VA’s $400k History Book Sidetracked by Crisis
When the media, investigators and Congress exposed the Department of Veterans Affairs’ broken and dishonest health-care system last year, VA officials were forced to postpone publication of a $400,000-plus history book that glowingly portrays the agency’s achievements.
The Arizona Republic obtained a copy of the unreleased manuscript, “Not Your Father’s VA,” showing a publication date of May 2014. In fact, the VA did not release the volume at that time, which was one month into a national furor over delayed care for veterans.
The book was produced under government contract by a company known as History Associates Inc. The project was authorized for $500,000, according to Jessica Jacobsen, a VA public affairs officer, but the final price tag was $411,700.
The manuscript was prepared by James Rife, History Associate’s senior researcher and writer. Subtitled “The Transformation of VA Health Care in the Late 20th Century,” the 267-page tome’s purpose is spelled out in an introduction:
“The history of VHA’s modern transformation deserves to be remembered and celebrated, and we are pleased to present this book as a testament to the dedication and perseverance of those many people who both carried it out and continued it into the 21st century.”
Just weeks before planned publication, congressional committees and media began investigating allegations that thousands of patient appointments in the Phoenix VA Health Care System were secretly backlogged, and some veterans had died awaiting care.
The VA Office of Inspector General eventually confirmed those reports and concluded Phoenix was part of a nationwide VA malaise that falsified data and delayed care for more than 100,000 veterans.
Those findings do not appear in a copy of the manuscript obtained by The Republic. However, Jacobsen, the VA spokeswoman, said the preface is being rewritten to reflect the 2014 crisis, and “Not Your Father’s VA” is now planned for release this year, possibly in June.
“Leadership changes at the VA caused the final publication action, which was to have taken place in late spring-early summer 2014, to get re-staffed,” she noted in an e-mail.
Jacobsen said the book was approved in 2007 by the Veterans Health Administration Leadership Board to memorialize improved care for veterans, especially reforms implemented by Kenneth Kizer, undersecretary for health during the 1990s. She said it is common for federal agencies to commission history books, and the VA had not done one since 1967.
Three of the book’s six chapters focus on Kizer’s tenure. Those sections describe how he “changed the entire organizational, cultural, and technological fabric of the agency and resulted in significant, measurable improvement in the quality of care, bringing VHA up to modern standards and even surpassing them.”
The final chapter describes efforts during the past decade, ending with VHA Under Secretary Robert “Randy” Petzel, who is quoted as saying he advanced the reforms implemented by Kizer.
“It did turn out to be the real beginning of a new VA,” Petzel says in the book. “The idea of excellence, quality, and safety are just so deeply embedded in our culture now that it’s unbelievable.”
Petzel wrote an epilogue for the book in April, the same month that the VA national controversy erupted. He resigned under fire a month later as veteran advocates, politicians and investigators were ripping VA’s leadership.
Jacobsen said three historians conducted peer reviews, and final editing was not done until August. By that time, she noted, “the urgency of the (veterans’ health care) crisis resulted in this project becoming a lower priority.”
Kizer, meanwhile, emerged as one of the agency’s harshest critics. In an interview this week, he said VA’s dysfunction was caused in part by insufficient resources, but the key culprit was an “abject failure” of management.
“I don’t think you can put one face or one name behind it,” he added. “But it ultimately comes down to an absence of leadership.”
Kizer is now director of the Institute for Population Health Improvement at the University of California-Davis, School of Medicine.In a July article co-authored with Harvard University’s Dr. Ashish Jha, for the New England Journal of Medicine, Kizer blasted his former agency for betraying its purpose.
“For years, it has been no secret that the VA’s front lines of care delivery are understaffed for the needs,” they wrote. “And, though there can be no excuse for falsifying data, we believe that VA leadership created a toxic milieu when they imposed an unrealistic performance standard and placed a high priority on meeting it in the face of these difficult challenges.
“Quite simply, the VA has lost sight of its primary mission of providing timely access to consistently high-quality care. Although it has garnered less attention than the wait-time problems, a disturbing pattern of increasingly uneven quality of care has also evolved …
“The Phoenix VA Medical Center ground zero of the wait-time scandal has mortality rates for common conditions that are among the highest within the VA and higher than those in many private hospitals. Its rates of cancer-related bloodstream infections are nearly three times the national average.”
Asked to comment this week on those assertions, VA officials in Arizona responded: “Phoenix VAHCS is committed to delivering high quality and safe patient care. While PVAHCS was recently recognized by the Joint Commission as a top performer in the areas of treatment of heart attacks, heart failure, pneumonia and surgical care, we continue to target efforts to reduce infection and mortality rates while improving patient satisfaction.”
They declined to provide comparative statistics on mortality and infection rates.
Jacobsen said funding is available to print about 2,000 copies of “Not Your Father’s VA” for distribution to VA facilities and federal libraries. Although a retail price has not been set for the general public, she added, “We are exploring having the book made available on Amazon, and for downloading onto electronic reader devices.”
Tags: Veterans News
