President Trump swears in new VA secretary: Here's what Robert Wilkie faces on day one

Donovan Slack | USA TODAY

Show Caption Hide Caption Wilkie Sworn In As Veterans Affairs Secretary Robert Wilkie has been sworn in as the next secretary of Veterans Affairs. (July 30)

WASHINGTON — President Donald Trump on Monday swore in the fourth secretary of Veterans Affairs in five years.

"I want to congratulate you and congratulate you strongly,” Trump told Robert Wilkie, previously an undersecretary at the Pentagon, who was joined by family members in the Oval Office ceremony.

"Since day one, my administration has been focused on serving the men and women who make freedom possible – our great veterans," the president said. "These American heroes deserve only the best and they will have it under Robert Wilkie – I have no doubt about it."

Wilkie said the Bible he was using to take the oath of office was one his wife's grandfather had carried into battle.

"I am humbled by the prospect of serving those who have borne the battle, those American men and women who have sacrificed so much," he said. "I look forward to this great adventure."

Wilkie is taking the reins of the veterans’ agency at a critical time. As VA secretary, Wilkie will be responsible for overseeing the creation of regulations governing when veterans can access VA-funded medical care in the private sector under a law signed by Trump in June. The issue already is the subject of a fraught political battle over the future of the VA.

At his confirmation hearing last month, Wilkie vowed he would oppose any efforts to privatize the VA and said he believes the most significant challenges facing the VA are "administrative and bureaucratic."

He said he plans to rely on his experience as undersecretary of Defense for personnel and readiness to improve morale and cut through the bureaucracy to modernize the VA.

"For the VA to thrive as an integrated health care network, it must be agile and adaptive," Wilkie said.

More: 5 things to know about incoming VA secretary Robert Wilkie

His nomination was confirmed by the Senate 86-9 and he has the support of veterans’ groups, including the American Legion and Veterans of Foreign Wars.

But he still faces a tough task righting the agency, which serves some 9 million veterans at more than 1,200 medical facilities. Here are five long-standing issues he will have to tackle:

Veterans are still waiting

The agency has instituted same-day walk-in services for urgent medical and mental health issues in recent years, but as of July 15, more than 700,000 veterans were waiting longer than a month for VA appointments, VA data show.

And there may still be some reason to question the reliability of that data. In March, an inspector general investigation of 64 VA hospitals and clinics in a swath of states from Kentucky to Illinois, found scheduling staff entered the wrong dates in the system in more than 5,000 cases.

That masked how long veterans actually were waiting for specialty care and mental health appointments. Even in cases accurately reflected in the system, most weren’t offered the chance to get care in the private sector.

“VA data continues to be a high-risk area,” wrote Larry Reinkemeyer, VA assistant inspector general for audits and evaluations.

Staffing shortages

The VA has had persistent difficulty recruiting and keeping enough medical care providers to meet veterans' needs.

In some cases in recent years, the shortfalls created an incentive to hire medical providers with problem records that may have prevented them from getting jobs in the private sector.

A VA hospital in Oklahoma knowingly hired a psychiatrist sanctioned for sexual misconduct who went on to sleep with a VA patient. A Louisiana VA clinic hired a psychologist with felony convictions and later found he was a “direct threat to others” and the VA’s mission. The Iowa City VA hospital knowingly hired a neurosurgeon last year who had racked up more than a dozen malpractice claims in two states and had his license revoked in one.

Last month, the VA inspector general concluded the agency still has more than 2,300 clinical vacancies.

‘Culture of complacency’

VA officials at every level – local, regional and national – knew for years about dangerous conditions at the VA hospital in Washington, D.C., but didn't fix them, the agency’s inspector general found earlier this year.

Investigators found “a culture of complacency and a sense of futility pervaded offices at multiple levels.”

“In interviews, leaders frequently abrogated individual responsibility and deflected blame to others,” the investigation report says. “Despite the many warnings and ongoing indicators of serious problems, leaders failed to engage in meaningful interventions of effective remediation.”

Such breakdowns were not unique to Washington. Problems with care festered for years at VA hospitals in Manchester, New Hampshire; Roseburg, Oregon; and Phoenix.

Disparities in quality of care

Despite those problems, the VA hospital system overall has scored better than private sector averages on many key patient-safety measures, including instances of avoidable death, respiratory failure, and infection.

But there are vast disparities among VA hospitals, according to VA data collected from October 2015 to October 2017. The death rate for surgical patients with treatable complications ranged from zero at the VA hospital in Sacramento, Calif., to more than 20% in Miami; Columbia, Mo.; and Detroit. In Long Beach. Calif, it was 26 percent. The private sector average was 16 percent, according to Medicare data.

The VA nursing home system – which has 133 facilities serving 46,000 veterans each year – has scored worse than the private sector for years on a majority of quality indicators, including rates of anti-psychotic drug prescription and residents’ deterioration, according to secret internal data obtained by USA TODAY and The Boston Globe.

The VA has argued its nursing home residents typically are sicker than private nursing home residents, but pledged to make improvements. Still, the House VA committee launched an investigation into VA nursing homes and plans a hearing in the coming months.

Appeals backlog

The agency has a backlog of almost 430,000 pending appeals of benefits decisions, and according to House VA Committee Chairman Rep. Phil Roe, R-Tenn., many veterans have been waiting six years or longer for a final ruling.

“That is unacceptable,” he said at a hearing last week.

Last year, Trump signed legislation that would modernize and speed up the appeals procedures, but the VA is behind on implementing IT functions to support the updated process.

Further, Roe said that he’s unsure if it will “make much of a dent in the appeals backlog since only 13 percent of eligible veterans” have opted to use the more rapid adjudication option.