MR. TOM GJELTENFrom WAMU and NPR in Washington, I'm Tom Gjelten of NPR sitting in for Diane Rehm. She's had a bad cold, but she is now on the mend. Twenty-six veterans affairs medical centers are now under investigation for alleged treatment delays and falsified data. That's up from the 10 centers that were identified last week. At a news conference yesterday to address the growing VA controversy, President Obama defended the agency and its head, retired army general, Eric Shinseki.

MR. TOM GJELTENBut veterans groups and many lawmakers are calling for swifter action. Joining me in the studio to talk about the state of the VA, Peter Gaytan of the American Legion, Ed O'Keefe of The Washington Post and retired army colonel, M. Thomas Davis, of the Center for a New American Security. Hello and thanks, all, for coming in today.

MR. PETER GAYTANGreat to with you.

GJELTENWe want you to be part of this conversation. I'd especially like to hear from veterans about your experiences with the VA. Please call. 1-800-433-8850 is our number. You can send us an email. Our address is drshow@wamu.org. You can get in touch with us via Facebook or Twitter. So President Obama clearly recognizes the VA scandal is a problem for his presidency.

GJELTENHe called this news conference yesterday on relatively short notice. He wanted to highlight some progress, improvements in treatment for veterans with post traumatic stress and brain injury, also what his administration is doing about the problems of homelessness and unemployment among vets.

PRESIDENT BARACK OBAMAThe point is, caring for our veterans is not an issue that popped up in recent weeks. Some of the problems with respect to how veterans are able to access the benefits that they've earned, that's not a new issue. That's an issue that I was working on when I was running for the United States Senate. Taking care of our veterans and their families has been one of the causes of my presidency and it is something that all of us have to be involved with and have to paying attention to.

PRESIDENT BARACK OBAMAWe ended the war in Iraq and as our war in Afghanistan ends and as our newest veterans are coming home, the demands on the VA are going to grow so we're going to have to redouble our efforts to get it right as a nation. And we have to be honest that there are and will continue to be areas where we've got to do a lot better.

GJELTENI want every veteran to know, he said, we're going to fix whatever is wrong. Peter Gaytan, your view from the American Legion.

GAYTANWell, the American Legion was happy to see the president take this issue on personally and make a statement yesterday. Now, what we feel needs to be done, and the president eluded to it in his remarks yesterday, is that we need to be patient and wait for the results of the Phoenix VA investigation. Now, the Phoenix VA investigation kind of started this whole issue rolling that has brought attention to the inadequacies in terms of access to healthcare for America's veterans.

GJELTENThat came from whistleblowers at the VA center in Phoenix.

GAYTANIt did. It came from brave VA employees who said, you know, this system's not operating properly and I'm seeing the detrimental effects its having on our veterans who are turning to the very healthcare system that was created to treat their unique needs. So the president bringing attention to this is helpful. The American Legion still believes that we need swifter action. It's not just about Phoenix.

GAYTANWaiting for the Phoenix investigation to end is needed, but waiting for the Phoenix investigation to end to prove the accusations that VA is indeed manipulating appointment times and appointment records for veterans, that has already been proven by VA themselves.

GJELTENCol. Davis, it seems the issue here is one of patience, how much time and Peter Gaytan used the word waiting. Can this country afford, can the people, can veterans afford to wait for these investigations to unfold or does action need to be taken sooner?

COL. M. THOMAS DAVISWell, I think you have to look at this from the perspective that nobody is taking exception to the fact that the VA is a large, sprawling organization and it's gotten rather calcified over the years and things need to be made -- steps need to be taken to make the access into the system much better. I know it's frustrating for veterans, but when you're going to investigate something that is this complicated, which has a long, lengthy history of difficulty, you want to make sure you get it right.

COL. M. THOMAS DAVISI remember we've had a few instances in days gone by where there was a quick rush to judgment to get to the bottom of an issue and you really don't get to the issue. You get to something which is a secondary or tertiary event. So I think that there has to be a degree of patience put in this to let these investigations run their course, to find out exactly what do we have. Do we have a problem here with some specific individuals who have been doing things they weren't supposed to do, who have been keeping secondary lists for reasons that they had of their own?

