...The operation permanently damaged Walker's back...
...He can't do anything...
...Yes," Vogel maintained, "that's right...
...It places special emphasis on training new doctors for careers in "psychiatry, primary care, anesthesiology, geriatrics, radiology, orthopedics, and physical medicine and rehabilitation...
...But far from meeting that goal, the VA practices shoddy medicine, denies legitimate benefit claims, and then covers up its malfeasance...
...I strongly suggest you, as director of our service, take appropriate administrative action against supervisors who, for whatever reason, encouraged or knowingly permitted the gross violation of the constitutional rights of claimants...
...Erspamer detailed the charges made by VA whistleblowers in San Francisco that VA regional field offices regularly denied veterans' claims in order to gain work credits...
...Abrams wrote additional memos outlining "significant, critical, and I believe damaging evidence of field-office malfeasance...
...Timely action on appeals is a major objective of the BVA [Board of Veterans' Appeals...
...115 nursing-home care units...
...Thomas Kenney and Barry Bos-kovich were hired by the VA's central office as consultants...
...a canteen finance center...
...We purge the files regularly...
...To prove its case, NARS is trying to show that its members were treated unfairly by the agency, and that legal assistance would help them redress the wrong...
...But rejecting a claim counts as much as accepting one, and it's faster, besides...
...asked the House Veterans Affairs counsel...
...In January, Federal District Judge Marilyn Hall Patel imposed a $ 115,000 fine on the VA for unlawfully and recklessly destroying documents...
...O'Dell says most VA adjudicators are "good, decent folks," but like soldiers in Vietnam, they "are trapped by the system...
...I'm not exaggerating...
...The man should have been receiving $ 1,600 per month at the least...
...five data-processing centers...
...At the very least...
...a records-processing center...
...Erspamer cited internal VA studies on the practices of VA field offices, including a Compensation and Pension Service "White Paper" which concluded: "Findings on Quality Review reveal a national pattern of failure to take action, improper development, inadequate notification, and premature denials...
...Twenty-four patients died...
...fifty-eight regional offices, including two insurance centers...
...a market center, and three supply depots...
...Abrams says that among the destroyed material were documents that showed veterans had been routinely denied benefits "because it was to the financial advantage" of field officers to do so...
...The incentive for robbing veterans of their rightful benefits is built right into the VA's system...
...Ivers steadfastly denied allegations that the agency was involved in a cover-up, saying the VA was "fully cooperating with the court...
...According to Abrams, Moore failed to act on his advice...
...three canteen field offices...
...Erspamer [NARS attorney] can show that it is in the best interest of our managers to have their people do, as quickly as they can, as many cases as possible," Abrams wrote...
...I am asking also a little protection from any harassment from the management of this place for telling it like it is...
...Consider the following facts: H In 1985, the VA medical system performed twenty-five liver transplants...
...The VA has for many years been plagued by serious, intractable problems arising out of the system it employs to rate adjudicator performance and assign merit awards...
...H In September 1985, an American Medical Association review of VA medical practices turned up forty-nine doctors working in the system whose licenses had been revoked, suspended, or restricted...
...These problems are especially egregious "in field offices in St...
...It was "ignored at the highest level," he said...
...It shows the VA knew what the problems were, and are, and refused to do anything...
...a prosthetic distribution center...
...You don't even own a shredding machine, isn't that what you said...
...It won't help veterans who have started to believe that they loved America more than America loved them...
...Veterans are suffering terribly," Kennedy said...
...Well, not everything that comes from Mr...
...He told me I was not to put anything in writing anymore," Boskovich told the court, "and that I was—if I found anything—I was to come to him and not to talk to anyone else...
...We contract out for document destruction...
...Part of the rush to the operating table may result from a desire to give hands-on experience to a young medical staff...
...The VA also uses a bureaucratic maneuver to "kill" (that's the actual terminology used by VA claims adjudicators) simple claims alleging disability resulting from an injury in the service...
...In 1979, nine VA hospitals were found to be staffed by foreign medical graduates, many of whom couldn't speak English...
