Reforming the VA Requires Standing Up for Science | Commentary
Robert McDonald’s nomination to head the troubled Department of Veterans Affairs was unanimously approved by the Senate recently.
“If you don’t want people in your community lying,” he said at his confirmation hearing, “you don’t tolerate them lying.”
If he is serious about transforming the department’s culture, he will utilize a tool that to this point has been mostly overlooked, and commit the agency to strong and meaningful scientific integrity standards.
We’re all familiar with the story: the VA used secret waiting lists to manipulate statistics and misrepresent wait times at its facilities. The consequences were deadly. The department has confirmed that at least 35 veterans died waiting for treatment in Phoenix alone.
The scandal resulted in several top officials resigning, but so far the VA hasn’t committed to reforms that would prevent such abuses. Lawmakers across the political spectrum have recognized that McDonald will need to change how the VA does business. “He’ll need to root out the culture of dishonesty and fraud that has taken hold within the department and is contributing to all of its most pressing challenges,” said Republican Rep. Jeff Miller of Florida, chairman of the House Veterans’ Affairs Committee.
“The VA needs significantly improved transparency and accountability,” said Sen. Bernard Sanders, a Vermont independent who caucuses with Democrats.
The VA failed to take advantage of a golden opportunity to improve its performance more than three years ago. In December 2010, White House Science Adviser John Holdren asked the VA and two dozen other federal agencies and departments to develop policies that would foster a culture of transparency, integrity and ethical behavior when it comes to how federal scientists, doctors and managers do their work. He was following up on President Barack Obama’s inaugural pledge to “restore science to its rightful place.”
“The department’s response? A draft policy that did little more than pay lip service to Dr. Holdren’s request. Both Public Employees for Environmental Responsibility and the Union of Concerned Scientists gave the VA’s draft policy terrible marks. In response, the agency quietly published a little-changed final policy in the Federal Register, but never updated the draft policy on its own website.”
A stronger policy could have prevented abuse like the wait list manipulation from spiraling out of control. Unlike other agencies, VA scientists and doctors don’t have adequate procedures they can follow for reporting violations of scientific integrity. Nor does the agency publicly report the results of any investigations it may undertake. Further, there are insufficient protections for those who raise concerns about safety and ethics violations, discouraging doctors from speaking up about the falsified records.
“The VA for far too long has condoned a culture of retaliation and intimidation regarding whistleblowers,” said Rep. Michael H. Michaud of Maine, ranking member of the House Veterans’ Affairs Committee, at a hearing.
Phoenix VA physician Katherine Mitchell testified that the department uses “sham peer reviews” to “permanently sabotage” doctors’ reputations. “I wouldn’t recommend in the current state that people get a job at the VA until professional work environment and whistle-blower protections improve,” she told the committee.
Other agencies and departments have demonstrated that culture change is possible and beneficial. At the National Oceanic and Atmospheric Administration, employees are explicitly allowed to speak to the media and offer their personal opinions without asking for permission. This gives the press more ability to understand the opportunities and challenges an agency is facing.
At the Environmental Protection Agency, scientific integrity complaints go through a formal review process and, if necessary, the agency’s inspector general gets involved. Complaints and their resolutions are compiled in a public report. Such sunlight is the ultimate disinfectant. Officials will think twice about fudging numbers if they know it’s easy to get caught.
If the proper scientific integrity and whistle-blower protections had been in place at the VA, the entire disaster could have at the very least been curtailed, or even completely avoided, and veterans would be more likely to receive the care they deserve.
Now that McDonald has been confirmed, one of his first steps should be to bolster the agency’s scientific integrity policy. Doing so would go a long way towards ensuring that anyone who lies about the care our veterans receive will be purged.
Michael Halpern is a program manager with the Center for Science and Democracy at the Union of Concerned Scientists.