COL. M. THOMAS DAVISOr, do have something which is more systemic? I think it could very well be that we've got something that is more systemic, but that requires somebody who really understands the organization to get to it.

GJELTENWell, Ed O'Keefe, you were following developments in Congress yesterday. They listened to the president speak and then the House turned around and passed, by a overwhelming vote, basically a measure of no confidence in what the administration was doing, taking it upon themselves to sort of tell the administration how to handle this, right?

MR. ED O'KEEFEYeah. It's a bill called the V.A. Accountability Act that actually had been written back in February in response to concerns at other facilities, about delayed treatment, about long wait times, about the general processing backlog of benefits and about the use of improperly sterilized equipment, because the committee had found, and the GAO has found and the inspector general at the Veteran's Affairs has found that in the past, some senior career employees or managers at these different facilities haven't necessarily been taken to account for these missteps.

MR. ED O'KEEFEThat instead, they end up getting either promoted or, in some cases, getting large bonuses for performance, even though there was mistreatment or delayed care at their facilities. So what this bill would do is essentially allow the VA secretary to more quickly, more easily demote or fire people who are in what's called the senior executive service, basically the top civilian ranks of career nonpartisan government officials and take them to account much more quickly.

MR. ED O'KEEFEIf he decides or she decides that that type of action is necessary, they then have to inform the two veterans committees that this has been done, which would essentially just be a sort of way of letting Congress know something has happened and I've taken action.

GJELTENWell, does General Shinseki want that authority?

O'KEEFEYou know, the administration's been a little cagey about what exactly they want. They haven't expressly said one way or the other whether the president would veto this. Instead, you see Jay Carney, the White House press secretary, come out and say, look, we have systems in place that allow us to take accountability. We're certainly open to that. We hope that the investigations will help us lead to who exactly might be responsible, but they walk around it.

O'KEEFEThey say a lot of cute things and they don't actually give a direct answer on whether or not the president would support it.

GJELTENSo Peter Gaytan, a big issue here is accountability as Ed says and the question is who should be held accountable? This bill would allow Secretary Shinseki to fire senior employees who he found had not handled their responsibilities properly, but your organization has gone further and actually called for the resignation of General Shinseki himself.

GAYTANThat is true. About two weeks ago in Indianapolis, our national executive committee met and under the leadership of national commander Dan Dellinger, a resolution was passed by the organization that calls for not only the resignation of Secretary Shinseki, but also Undersecretary Petzel and Undersecretary Hickey. Now, that resolution was voted on by the membership.

GAYTANIt's driven by the membership of this organization and Commander Dellinger took the stand and said the American Legion believes that VA, in order to be held accountable and to improve the processes that ultimately affect the delivery of healthcare at VA -- and that's the point here. We're talking about investigations and resignations, but the main point here is, because of the inadequate leadership, inadequate management, inadequate oversight at the Department of Veteran Affairs, today veterans are waiting longer than they have to to receive healthcare.

GAYTANWe're talking about healthcare they've earned through service to this country. The system of the VA needs to operate in a way that we, as a nation, meet our obligation and we show the thanks of a grateful nation by delivering the benefits that are earned. And this debate and this process and this wait in the investigations, we need to keep in mind the goal here. The goal here is to improve the VA healthcare system so those men and women who have earned the right to access VA healthcare receive it.

GAYTANAnd that's what the American Legion stands for and that's why that resolution was passed that calls for the resignation of the leadership of VA because we're not talking about Phoenix. We're talking about 26 VA hospitals. Since Phoenix broke, we've received, like I said, hundreds of phone calls, emails and letters from veterans and VA employees themselves.

GJELTENSaying what?

GAYTANExplaining how bad the situations are personally for them at specific locations. So we're going through that, but we are patient. We're waiting. We want to see what happens, but we have legionnaires and we have staff at the American Legion who are going to these facilities and listening to veterans, saying we hear what your concerns are and we want to be part of the solution.

GJELTENWell, Tom Davis, I'm sure you agree with Peter Gaytan that the goal here is to improve services for veterans. How much a part of this improvement should be done through improved accountability or is the blame game really irrelevant here?