...After the hearing, Abrams remained outraged about this incident...
...I guess my only regret is that even if we win the court case, it won't help those veterans already victimized by the system," Erspamer says...
...227 outpatient clinics...
...The VA says it is careful to make cer'A veteran who had both legs blown off in World War II was denied benefits,' a VA official testified...
...In essence, RAM rewards the VA hospitals that spend the most money and perform the most operations, whether they are needed or not...
...The way to win this case is to distance the Compensation and Pension Service, the Department of Veterans Benefits, and the Veterans Administration from the people who, to improve their performance evaluations, abused our claims-processing system and violated the rights of our claimants...
...A veteran who had both legs blown off in World War II was denied benefits," Abrams testified...
...Abrams is a legal opinion," Dunlap said...
...Walker entered the VA's Asheville, North Carolina, medical center for removal of a ruptured spinal disc...
...I have harassed no one...
...In either case, he noted, it is "a breach of trust with veterans...
...Dunlap defended his actions: "I have done nothing wrong...
...He suggests that instead of wearing badges reading May I Help You?—a tradition among those in the system with everyday contact with veterans—VA employees should wear buttons reading, May I Count You...
...H In January 1985, thirty-nine-year-old Randall Walker, a Vietnam veteran, was awarded $2.47 million by the VA after he threatened to file a malpractice suit against the U.S...
...In a memo dated September 25, 1986, and sent to the VA's Director of Compensation and Pension Service, Gerald Moore, Abrams summarized his findings: "Mr...
...Doctors removed the wrong disc and the patient lost nine pints of blood in what Mark Perry is the Editor of Veteran, the publication of the Vietnam Veterans of America...
...According to an 1864 statute drawn up in the midst of the Civil War, veterans are not allowed to pay their lawyers more than $10 in benefits claims against the Veterans Administration...
...Just because he's a lawyer doesn't make it a legal opinion...
...seventeen VA regional-office activities...
...Both processing time and BVA response time improved substantially during FY 1985...
...The admission brought muffled laughter from onlookers...
...We'll get to the bottom of this," he pledged, adding that the committee would cooperate in "protecting those who want to come forward...
...He has served another veteran, solved another problem...
...I was worried because I knew that Thomas Kenney had received a death threat as a result of what he said in court," Boskovich told the committee...
...The VA's methods aren't usually subject to such public scrutiny," Representative Lane Evans, Democrat of Illinois, acknowledged just moments before the hearing began, "but the California case is so damaging, the claims so broad, that it's time we found out whether the VA is really doing the job it's supposed to...
...In my opinion, the VA doesn't understand just how serious these allegations are...
...Representative Evans asked Dunlap during the hearing...
...states the agency's 1985 annual report...
...What made you think you had the right to rip up a legal opinion given to you by the VA's legal consultant...
...I was told to keep my answers to any questions [in the courtroom] to a simple 'yes' or 'no.' If asked whether the world was round, I was to say 'no' because it's actually spherical...
...At the very least.' tain its benefits-claims procedures "meet high standards of due process, legal sufficiency, and consistency...
...Erspamer has obtained reports identifying regional offices that prematurely denied claims without notice so that credit for completed work could be taken (Baltimore...
...In fact, it's well outside our regulations...
...A California veterans group, the National Association of Radiation Survivors (NARS), is challenging the constitutionality of this statute in Federal court...
...Allegations of VA malfeasance, destruction of documents, perjury, and obstruction of justice in the NARS case prompted an extraordinary joint hearing before the House and Senate Veterans Affairs Committees on March 17...
...One VA employee, Ronald Abrams, who asked his superiors why they weren't providing court-requested documents, was told to look for another job...
...otherwise would have been routine surgery...
...Conditions Less than Honorable When veterans come knocking, the VA bars the door BY MARK PERRY In the lobby of the Veterans Administration headquarters in downtown Washington, an impressive bronze plaque proclaims the agency's goal: to care "for him who shall have borne the battle, and for his widow, and his orphan...
