Will the problems at the VA ever stop?

The Boston Globe and USA Today recently released a report of the VA's performance at a hospital in Brockton, MA. The report concluded that the hospital showed a “blatant disregard for veteran safety”. Some of the findings:

investigators found two nurses fast asleep during their shifts, even though the facility knew it was under scrutiny and inspectors were coming to visit.nurses and aides did not empty the bedside urinals of frail veterans, failed to provide clean water at night and didn’t check on the veterans regularly.care at many VA nursing facilities, according to the agency’s own secret internal ratings, was worse than at private nursing homes.

The VA has 133 nursing homes across the country that serve 46,000 veterans annually. Newly released VA data show that 95 of them — about 71 percent — scored worse than private nursing homes on a majority of quality indicators, such as rates of infection, serious pain and bed sores. Roughly the same number, 93, received one or two stars out of five for quality in the agency’s own ratings.

More problems at the VA

We've read about the VA's problems handling medical claims. Now, we learn it has problems paying college tuitions. Earlier this year the VA changed the way education claims are processed. Payments were tied to campus Zip codes to eliminate many overpayments. It also changed some calculations to offset costs of additional education programs. 

These changes sound pretty straightforward, but they are extraordinarily difficult for the VA. They are either underpaying, not paying or late paying the veterans' educational claims. About 450,000 veterans are affected.

The VA had the time (almost a year) and the money ($30,000,000) to update their system, but failed to do so. Will heads roll?

Government follows the Corporate World

Many companies pay their CEO and other executives exorbitantly with little regard for performance. The federal government is following suit, not in the amount of pay but in a total disregard for the executive's performance. The Veterans Administration just paid $3.8 million to its senior executives. Admittedly, that's less than what many corporate CEOs get. But the money the VA is paying out comes from us. Three-fourths of the senior VA executives got a bonus for last year. Some got a bonus of as much as 20% of their salary. Has the VA performed that well over the last year?

No way to treat addicts

It looks as though the VA is having problems treating veterans who have become addicted.  The Center for Investigative Reporting asserts that prescriptions for four opiates – hydrocodone, oxycodone, methadone and morphine – have surged by 270 percent in the past 12 years.  This is not because of an increase in the number of veterans being treated, as 270% is much less than the rate at which the growth in VA patients has occurred. A 2011 study by the VA's Health Services Research and Development Service reported that veterans seen by the agency’s doctors were dying from prescription drug overdoses at nearly twice the national average.  It looks as though the agency is overmedicating its patients as it struggles to keep up with their need for more complex treatment; the agency has issued more than one opiate prescription per patient, on average, for the past two years.

Adding to the cost of our wars

The Army Times reports that each month 950 veterans who are being treated by the Veterans Administration try to kill themselves; 7% (6 victims) succeed. The VA extrapolates that double that number who are not being treated by the VA kill themselves.

Each month the VA's suicide phone line receives 10,000 calls.

Last year 1,621 male veterans of our 21st century wars attempted suicide, 84 succeeded; 4 of the female veterans of these wars killed themselves, 247 tried.

A Sample of GAO Reports

The following is just a small sampling of what the GAO produces every month. Look through them. You'll see big numbers - our money - being wasted. You'll read about poor internal control, lack of oversight, poor management, outright theft, etc. And you'll see that the GAO is interested in more than saving money.

If Obama and company really want to save money, this is where they should start.

Top 10 List for June 2011

An alphabetical listing of the top 10 areas of significant work and the reports and testimonies in those areas issued in June 2011.