DAVISNo, the blame game is not irrelevant here. There certainly has to be somebody responsible and there has to be somebody that's going to take responsibility for things that have happened, if, in fact, they've been inappropriate and improper. I think the issue kind of comes down to who is the best person to do that. Now, my view is, I've known General Shinseki for a long time. I know he understands the caution that one has to ascribe to data.

DAVISBack when he was chief of staff, he had to deal all the time with data that was coming up about our recruiting program was doing well when, in fact, there were times it was challenged. Our readiness was at a certain level when there were times that it perhaps wasn't as good as it needed to be. And he knows how to make changes in personnel. I know he has removed people from various senior responsibility in the army in days gone by.

DAVISThis is not foreign terrain to Eric Shinseki. What he does need, and I haven't spoken to him and I don't feel I should leave anybody with the idea that I'm speaking for him because I'm certainly not, but my guess is, is that he probably feels that he needs, as most people who run these major organizations in government need, greater latitude in making changes quickly and in making personnel adjustments rapidly.

DAVISAnd frankly, you just don't get that in the public sector the way you do in the private sector.

GJELTENEd O'Keefe.

O'KEEFEThat's the point. You know, removing the top political appointees would be one thing, but I guarantee you in his private moments, the former army General Eric Shinseki, any cabinet secretary, any CEO who's come into government to try to run one of these departments, would tell you that the way the public sector rules of engagement and due process exist right now is it's nearly impossible to get rid of people unless they take paid administrative leave or decide to opt out and take an early retirement.

O'KEEFEThat's what happened in the case of that woman Lois Lerner who was running the IRS division that got in trouble last year. They couldn't outright fire her, even though they were waiting for due process to carry out. And so I think if Congress really does want to look at this problem, not only at the VA. but elsewhere, one of the things that would help would be more accountability towards the rank and file who run these hospitals.

GJELTENEd O'Keefe is congressional reporter for The Washington Post and he used to cover the VA. My other guests are Peter Gaytan, executive director of the American Legion and Col. M. Thomas Davis, U.S. Army retired. He's a senior fellow at the Center for a New American Security. We're gonna take a short break and then we'll come back and pick up again with this discussion. Stay tuned.

GJELTENAnd welcome back. I'm Tom Gjelten. I'm sitting in today for Diane Rehm and we're discussing the Veterans Affairs scandal and the issue of why our veterans are not receiving the timely treatment they have earned and deserved. My guests are Peter Gaytan, executive director for the American Legion, Ed O'Keefe who's congressional reporter at the Washington Post and Colonel M. Thomas Davis, retired Army colonel and a fellow at the Center for a New American Security.

GJELTENRight off the bat I want to read quickly some emails and tweets we've gotten, just to put this in context. First of all, even before the show started we had a note on our Facebook page from someone calling themselves Special Forces Matt. "I am supremely thankful for the VA. The care I have received has been outstanding thanks to dedicated and selfless doctors and their helpers. VA Medical information management is light years ahead of what I have seen in the civilian sector, saving time and money. A lot of smart and good people work at the VA and I thank them all for their service."

GJELTENHe, however, goes on to be very critical of the Obama Administration's handling of this scandal. So on the one hand he's actually defending the VA and defending General Shinseki, although he is critical of the Obama Administration. A couple more. This email, there's no name for it, "Fewer soldiers are dying on the battlefield. Improvements in battlefield emergency medical care mean more soldiers return without limbs. The VA saved my life. If you can wait you do, if you can't you don't." I'm not sure what exactly he means by that last comment but...

GJELTENAnd finally Tom Cheney -- again, we're hearing from veterans which is really good -- "I have undergone five surgical procedures at two VA hospitals and I have nothing but good things to say about my treatment." Peter Gaytan, you certainly would appreciate that what the VA has to deal with in the aftermath of these two wars is like nothing the VA has dealt with for years and years and years.

GAYTANAnd, let's be clear here, that the American Legion is a partner with the VA. The American Legion provides the strongest voice of any veteran service organization because we're the largest. We provide that voice. On that Capitol Hill we say, the VA needs this much funding. The VA needs this many full time employees. Specific locations where the American legion goes to the hospitals and spends three or four days to talk to the administrators, to talk to the staff, to talk to the veterans, stakeholders who own that hospital.