...Scary to say the least," is how Democratic Representative Don Edwards of California characterized Boskovich's testimony...
...It's very similar to Vietnam: You measure success by numbers, not by the justice of the system...
...So what does he do...
...What's more, Abrams noted that "Mr...
...Paul," Erspamer testified, adding after the hearing that there is a "system-wide" denial of normal due-process rights to America's veterans...
...This RAM method measures how much money a hospital receives and correlates that with how much care is actually given...
...He can also show that adjudication duties dealing with the fairness of the adjudication process such as: control of claims, supervisory review of old claims, thorough development, recognition of all issues, providing adequate notice, documenting that notice was given, and careful quality review tend to adversely affect gross productivity and timeliness statistics____Mr...
...It's "the smoking gun of the whole thing," he says...
...Evans asked Ivers...
...Some veterans can't receive any kind of care because the VA summarily dismisses their claims...
...A recent annual report sketches the breadth of the VA's facilities: "The Veterans Administration operates 172 medical centers...
...The VA never destroyed documents," he told the committee...
...The claims officer had asked him how much money he made, even though that has nothing to do with deciding a claim...
...The VA's general counsel, Donald Ivers, testified that "there were problems" in the agency's efforts to "cooperate in the discovery process" but that the VA had "taken steps to solve the problem...
...One person who does understand the seriousness of the allegations is Gordon Erspamer, the NARS attorney whose father died as a result of cancer caused by atomic tests...
...U Last October, Representative John Rowland, Connecticut Republican, received letters from Colleen Kennedy, a VA employee at the West Haven Veterans Medical Center, claiming that hospital staff had been placed on "mandatory overtime...
...It's not working...
...The purging was just part of our normal procedures," Dunlap told the joint committee when asked about the incident...
...medical schools, supporting "approximately 8,000 full-time medical residency positions," the agency reports...
...The VA can boast about its size, but not about the quality of its care...
...VA employees who helped expose these abuses have been threatened by their superiors...
...Basically, this is a body-count system," says Rick O'Dell, a Vietnam veteran and VA watchdog...
...The faster a claim is processed, the more rewards are possible, including higher salaries and promotions...
...Government...
...According to Abrams, the memo was "ripped up in a fit of anger" by Michael Dunlap, supervisor of the VA's Field Operations Staff...
...Boskovich implicated the VA's Assistant Policy Director, Gary Hickman, in the attempt to cover up the VA's abuses...
...But the most damaging testimony during the day-long hearing came from Ronald Abrams...
...We cannot defend the actions taken by some regional and central office supervisors and win this case," he wrote to Moore...
...How long do we have to wait before the VA cleans up its act, before this committee runs a full-scale investigation of your activities...
...We don't have a shredding machine in the entire building...
...109 cemeteries...
...Abrams returned from testifying at the NARS trial in San Francisco to find a "swastika inside a Star of David laying on my desk...
...He can't go to court...
...The ruling stunned the Veterans Administration, which was forced to warn its employees not to threaten colleagues testifying for the plaintiffs in the case but to accede to the court's appointment of a "Special Master" to make certain the VA complies with the law...
...The rights of veterans are far more circumscribed than those of welfare recipients, Social Security claimants, indigents, and, ironically, those of accused criminals, who are often provided legal counsel at Government expense," testified NARS attorney Gordon Erspamer...
...Chris Bisgard...
...During the "discovery" process of the case, the Veterans Administration destroyed thousands of documents it had been ordered to produce...
...The man should have been receiving $1,600 per month at the least...
...Luckily, he consulted with other doctors, who said such an operation would probably kill him...
...The VA even assigns "end product codes" to quantify the productivity of each employee...
...He has survey trip reports and white papers documenting that certain stations: ignored claims (Phoenix), established and cancelled control improperly (Baltimore, Hartford, San Francisco), discouraged complete development (Baltimore), ignored or didn't emphasize documentation of due process, and carelessly performed local quality review (many regional offices...
...But the significance of the memo wasn't lost on Gordon Erspamer...