1. Auto Safety

Auto Safety: NHTSA Has Options to Improve the Safety Defect Recall Process

GAO-11-603, June 15, 2011

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 63 pages)   Accessible Text   Recommendations (HTML)

2. Combating Terrorism

Combating Terrorism: U.S. Government Should Improve Its Reporting on Terrorist Safe Havens

GAO-11-561, June 3, 2011

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 51 pages)   Accessible Text   Recommendations (HTML)

3. Diplomatic Security

Diplomatic Security: Expanded Missions and Inadequate Facilities Pose Critical Challenges to Training Efforts

GAO-11-780T, June 29, 2011

Summary (HTML)   Full Report (PDF, 12 pages)   Accessible Text

Diplomatic Security: Expanded Missions and Inadequate Facilities Pose Critical Challenges to Training Efforts

GAO-11-460, June 1, 2011

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 75 pages)   Accessible Text   Recommendations (HTML)

4. FEMA

FEMA: Action Needed to Improve Administration of the National Flood Insurance Program

GAO-11-297, June 9, 2011

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 86 pages)   Accessible Text   Recommendations (HTML)   Podcast

5. Flood Insurance

Flood Insurance: Public Policy Goals Provide a Framework for Reform

GAO-11-670T, June 23, 2011

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 21 pages)   Accessible Text

6. Influenza Pandemic

Influenza Pandemic: Lessons from the H1N1 Pandemic Should Be Incorporated into Future Planning

GAO-11-632, June 27, 2011

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 67 pages)   Accessible Text   Recommendations (HTML)

7. Influenza Vaccine

Influenza Vaccine: Federal Investments in Alternative Technologies and Challenges to Development and Licensure

GAO-11-435, June 27, 2011

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 58 pages)   Accessible Text

8. Nuclear Waste

Nuclear Waste: Disposal Challenges and Lessons Learned from Yucca Mountain

GAO-11-731T, June 1, 2011

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 19 pages)   Accessible Text

9. Recovery Act

Recovery Act: Funding Used for Transportation Infrastructure Projects, but Some Requirements Proved Challenging

GAO-11-600, June 29, 2011

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 60 pages)   Accessible Text   Podcast

Recovery Act: Funds Supported Many Water Projects, and Federal and State Monitoring Shows Few Compliance Problems

GAO-11-608, June 29, 2011

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 66 pages)   Accessible Text   Podcast

10. Taxes and Identity Theft

Taxes and Identity Theft: Status of IRS Initiatives to Help Victimized Taxpayers

GAO-11-721T, June 2, 2011

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 17 pages)   Accessible Text

11. VA Health Care

VA Health Care: Actions Needed to Prevent Sexual Assaults and Other Safety Incidents

GAO-11-530, June 7, 2011

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 78 pages)   Accessible Text   Recommendations (HTML)

VA Health Care: Improvements Needed for Monitoring and Preventing Sexual Assaults and Other Safety Incidents

GAO-11-736T, June 13, 2011

Summary (HTML)   Highlights Page (PDF)   Full Report (PDF, 30 pages)   Accessible Text

 

The Truth Shall Set You Free

Who do you believe? Jimmy Carter or Condoleezza Rice? Carter says no one told him not to talk with Hamas. Rice claims an Assistant Secretary of State did tell Carter not to go to the Middle East and not to meet with Hamas.

Who do you believe? Patty Murray or the Veterans Administration? Senator Murray claims that the 12,000 troops attempt suicide each year. the VA says 800. This case is a lot clearer than the Carter-Rice one as Murray has a VA e-mail supporting her assertion.

One place to cut the budget?

About 20% of the soldiers who have served in Iraq and 12% of those who have served in Afghanistan suffer from Post-Traumatic Stress Disorder (PTSD). A little over 210,000 veterans receive disability payments for PTSD from the government, costing $4.3 billion last year.

Not all who claim PTSD are approved for benefits. Since there is no standardized process for deciding a particular case, the odds of approval vary from state to state. The VA, as the result of an internal study, feels that some of those receiving benefits shouldn't be. In fact, they've estimated that 2.5% of the claims are potentially fraudulent. Thus, they have decided to review the cases of the 72,000 soldiers who are receiving the maximum benefit of just under $3000 a month. They may be right in their estimate of fraud, but that's due to the claims examiners being fooled. One question: Since the approval of claims is a function of where the claim originates rather than the severity of the problem, why is the VA not reviewing cases of those who have been denied benefits? If the claims examiners screwed up in approvals, it's likely they also screwed up in denials as well.

