The Atlanta VA’s former three-star rating ranked it in the middle 40 percent of the department’s medical centers.

Troubles at the Atlanta VA persist despite years of reform attempts because department heads are slow to change, said Bob Teets, a U.S. Marine veteran who serves on the Atlanta VA director’s advisory council. These physicians are more concerned with preserving their reputations than alerting top administrators to problems, he said.

“I don’t think the various department heads, the chiefs of department, are kind of getting it,” Teets said. “They have a tendency not to think of things as urgently needing repair.”

U.S. Marine combat infantry veteran John Paulson, who serves as an officer with the Buckhead post of the American Legion, said he has received good care. But his doctor of eight years left the VA and he still hears complaints about long wait times.

“They have so much bureaucracy that they literally choke the innovativeness and the decisiveness that doctors practice normally, they choke it out of them,” Paulson said.

Atlanta VA Medical Center. PHIL SKINNER/ AJC

The ratings drop is only the latest bad news for the hospital, which serves 145,000 of the region’s veterans annually and is one of the fastest-growing in the country.

A Sept. 18 report by the VA's Office of Inspector General found that the Women Veterans Health Program failed to complete mammograms for 42 patients from fall 2014 to summer 2017. A defined process to track them did not exist, facility procedures were inconsistent, and agency needed more women's health providers, the inspectors found.

A June Inspector General audit found that the hospital has the highest staffing shortages of any VA hospital in the country. The hospital was short 89 positions, including neurologist, pathologist, psychologist and nurses slots.

Earlier this year, the inspector general found that the facility failed to conduct criminal background checks and drug screening for employees in a timely manner.

A rash of veteran suicides tied to the Atlanta VA prompted calls for reform in 2013. Complaints continued, and Walker was appointed to lead the health system in 2016.