GAYTANLet's be clear here. These VA hospitals, our veterans are dedicated to these hospitals. The American Legion legionnaire volunteers at the VA hospitals save the VA millions of dollars every year. The American Legion has an investment in the VA. We want to save the VA. This is about improving that process and making sure that the veterans that you just read their emails, that every veteran can say the same thing, that veterans aren't coming to us and saying, I don't know what's happening with the quality of my care. I don't know how long it's taken me to get access to the VA health care system. This is all about improving a process that we as a nation owe to our veterans.

GJELTENBut I guess what I'm wondering is whether some of this criticism, in particular that directed against General Shinseki, is unfair given that he, as Veterans Affairs Secretary has been saddled with a task that would daunt any VA secretary.

GAYTANIt's understandable that it's a big task but accountability has to be called for. When we have 26 VA facilities, and that's just the beginning, that are suffering because of poor management, it has to be understood at every level of that agency.

GJELTENTom Davis.

DAVISWell, I just want to emphasize that point. You know, one of the reasons that this burden has been so heavy on the VA over the last few years is back near World War II you have about three soldiers wounded for one soldier killed. And by Korean that had gone to one to four. Currently it's like one to ten. So you've got a lot of people who would be dead in days gone by who are not under the care of the VA.

DAVISI think the comments that you got from the soldiers -- or veterans sending their comments in there pretty much underscores what all of us pretty much agree with, that once you get into the system the care that you get from the VA is excellent. The challenge has been getting into the system. And as I said yesterday in the piece I wrote, I think that this, in no small way, is a matter of the burden of proof. I think the veterans, if he shows up with proper documentation, D Form 214, give him the care until you can determine he's not entitled to it, if you determine that as opposed to currently withhold the care until you determine that he is.

GJELTENEd O'Keefe, a lot of attention has been focused on this statistic, if it can be verified, that 40 veterans died in the Phoenix center while waiting for treatment. But your newspaper reported this morning that it's not necessarily clear that those veterans died because they were delayed treatment.

O'KEEFEAnd that's based on comments by the VA inspector general who told the Center of Veterans Affairs Committee last week that his initial review of the allegations are that while these 40 people did die, there's -- to his knowledge at least so far, and this is based off of testimony exactly a week ago, that none of those deaths were directly caused by the delays, that they were either sick or something else happened. But it wasn't because they weren't -- it wasn't necessarily because they had been basically log jammed by the lack of care. It's an explosive allegation and that's why it is being investigated. But again, his initial finding was that that allegation so far at least is not true.

GJELTENAnd another thing -- another thing in your article this morning was that 26 centers have been identified but so far, if I'm not mistaken, you reported that only one-sixth of VA medical centers have been sort of implicated in these issues so far.

O'KEEFEAnd the idea that you are putting together lists of people who are not officially in the computerized scheduling system or any other delay beyond the 14-day mandate, it appears according to the VA that about one-sixth of the 150 are implicated. And another thing to keep in mind regarding Phoenix, part of the reason people have said that they have had this issue out there, remember it has the second largest veterans population in the country behind Los Angeles. There's about 275,000 eligible veterans in and around Maricopa County out there. So it is a big market for the VA. And that, they say, is one of the reasons why perhaps there have been delays in care.

GJELTENWell, Peter Gaytan, you know, the fact that Arizona is such a large market for veterans to me, just looking at it as a layman, I would jump to the conclusion that a lot of those veterans are Korean War veterans or veterans who are pretty advanced in age who have retired to the southwest, or is there some other explanation? Are we talking here about a really aging veteran population that is most -- that's having the most issues?

GAYTANWell, I think system-wide you're seeing an aging of the VA patient population because the Vietnam era veterans are reaching that age where maybe they didn't go to the VA before but now at a point in their lives they're realizing they've earned that benefit. Let me go ahead and access the health care that in my advanced age now I can actually utilize.