In the current review, veterans will have to prove that a specific incident was the cause of their PTSD. I doubt that reliving their war experience is a pleasant experience for anyone, even those who do not suffer from PTSD. Is this the right way to treat our veterans? There are a heck of a lot more places to cut the budget without insulting those who gave their all for us. How much will this review cost? They'd be better off putting the money into standardizing the claims review process.

Slower than almost everybody else

That's the U.S. with regard to internet speeds. Take downloading a high-definition movie, for example. In our big cities it takes about 1.4 minutes if you are paying for our highest speeds; by the way you pay about $300 a month for such service. If you lived in  Seoul, Hong Kong, Tokyo, Zurich, Bucharest and Paris, it would take 7 seconds and cost you $30 a month.

But if you live in Chattanooga, Tenn.; Kansas City (in both Kansas and Missouri); Lafayette, La.; and Bristol, Va., your speed is about the same as the foreign leaders. Is that because these cities do not have Comcast and other monopolies as their carrier? They have a city-run network or start-up service.
the lack of competition in the broadband industry. 

As the head of the FCC recently said, "Three-quarters of American homes have no competitive choice for the essential infrastructure for 21st-century economics and democracy.” 

Water, water everywhere and not a drop to drink

Will we see that day soon? Charleston, W. Va., had a problem in January when a chemical used in the processing of coal leaked from a ruptured storage tank into the Elk River, contaminating the water supply for about 300,000 people. Last week, Toledo had a problem. Its water supply was declared unsafe because of the presence of microcystin, a toxin released by algae blooms in nearby Lake Erie.

The local water plants were at a loss as to what to do, so they could only say "don't drink the water". The problems in both areas were man-made.  In Charleston, it was an upstream industrial spill; in Toledo, polluted runoff, including from agriculture, along the Great Lakes stoked the slimy, fluorescent algae blooms that sent residents flocking to supermarkets for bottled water.

We need money to keep the water supply functioning. The Environmental Protection Agency says the capital needs of water utilities over 20 years amount to $384 billion to keep tap water clean and another $298 billion to address wastewater and runoff. By comparison, over the last 25 years, the E.P.A.’s primary wastewater grant and loan program distributed over $100 billion, a fraction of the investment the nation needs to make now.

It sounds like another situation that we will ignore until it happens to us.

Stopping Venality

Readers may recall that I have written fairly often about the changing mores of medical journals vis-a-vis the pharmaceutical companies. Part of the problem lies with the FDA, which has remained silent on the issue. However, in the waning days of Bush II, the FDA did speak up by issuing a "guidance" document which authorized drug companies to use articles in medical journals as part of their marketing arsenal.

The FDA did so despite protests by Republicans and Democrats in Congress, the VA, attorneys general of Illinois and Oregon, health advocacy groups, insurers and state prosecutors. Furthermore, in the past five years alone courts have awarded over $6 billion in suits against the drug companies for off-label marketing. Yet, our government thought this was a good idea. Will the new managers of the FDA rescind this "guidance" document? Will medical journals monitor the articles they print? Will pharmaceutical companies rein themselves in?

The Ku Klux Klan in the 21st century

It's coming back. The following video is from 2012 at which time the group had grown from 500 to 6000. Now it is around 8000.

 

Their most recent activity involves a protest today against the removal of a statue of Robert E. Lee in Charlottesville, VA. The protesters will be armed. The Loyal White Knights of the Ku Klux Klan have threatened that many of their members will be armed. 

Combining work and vacation time

David Shulkin, the secretary of veterans affairs, has been called to task by the Inspector General for a 10-day, $122,000 business trip he took to Europe in July, which included $4200 airfare for his wife. He led a VA team to Copenhagen and London for 10 days in July,but only 3-1/2 days were devoted to business. The rest of the time was spent on sightseeing and unofficial activities, such as attending the Wimbledon tennis tournament using free tickets. He was not alone; he was accompanied by his wife, a small staff and a six-person security detail.

To justify paying for the secretary’s wife’s $4,000 airfare, the IG's report said, the department’s chief of staff altered an email to indicate that Dr. Shulkin and his wife had been specifically invited to an honorary dinner in Denmark, when in fact they had not. While the couple were in London, the report found, they improperly accepted tickets to a tennis match at Wimbledon.