...There's no appeal...
...sixteen domiciliaries...
...One such document detailed field-office failures to keep track of correspondence the VA sent to veterans whose benefit claims were denied...
...The whole Government-funded medical system is a disaster," says Dr...
...They denied him his rights," he said...
...As of 1985, the VA hospitals were affiliated with 101...
...This Abrams report was not only ignored, it was actually destroyed...
...There are no incentives for providing quality medical care...
...I have threatened no one...
...Bisgard, a onetime candidate for the top medical job in the entire VA system and former Deputy Assistant Secretary for Medical Readiness at the Department of Defense, says the Government should either provide "quality medical care, or get out of the business once and for all...
...The VA just thought it could go along with the system it has...
...both men testified in the NARS case in San Francisco and provided damaging information on the VA's plan to circumvent the court's discovery process...
...In fact, there are disincentives...
...We were told to keep our noses out of it," Kenney told the court...
...VA field-office employees, who decide whether the agency should cover disability benefits claimed by veterans, are rewarded according to the number of claims they process...
...It does not account for the quality of the care, nor does it assess whether the procedures that veterans undergo are necessary...
...There is also a pattern of errors involving a complete absence of notification...
...Though the VA's forms are difficult to understand, failure to respond within sixty days means the veteran's benefit claim is "killed"—and a VA employee racks up another "end product code...
...A full-time VA legal consultant, Abrams was the author of the "White Paper" that Erspamer had quoted...
...Then the benefits people denied him his claim...
...Abrams recommended a court strategy that would admit fault on the part of individual employees but not the VA as a whole...
...Either the field offices are incredibly incompetent, or we deny claims without ever telling veterans," Abrams wrote...
...Poor medical practice appears to be endemic throughout the VA...
...According to Representative Ted Weiss, Democrat of New York, "the death rate for heart surgery is 5.2 per cent in VA hospitals compared with 3.1 per cent in other hospitals...
...Here's how it works: The claim is acknowledged by the VA in computer-generated correspondence which tells the veteran he must supply evidence of his disability within sixty days of the letter's receipt...
...Abrams told the committee he had warned VA officials that his findings could cause problems for the agency in the NARS case...
...Patel also ruled that threats against VA employees who described the destruction of documents "may constitute criminal conduct, namely obstruction of justice and contempt of court...
...Abrams testified that he had been dispatched by the VA's central office "in the normal course of my duties" to conduct site inspections of VA field offices...
...Kenney told the committee that he was criticized for being "overly cooperative" with the court, and Boskovich recalled his supervisor telling him "I should be more concerned with my family than with the NARS case...
...Yet one VA official, who would not be quoted by name, notes that as the "performance of the system has improved, so has our monitoring of due process...
...Rowland asked VA administrator Thomas K. Turnage to launch an "immediate and a thorough investigation and evaluation of the center's performance...
...The VA evaluates a hospital's performance by what it calls a "Resource Allocation Methodology" (RAM...
...But according to a letter received by NARS attorney Erspamer in July 1986 from an anonymous VA employee, "Michael Dunlap, the supervisor of Field Operations, ordered the consultants [Kenney, Boskovich, Abrams, and others] to purge the station files of derogatory information about the stations as well as the adjudication officers...
...He chose not to have it done...
...We don't even own a shredding machine...
...Erspamer can show that a manager's bonus and merit pay evaluation is based in part on the adjudication division's productivity...
...11 Last September, VA medical officials admitted that high mortality rates at fifteen of forty-seven VA hospitals were forcing the agency to close down its heart surgery units...
...This effectively denies them the opportunity to press charges against the agency...
...Raymond Vogel, the VA's Chief Benefits Director, went further...
...Petersburg and Minneapolis-St...
...At the Congressional hearing, the two VA consultants revealed a systematic attempt by the VA to muzzle them...
...One of the most insulated bureaucracies in Washington, the VA acts as a giant hospital conglomerate...
...In one recent case, a patient was told he needed a heart transplant...
Vol. 51 • May 1987 • No. 5
