Neurosurgery, one would assume, is a difficult task requiring intelligence, skill, and intense focus. But as former presidential candidate and current Secretary of Housing and Urban Development Ben Carson recently declared, it is a positive cakewalk compared to working in Donald Trump’s White House. “There are more complexities here than in brain surgery,” Carson told The New York Times in an interview, perhaps a lame excuse for what the Times revealed to be a morass of problems at HUD: steep cuts to both staffers and budget; a brewing ethics scandal over Carson’s furniture budget; and a president indifferent to both the mission of HUD and to the man he appointed to lead it, whom he reportedly considers a beta “winner,” not an aggressive “killer.”

The result, as the Times reports, is that Carson has been either unable or unwilling to secure the funds that HUD desperately needs to take care of the millions of low-income Americans who rely on public housing and other forms of assistance:

Mr. Carson, people close to him say, hates asking anybody for money — and has told advisers that he feels acutely uncomfortable asking the president for anything that could be construed as a favor. When the White House budget director, Mick Mulvaney, proposed an 18 percent cut to HUD late last year, Mr. Carson reluctantly reached out to the president. Mr. Trump expressed sympathy. Then he told him to “talk to Mick” about the details.

Carson eventually negotiated a 14 percent cut. But “he often simply seems out of the loop—telling senior staff members at a gathering last spring that the president had given him assurances that HUD’s budget would not be cut at all.”

While tensions between the president and his disempowered deputies are endemic to the Trump Cabinet, Carson, who accepted the position even as his allies begged him not to, has a unique way of aggravating them. When the Times brought up the fact that he allowed his businessman son to attend a HUD listening tour, despite the department’s warning about a possible ethics violation, Carson replied that he’d solved the problem by asking his wife and son whether they thought they were doing anything wrong. “I don’t have any problem with ethics,” said the man currently under fire for ordering a $31,000 dining-room set with taxpayer money, adding that his son was “integrally important” and just wanted to help. “I’m not going to just say no because it looks this way or that way,” Carson said. “We are ethically pure.”

Such questionable quips have become another hallmark of Carson’s tenure; in his very first appearance before HUD staff, Carson described African-American slaves as “immigrants who came here in the bottom of slave ships” searching for “a land of dreams and opportunity.” In a subsequent appearance, he called poverty a “state of mind” that could be resolved with “the right mindset.” Both flubs caused a media uproar, largely overshadowing Carson’s vision for the agency: something called the EnVision Centers project, which seeks to establish thousands of centers to provide low-income families with job training, education, and health-care services. But even that, sources tell the Times, is floundering. Shortchanged by Trump, who allotted only $2 million to the project, Carson has likewise failed to impress outside donors, one of whom reportedly asked, “What does this have to do with public housing?”

In many ways, it was easy to predict that a man whose campaign for president faced innumerable self-imposed stumbling blocks would make for an equally bumbling agency head. But Carson’s incompetence has had more concrete effects, too. Per the Times, his first six months in office saw the departure of dozens of experienced staffers, as well as resistance from the White House over new nominees, and his hesitance to lobby the president for funding has come at a steep cost. “I think you have to come to the job with a sense of what the duties and responsibilities are,” Texas representative Al Green told the Times. “If you don’t come with that sense, and the doctor didn’t, it doesn’t matter what your intentions are, you aren’t going to succeed. We are seeing that now.”