Shulkin is not the only cabinet secretary to be accused of lavish spending on travel. Tom Price was dismissed as secretary of health and human services over his use of private jets.

The VA, a case study in no management

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Veterans and suicide

Some interesting and disturbing facts from a Veterans Affairs press release:

Veterans are about 20% more likely than non-veterans to kill themselves.
Female veterans are 250% more likely than female non-vets to do so.

Some quotes:
“This report is unprecedented in its comprehensive analysis of suicide rates among all U.S. Veterans,” VA Secretary Dr. David J. Shulkin.
“Rates of suicide were highest among male OEF/OIF/OND veterans ages 18 to 29 and decreased with age” — referring to Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn.

7 years and counting

That's how long the GAO has been trying to get government agencies to buy smarter. In 2005 the Office of Management and Budget initiated the process of strategic sourcing and urged its adoption by government agencies, as companies had found that its use could lower the costs of procurement by a considerable amount.  GAO has just issued a report of their investigation of how four agencies (DOD, VA, DHS and Energy) use this process.  These four agencies make 80% of the government's purchases, so savings to us can be considerable, on the order of $50 billion annually.  

However, the GAO found that the process was really only being used to any degree by DHS (a surprise to me).  Will the publication of this report motivate the other agencies to get serious about the process?

I've said repeatedly that just following the GAO's recommendation will save us billions of dollars each year.  It's not that hard to find the recommendations.

Your life expectancy may depend on where you live

That's what a study by the Institute for Health Metrics and Evaluation, a University of Washington division, seems to show.  For example, people in Johnson County near Kansas City, Kansas, have high life expectancies matching those in comparable countries such as Sweden and Switzerland.  Residents in Wyandotte County, also near Kansas City, have life expectancies matching those of Libya or Sri Lanka.

Kansas was not the only area showing stark differences.  "In Marin County, Calif., men could expect to live to a ripe 81.6 years. In two Mississippi counties, male life expectancy was just 66.1 years, about the same as in Pakistan.  Women’s life expectancies ranged from 85.8 years in Collier County, Fla., to 74.1 years in McDowell, W.Va., comparable to that of Algeria."

The question is why the differences.  Some of the reasons proposed: high unemployment, low rates of home ownership, low educational attainment, poverty, quality of public health.

Look at the results for your county: Life Expectancy US Counties

Read more here: http://www.mcclatchydc.com/2012/04/30/147111/study-life-expectancies-in-much.html#storylink=cpy

Read more here: http://www.mcclatchydc.com/2012/04/30/147111/study-life-expectancies-in-much.html#storylink=cpy

Costs and Benefits

We don't do too much analysis of costs and benefits when it comes to prescription drugs. Other countries do. They first see whether the new drugs really have solid benefits that the proposed price justifies. Then, they'll haggle over the price. We don't regulate or negotiate the prices of new prescription drugs when they come onto market.  The drug companies charge what they want. As a result, we pay more than other countries do.

There is one exception. The VA does negotiate drug prices. It gets drugs that are usually 40 percent cheaper than what Medicare pays. But it also covers fewer products.

Vital Employees

If the government shutdown occurs, which seems more likely day by day, in which departments would you furlough employees and how many of the employees would you furlough?  Here is what the government is planning:

97% of NASA employees
94% of EPA
87% of Commerce
82% of Labor
81% of Interior
80% of Treasury
69% of Energy
52% of Health and Human Services
50% of Defense
33% of Transportation
29% of Social Security
15% of Justice
14% of Homeland Security
4% of VA

Veterans killing themselves

7300 veterans killed themselves in 2014. That's 20 a day, almost 1 an hour. The VA looked at 55 million veterans records between 1979 and 2014 from all 50 states. Two interesting findings: 65 percent of all veterans who committed suicide in 2014 were 50 years or older. Since 2001, adult civilian suicides increased 23 percent, while veteran suicides increased 32 percent.

However, the rate of suicide was less for those male veterans who used veterans affairs services (11%) and increased 35 percent among those who didn’t. Among female veterans who used the services suicides increased nearly 5% and increased 98%.