Veterans

Amid pandemic, Veterans Affairs secretary sees reason for both optimism and worry

Ahead of Veterans Day last year, coronavirus wasn’t anywhere on Robert Wilkie’s priority list for his department. Now, a year later, the ongoing pandemic is the Veteran Affairs secretary’s top focus.

In the last seven months, the department has seen more than 80,000 cases and 4,000 deaths connected to coronavirus. And now, on the eve of Veterans Day 2020, a second wave of the illness is threatening even more casualties.

Like much of the rest of the world, the virus has upended a host of department plans and priorities, forcing massive changes in everyday VA operations. Burials were suspended for several months. Non-emergency medical appointments were delayed or shifted online. Tens of thousands of VA workers were pushing into telecommuting for the first time.

But Wilkie this week said he is proud of the department’s response to the pandemic so far, if still wary of the havoc it could still cause on veterans nationwide. He spoke with Military Times on Monday to outline what he sees as the successes of his 16 months leading the department and the state of the department now.

Editor’s note: Portions of this interview have been edited for length and clarity.

MT: Active coronavirus cases went over 8,000 this weekend, the number of inpatients at VA hospitals has risen to more than 630 in recent days. What’s your assessment of VA’s response to the pandemic?

Wilkie: Remember what I’ve been saying since March: We can expect a boomerang in the fall and the winter and the possible convergence of COVID with flu.

The good thing is we’ve had our emergency procedures in place longer than any other health care system in the country. We haven’t relaxed. I’ve been traveling the country, checking out preparedness everywhere from California to South Carolina. And all of those precautions are still in place.

Of the 72,000 infections, 61,000 veterans and fully recovered. So that’s a good thing. That’s that leaves us with, as you mentioned, about 8,000 active cases out of 9.5 million veterans.

Our veterans don’t live in a cocoon … where you can block yourself off from the rest of the world. They live in the communities.

I resent some out there, particularly in the twittersphere, saying that these numbers are the result of VA negligence. If this thing can invade Buckingham Palace and take out Prince Charles and his family, you can’t prevent the spread by some procedure in a hospital. We’re not immune from what happens in the country.

The projections for us were deaths in the tens of thousands. At minimum, a quarter million infections. Well, because we got out ahead of this and we started sending communications out, I think we did have the impact of ameliorating the effectiveness in terms of making sure people knew what was out there.

MT: So you don’t see any reason to believe these cases have been made worse by VA procedures or policies?

Wilkie: No. And, you know, we also have the lowest infection rate amongst our medical employees of any healthcare system in the country. So we’ve done everything we could to protect people.

The largest single case of infection amongst veterans happened in February on the streets of New Orleans during Mardi Gras. Thousands and thousands of veterans who were among the 2.1 million people on the streets of New Orleans on Mardi Gras day, thousands of thousands of veterans were infected during that. Where we see hotspots in the country, we usually see hotspots among veterans.

MT: Do you see any reason now to look at additional restrictions or security measures for hospitals because of the increase in cases nationwide?

Wilkie: It depends on what’s happening around them. If you were to see a spike, then you would probably, based on the best medical evidence, ratchet down. We’ve never closed. But [we could] ratchet down the move back to normal operations. It just depends on what’s going on and in the community.

In some cases, [the decision] will be medical center by medical center.

MT: Should there be a massive expansion of coronavirus testing for veterans?

Wilkie: There has to be a reason for a test: if you don’t feel well, if you’re going to have surgery, that kind of thing. Right now, I don’t see a change in our procedures. And it has worked pretty well.

MT: The annual veterans suicide report has been delayed. When should we expect that to be released?

Wilkie: Soon. And I can give you the reason why. For those in VA care, I expect to see a reduction in the number of suicides. What we’re still trying to determine is those that we don’t see, and what is the impact of what has happened in the country.

We got a ridiculous letter from [Capitol] Hill, about not doing enough on suicide. One of the things we’ve been preaching is the need [for community partnerships], and the president signed that legislation a few weeks ago, so that we can provide financial support to communities, to charities, to help us find those veterans we don’t see.

I think we’re in a much better place than we were just a few months ago. Of course, we’ve got the [presidential] task force. But what I think this report will show is that once you get into VA care, the chances of death by suicide go down. It’s finding those veterans and getting them in that is the key. And I think we’ve finally turned the corner on that.

MT: How would you grade the department today?

Wilkie: We’re in a better place than we have been in decades. Our morale is at an all-time high. Our patient satisfaction rates at an all-time high. We’ve hired 54,000 people since April.

We’re pushing forward on electronic health records. We’ve opened up the spigots on caregivers. We as an institution can’t go back to the way things were four years ago, three, four years ago.

I think part of the reason for the success is that we have done something that’s counterintuitive in Washington. We’ve pushed a lot of the decision making down to the hospital level, to people who know their patients, who know their communities. And we’ve stopped delivering these one-size-fits-all directives from this headquarters.

If I could identify a challenge, it is to continue to be as diligent as possible on this during this epidemic, and make sure that we don’t lose sight of how to care for and how to respond to spikes. And make sure that every veteran gets a flu shot. You know, we’ve got drive up flu shots now. We need to do as much as we can to make sure that veterans have the resources to fight this thing.

MT: How important is that electronic medical records overhaul?

Wilkie: It is revolutionary. I’m not known for being discourteous, but the critics, all you hear is crickets right now. We just pulled off the most expensive IT program in government history.

[This] will change the way we do health care, because it’s not just simply a scanning device. It’s interoperable, not only with the Department of Defense, but with the private sector. So that for the first time without having to go through … an 800 page paper record, you now have a complete picture of a veterans health.

And this is also a tool to fight opioid abuse, and also to combat mental illness. That’s going to be with us. It’s working in the Pacific Northwest. And it’s going to go next Michigan and Ohio and Indiana, and then begin to spread out from there as well.

MT: Critics have complained that community care programs have contracted too much during the pandemic. Do you still see that as a key tool for the department?

Wilkie: We’re fully committed to community care. However, a lot of the private sector venues that we would use for veterans have just dried up.

They’ve stopped taking veterans because they have engaged in their own emergency procedures. So as this eventually goes away. we’ll see that ramp up again on community care.

I will also say something that is unusual for a Republican, because I’m not only talking about how good government is, but also how good the future should be for VA. Veterans are choosing to come with us at record record rates. They’d much rather be in a VA [hospital] than in the private sector.

We’re more than just a health care center. We really are a town hall. You got into the lobby of most VA medical centers. And I can, I’m gonna guess that about 40, almost 50 percent in that lobby at a normal time are not there for any medical appointment. They’re there to talk to people who share their experiences. And in that sense, we’re very different from the private sector. We offer a home away from home for veterans, and it’s an important part of the military culture.

MT: Congress still hasn’t passed a budget for fiscal 2021. Is that hurting VA?

Wilkie: Right now, it just means that we have to keep pushing for a resolution. We’re not at a loss for any money. And I can tell you sitting here that I know the Congress is on a good trajectory [with the VA budget].

You know, if you look at what Rep. Debbie Wasserman Schultz [the Democrat leading the House Appropriations subpanel on VA funding] and what she’s done, she took my $240 billion budget proposal and raised me $10 billion more.

So I’m very comfortable with the way that Congress has been heading when it comes to VA funding. We’re one that they’re not going to let fall by the wayside.

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