GAYTANSo I don't think we need to concentrate on specifics of which age group. If any veteran turns to the VA and they're denied care, that's an injustice. And let's go back to the 40 decider, either proven or unproven. Dr. Foote who worked for the VA for 25 years claims that this happened. If it did happen it's horrible. But the fact that a process exists system-wide that allows VA employees to take a veteran's name, write it on a piece of paper instead of in putting it into the electronic appointment system software that VA has to track VA patient appointments, that is horrible.

GAYTANThe fact that processes are not being followed and the system is being gamed by a VA employee to deny that veteran health care, so that employee and their boss can be considered for a bonus is horrible. If they're driven by that bonus more than they are about the quality of work that they provide to a veteran, that needs to be changed. And that's system-wide.

GAYTANWe can't talk about investigations of leadership and who deserves and who doesn't. If the process is as widespread as it is and it's failing veterans because VA employees have the ability to manipulate records at the expense of the health of any veterans regardless of death or not, that health care that's delayed is health care denied.

GJELTENAnd that is a management issue, isn't it, Tom Davis?

DAVISI think that that pretty much is a management issue. And of course if you've got people who have access to a systematized IT process by which you can enter data and collate data and therefore present data to senior management, that system ought to be used. The fact that, as Peter's referring to, somebody would actually go to a handwritten list that they stick in a drawer and they enter at their own convenience, you know, that's obviously inappropriate behavior. Inappropriate behavior is something that senior management has to get to.

DAVISSo going back to our other comments about the organization and the process itself, when you go to the comments you got from your veterans, the care is good. Once you get in the system the hospital care is good. At the top level I think the leadership is committed, dedicated and experienced. So you've got something going on in between. And that's probably where the focus absolutely needs to be and that is a managerial issue. But you need people with the authority to make the changes that they need to make and not take months, even years to try to get down to the source of the problem.

GJELTENSo maybe it would be a good idea to give Secretary Shinseki that kind of authority to make those personnel moves.

DAVISWell, I think it would be a good idea because I've seen -- he -- you know, a chief of staff of the Army, you know, has limitations as well. Anybody in the public sector does, as I mentioned. But he can make certain moves and I have seen this man do it. I know there have been problems in the past during his tenure in the Army when he was a commander in Europe where people have not met his standards and he replaced them. So he's not shy about doing that.

GJELTENOkay. Ed O'Keefe.

O'KEEFEWell, Peter, I just wanted to clarify, so the way you see it until every single employee who did this, who used those written lists is kicked out, you guys essentially won't be happy and won't rest the case.

GAYTANOh, no. I don't want my comments to be interpreted that way. I think the problem has to be solved. And it has to -- the process needs to be improved so the employee is not capable of doing the things that allegedly are occurring now. And if this wide, it's kind of obvious that it's actually happening. So the focus needs to be on the process so any VA employee cannot do this manipulation of information.

O'KEEFEBut why not have those people who did this also removed from the system because the veterans who are getting care are the ones interfacing with these people every day. If they're more interested in the bonus than the veteran, why should they even be allowed to work in the hospitals?

GAYTANWell, that's true. And that -- ultimately if the process of identifying and reprimanding takes place by middle management to those VA input technicians, that has to be done -- that's not something we need to call for. It's just an obvious result of any action that's taken by management.

GJELTENSo here's an interesting email. This is from Patricia in Chicago, and this has to do with this sort of central controversial issue of getting appointments at the VA. She writes, I understand it's difficult to get appointments at VA because there are not enough clinicians. There aren't enough clinicians because a doctor or psychiatrist has to have special training above and beyond what's needed outside the VA. The media has not explored this factor about what causes the delay in scheduling. It's not just that the VA doesn't know how to make appointments."

O'KEEFEI remember having a conversation with the former Deputy Secretary of the VA W. Scott Gould, who's a Navy veterans himself, early on in his tenure. And he had told me how one of the big things he was focused on was trying to find young medical students who are coming out of the education system and trying to recruit them to take positions at VA medical clinics or hospitals. And he said, it's awfully challenging because I can't pay them. I can't afford to pay them what they would earn if they worked at Johns Hopkins or at, you know, Brigham and Women's Hospital in Boston or, you know, New York Presbyterian. I don't have that kind of money.

