Darin Selnick explains how the VA is violating federal health care law and overruling doctors’ decisions
Since passage of the VA MISSION Act in 2018 and rollout of new access standards for community care, veterans have had more options in where they get their medical care.
At least, that is how the law was intended to work.
Information obtained through Freedom of Information Act requests has revealed the Department of Veterans Affairs is using outdated guidance and intentionally driving veterans away from non-VA care.
And a recent investigative report from inewsource and USA Today has put faces and names to the veterans denied care or afflicted by delays. It’s a crisis hurting veterans around the country.
We asked Concerned Veterans for America Senior Advisor Darin Selnick, who spent years working in veterans health care policy at the VA and the White House and was instrumental in getting the VA MISSION Act signed into law, to break down what investigative reports have uncovered at the VA and what the findings mean for veterans health care.
Q: What is the biggest lesson from this inewsource and USA Today investigation?
A: The VA is violating the MISSION Act and veterans Community Care Program regulations in order to save money and keep patients at VA facilities. VA medical center management is overruling care decisions made by VA doctors and their patients, in some cases even cutting off care entirely.
Q: VA administrators are going above the heads of doctors on medical decisions?
A: Yes. The MISSION Act requires the “veteran and the veteran’s referring clinician to determine if it is in the best medical interest of the veteran” to be eligible for community care. The VA is not following that directive.
Instead, the medical center chief of staff, or other staff delegated the authority, is approving or denying the consult and deciding if the veterans should get community care, often overruling the veteran’s clinician and the veteran.
Q: How are those decisions affecting veterans and their health?
A: Keep in mind, administrators who are making decisions about community care don’t necessarily have all the facts or even the medical knowledge to be making health care choices for veterans. Denying community care means veterans are stuck waiting for appointments at the VA, and the wait for those appointments could be weeks or months.
So the impact on veterans is significant.
In the inewsource piece, several veterans discuss how those decisions affected them. Kiowa Wolf’s non-VA mental health treatments were cut off and Gary Shearer is forced to drive more than 50 miles to a VA facility for check-ups despite his community care eligibility.
Sadly, these are just the tip of the iceberg.
Q: So the problem is more widespread?
A: Yes. On top of what we’ve learned from investigative reports, FOIA documents from the VA reveal that the problem is nationwide and embedded in VA training, policy, and guidance. Some key findings include:
- VA’s failing to follow VA MISSION Act wait-time eligibility and denying community care.
- VA’s canceling and rescheduling appointments without the agreement of the veteran or offering community care.
- VA’s inadequate documentation of when veterans opt out of community care.
- VA’s using cost to determine administration of Community Care Program.
- VA’s neglecting to advise veterans of their options and actively dissuading use of community care
Q: You mention using cost to determine whether a veteran should be referred to community care. Is the VA that strapped for cash?
A: No, quite the opposite; the VA is flush with cash. The VA received nearly $20 billion in supplemental funding at the onset of the coronavirus pandemic. That was on top of the VA’s regularly appropriated funds. A Government Accountability Office report indicated that a year after receiving those funds, the VA has spent less than half.
The VA is wrongly choosing to use the cost of non-VA care as an excuse to keep veterans at VA facilities.
Q: What should veterans do if they are being denied community care under the VA MISSION Act?
A: Veterans need to be their own advocates and know what the law requires the VA to do. If community care is denied, there are a few things vets can do to get the VA’s attention.
- Contact their local VA patient advocate at the Veterans Experience Office and file an appeal of their denial.
- Contact their local congressional representative or senators’ offices. These offices have veterans case workers who can dig into the issue or send the VA a congressional inquiry.
- Contact local media investigative reporters and ask them to do a story. Many of the experiences we’ve heard about at CVA have come from investigative reporting like inewsource, and from local news in Georgia and Florida.
- Meet with the local VA medical center directors to discuss how VA is improperly denying community care.
Q: How can veterans and advocates help make changes at the VA?
A: The veterans who are facing delays and denial of care from the VA need to be heard. There are a few easy ways to do that.
- If you or a family member have experienced issues with community care, tell us that story at My VA Story. We collect veterans’ stories and share them to get the word out about what is going on at local VA facilities.
- Get in touch with your lawmakers to demand change. With just a few clicks you can send letters directly to your senators, representative, and the White House asking for better health care choices for veterans and accountability when the VA doesn’t administer care according to the law.
- Spread the word to get more people on board to help reform the VA. CVA created some great resources to help.
The VA needs to adhere to the VA MISSION Act and give veterans access to timely care. Until that happens, VA leaders shouldn’t get bonuses. Get in touch with your lawmakers to demand a freeze on bonuses until vets get the care they need.