WASHINGTON — Citing "significant and chronic system failures" in the nation's health system for veterans, a review ordered by President Barack Obama portrays the Department of Veterans Affairs as a struggling agency battling a corrosive culture of distrust, lacking in resources and ill-prepared to deal with an influx of new and older veterans with a range of medical and mental health care needs.
The scathing report by deputy White House chief of staff Rob Nabors says the Veterans Health Administration, the VA sub agency that provides health care to about 8.8 million veterans a year, has systematically ignored warnings about its deficiencies and must be fundamentally restructured.
Obama ordered the review last month in a response to widespread reports of long delays for treatment and medical appointments and of veterans dying while on waiting lists. But Nabors' report goes far beyond the lengthy waits and manipulated schedules raised by whistleblowers and chronicled in past internal and congressional investigations.
The review offers a series of recommendations, including a need for more doctors, nurses and trained administrative staff — proposals that are likely to face skepticism among some congressional Republicans who have blamed the VA's problems on mismanagement, not lack of resources.
"We know that unacceptable, systemic problems and cultural issues within our health system prevent veterans from receiving timely care," Acting VA Secretary Sloan Gibson said in a statement following an Oval Office meeting Friday with Obama and Nabors. "We can and must solve these problems as we work to earn back the trust of veterans."
While the review finds deficiencies throughout the VA, it is especially critical of the Veterans Health Administration, which has already undergone some housecleaning. Earlier this week, the VA announced that Dr. Robert L. Jesse, who has been acting undersecretary for health and head of the VHA, was resigning. Jesse has been acting undersecretary for health since May 16, when Robert Petzel resigned under pressure months before he was set to retire.
Nabors' report found that the VHA, the country's biggest health care system, acts with little transparency or accountability and many recommendations to improve care are slowly implemented or ignored. The report says concerns raised by the public, monitors or even VA leadership have been dismissed at the VHA as "exaggerated, unimportant, or 'will pass.'"
Rep. Jeff Miller, the Republican chairman of the House Veterans' Affairs Committee, said the report was a late but welcome response from the White House and vowed to work with the administration to fix the system.
"It appears the White House has finally come to terms with the serious and systemic VA health care problems we've been investigating and documenting for years," Miller said in a statement.
Among Nabors' other findings:
__ As of June 23, the independent Office of Special Counsel, a government investigative arm, had more than 50 pending cases that allege threats to patient health or safety.
— One-fourth of all the whistleblower cases under review across the federal government come from the VA. The department "encourages discontent and backlash against employees."
— The VA's lack of resources reflects troubles in the health care field as a whole and in the federal government. But the VA has been unable to connect its budget needs to specific outcomes.
—The VA needs to better prepare for changes in the demographic profile of veterans, including more female veterans, a surge in mental health needs and a growing number of older veterans.
"No organization the size of VA can operate effectively without a high level of transparency and accountability," said Sen. Bernie Sanders, the Vermont independent who heads the Senate's Veterans' Affairs Committee. "Clearly that is not the case now at the VA. "
Obama asked Nabors to stay at the VA temporarily to continue to provide assistance.
The White House said that over the past month, the VA has contacted 135,000 veterans and scheduled about 182,000 additional appointments. It has also used more mobile medical units to attend to veterans awaiting care.
Since reports surfaced of treatment delays and of patients dying while on waiting lists, the VA has been the subject of internal, independent and congressional investigations. The VA has confirmed that dozens of veterans died while awaiting appointments at VA facilities in the Phoenix area, although officials say it's unclear whether the delays were the cause of the deaths.
One VA audit found that 10 percent of veterans seeking medical care at VA hospitals and clinics have to wait at least 30 days for an appointment. More than 56,000 veterans have had to wait at least three months for initial appointments, the report said, and an additional 46,000 veterans who asked for appointments over the past decade never got them.
This week, the independent Office of Special Counsel concluded there was "a troubling pattern of deficient patient care" at the Veterans Affairs that VA officials downplayed.