O'KEEFEWhile the work would be fulfilling and while they would earn a good decent living, they could make five times more working in the private sector. So yes, the VA structurally has a problem in attracting top talent and qualified talent. And yes, they expect that people who work in their hospitals have a better understanding and training on how to deal with guys who came home without legs or people who have PTSD or, you know, aging veterans who have agent orange-related illness. And you can't necessarily get that if you walk into Johns Hopkins or National Medical Center here in Washington.

GJELTENEd O'Keefe is congressional reporter at the Washington Post. I'm Tom Gjelten. You're listening to "The Diane Rehm Show." And if you're just joining us we're obviously talking about the scandal at the Veterans Affairs Agency. My guests are Peter Gaytan, executive director of the American Legion and Ed O'Keefe and Colonel M. Thomas Davis, U.S. Army, senior fellow at the Center for a New American Security.

GJELTENPeter Gaytan, Tom Davis mentioned what -- a much higher percentage of deployed soldiers and marines are coming home injured now who would've been killed in previous wars. And because of body armor and because of battle field -- improvements in battlefield trauma surgery, a lot of those soldiers and marines are grievously wounded, mutilated, missing limbs and so forth.

GJELTENHow do you evaluate the performance of the VA on dealing with some of these new injuries of these wars, the missing limbs, the need for prosthetic development, the traumatic brain injuries we've seen, the post traumatic stress, all new challenges that the VA medical system has not dealt with before or not to this extent?

GAYTANRight. The American Legion has a team of employees and legion volunteers who have expertise in therapy and treatment. And that -- they come together and we form a system-worth-saving taskforce. The system worth saving is the VA. And we have a taskforce that visits VA hospitals. I've been on many of those visits and I've seen the progress that VA's made, not only with their prosthetics but their therapy, PTSD, TBI outreach. And I will say a lot of those successes are based on VA's partnership with medical teaching schools.

GAYTANThey partner with students at medical teaching schools and they do research and development on specifics, like you mentioned, on PTSD, TBI, limb replacements. And they're making progress. And it goes back to the quality of health care that we talked about. VA is a system worth saving. And the American Legion wants to ensure that the integrity of that agency is -- continues into the future because the needs of America's veterans are not going to disappear.

GAYTANWe are still welcoming home a new era, a new generation of America's veterans. And we have veterans in this nation who depend on VA. And it's our obligation to make sure VA operates at that level. And we need to look at the best practices. That quality of care that your veterans are talking about, that advance in research and development that VA is capable of, we need to spread that across the entire agency to ensure that we can continue to provide quality health care.

GJELTENWe've gotten a lot of emails similar to this one. This emailer asked, "Is this issue really about the lack of funding for the VA? Who authorizes and approves those funding resolutions? The House of Representatives, which voted last night to change the accountability at the VA, the House of Representatives has reduced funding for the IRS, the EPA, the FDA, the CDC, the FCC, etcetera," talking about a lot of federal agencies. Ed O'Keefe, to what extent is this a budgetary issue?

O'KEEFEWell, it is part of it. Certainly the budget has increased as veterans have returned home from the wars but I think, you know, the president would tell you, the department officials would tell you, the Legion and the VFW and others would tell you that there can always be more. But of course we do live in these austere times and there's been concerns about too much federal spending.

O'KEEFEThe problem is it costs billions of dollars to build new medical centers, especially in areas of the country where veterans are now living, whether they're older or younger. And the cost of treatment is quite expensive. If you wanted to...

GJELTENGo ahead, Peter.

GAYTANSince you brought up the construction of VA hospitals, another aspect of delayed delivery of health care is the delay in the four VA hospitals that are being constructed right now, Colorado, New Orleans, Orlando and Denver. Each one of those has suffered drastic delays in completion. Each one of those is suffering cost overruns. Those are additional failures that are not being handled by VA.

GAYTANI mean, we're talking about years that the veterans had to fight for the hospitals, especially in Denver, in New Orleans. They had to fight for those hospitals to be constructed. Now they're talking about year, two-year delays. There were problems with the contractors down in Orlando. That has to be -- better oversight has to be provided to ensure that these VA hospitals are built so veterans can access that health care.

GJELTENTom Davis, a quick comment before we go to a break?

DAVISI was just going to say that I was in the program budget business in the Pentagon for a long time. So I'm quite converse and an expert on the defense budget, much less so on the veterans budget. But I will tell you that you know, all these things are always a challenge. I mean, anybody who's added an addition to their house recognizes that a contractor is generally going to cost you more and take longer than you're originally told.

DAVISThe government is not immune from that. But what this is going to take is somebody who is really committed to stay with it and push it through. And I think that takes a committed dedicated guy who's familiar with complex organizations. And General Shinseki is that sort of person. He just needs the authority and I think he needs the latitude to go after it.

GJELTENWell, I did notice that General Shinseki was not standing at President Obama's side yesterday. And after the break we can talk about whether there's any significance to that or not. Just heard from Tom Davis. He's a retired U.S. Army colonel. We're going to take a short break right now and then we'll be back.

GJELTENAnd welcome back. I'm Tom Gjelten. I'm sitting in for Diane Rehm today. And our topic in this hour of "The Diane Rehm Show" is the scandal at Veterans Affairs and what can be done to improve treatment for our veterans. My guests are Peter Gaytan, executive direction of American Legion, Ed O'Keefe, Congressional reporter at The Washington Post where he used to cover the V.A. and Col. M. Thomas Davis, U.S. Army, retired and a senior fellow at the Center for New American Security.

GJELTENAnd just before the break I noted that Gen. Shinseki was not at the White House yesterday when President Obama came out and defended Gen. Shinseki and the VA. Any significance to that, Ed?

O'KEEFEWell, they had met earlier in the Oval Office, along with Rob Nabors, who's the former deputy White House chief of staff who was in Phoenix today to sort of begin the White House-led review of what's going on, which is kind of above the inspector general. The two of them have to report back to the President by next week. I think ever since George Bush stood alongside his embattled FEMA director back in the day, White Houses have learned, or at least top White House aides have learned that it's probably best to keep a little visual distance between the president and the guy who's being called upon to get out of town.

O'KEEFESo, look, Shinseki's been there 2009. He's a 40-year Army veteran. He served in Vietnam. He lost part of his right foot during that war. He's a guy who was brought in at the start of the Obama administration to help begin what the president was describing as the modernization of a sprawling department. Remember that when the president ran for office back in 2008 it was in the wake of the Walter Reed Medical Center scandal. That was a Defense Department-run hospital that has since been closed and merged with one up the street here.

O'KEEFEBut it was indicative, he said, of general government mismanagement and mistreatment of veterans. So he brought in Shinseki, who was a skilled and experienced Army leader, to go in there and begin changing the place. All indications are, if you look at customer service reviews, if you look at sort of employee surveys of the place, that they love the fact that Shinseki is there and has begun to help change the quality of care.

O'KEEFEYou read emails earlier from people who said, "Once I'm in the system…

GJELTENRight.

O'KEEFE…I love it. It's great." And Iraq and Afghanistan veterans, to some extent, believe that they're now getting a handle on the types of injuries they have. What's the fate of Shinseki? I suspect it will play out much like Kathleen Sibelius. That once the problem is fixed he will find time to go.

GJELTENWell, some people have pointed out that if you really care about -- and I'm curious what you think about this, Peter Gaytan -- if you really care about improving the operation of the VA, maybe this is not the best time to bring in somebody new and go through all the turmoil that a change of leadership necessarily would entail.

GAYTANWell, if we're afraid that there's going to be no leadership when Secretary Shinseki walks away, I think we're seeing the results of lack of leadership by 26 facilities who are claiming that VA employees are manipulating appointment records that ultimately end in delayed care for veterans. But let me point out, after that press conference, the first thing that happened at the highest level of VA was they -- the secretary rescinded Helman's bonus that was given to her one month ago.

GJELTENWho is that, now?

GAYTANHelman is the Phoenix VA Medical Center director who was suspended indefinitely…

GJELTENRight.

GAYTAN…once these accusations came out. Just yesterday it was announced that Helman received a $5,000 bonus -- I think it was more $5,000.

O'KEEFENo. It was $9,345.

GAYTANThat was the year before.

O'KEEFEOh.

GAYTANJust last month…

O'KEEFEOkay.

GAYTAN…she received another $5,000, at least, bonus. We're talking a month ago. She was already put on leave and the VA rescinded, just yesterday, a bonus that they didn't know was even given to her. They attributed it to a clerical error. If things are happening at that level, that an award can be given to a VA Medical Center director who's suspended, and blamed on a clerical error, there's not enough oversight in any one of these processes.

GJELTENOkay. I want to go -- I want to bring in the callers, now, at this point. A few minutes ago, Peter was on the line. He said he was injured in Afghanistan, spent time in a VA hospital and he said it was horrible. Unfortunately, Peter got tired of waiting, I guess, to go on the air, and he hung up. I do hope our callers are patient because it is really important for us to hear from you. Let's go now to Jeff, who's on the line from Florida, St. Augustine, Fla. Hello, Jeff. Thanks for calling "The Diane Rehm Show."

JEFFHey, good morning. I want to preference my comments by saying my dad's a Vietnam-era veteran, spent time in Southeast Asia. And my grandfather was gravely wounded in France in World War II, really hobbled for life. But, you know, I think -- I guess it's hard to turn on the news and having gone from the Affordable Care Act debate to now. You know, you've got politicians falling all over themselves to support single-payer healthcare in the form of the VA.

JEFFAnd, you know, I honestly think that, you know, we need to take great care of guys that were recently wounded, but, you know, people like Vietnam veteran era guys like my dad, you know, he's in Medicare. I mean, he could sign up and go to the VA. He would qualify. You know, but he pays his Medicare premium and, you know, he uses Medicare. And as much as I'm against, you know, privatizing all this stuff, you know, I kind of consider myself a liberal-leaning technocrat.

GJELTENOkay.

JEFFBut, you know, I just think that the idea that we're going to be providing all of this care, you know, through this one, obviously, very inefficient system, not well funded. And the problem is is that in this country you have to compete with the private hospitals…

GJELTENRight.

JEFF…for doctors, like these guys were just saying and for administrators. I mean, she got a $5,000 bonus. The hospital administrator in Flint, Mich. was making $5 million a couple years ago, in Flint, Mich.

GJELTENOkay. Jeff, that's -- you've made…

JEFFAnd, you know, in England -- just a quick point. In England, once you come back from the battlefield, you go into National Health.

GJELTENRight. Okay. Let's take up that. Tom Davis, I see you have a West Point ring on your finger. When did you go into the Army?

DAVISWas commissioned on June 7, 1972.

GJELTENOkay. So you know something about Vietnam-era vets. What about this point that veterans who are in the Medicare system should look first, perhaps, to that system, so that they can relieve a little bit of the burden on the VA system?

DAVISWell, I didn't serve in Vietnam. I was just…

GJELTENBut you're of that era.

DAVISI'm of that era. I always -- people always characterize me as a Vietnam-era vet. And I'm always a little reluctant to have that because I didn't go to Vietnam. We were asked to go elsewhere in the aftermath of the war. But the good news is, Tom, that people have those choices here. I mean, if you have a facility that's nearby, it's a VA system, in the VA system, a VA hospital, you can go to that. If you're TRICARE you can go to a military facility if you want to do that.

GJELTENTRICARE is the DOD medical system.

DAVISIt's the DOD medical system. You know, I personally -- I'm now retired. I use TRICARE Standard. I go to private doctor. I will tell you I had a friend who runs a blog out in -- a former Army colleague of mine -- runs a blog out in Nevada. And a lot of people that have responded to that have said pretty much what you're just hinting at right there.

DAVISYou know, will this not put a burden on the VA system at a point in time where we've got a lot of people coming back who are wounded, who have gone through an intense operation? You know, this current environment, this current war we've just gone through is different than what we've done before.

GJELTENRight.

DAVISVietnam was what we called personnel replacement. We sent soldiers to Vietnam, one soldier at a time, replaced units. We send units to Iraq and Afghanistan and we rotate units. And they go back and back and back. And have had experiences that are very uncommon in the military experience. And that's reflected in the wounds they come back with, in the efforts to diagnose PTSD.

DAVISAnd I'm proud to say my old -- my dear friend from Army days, Pete Chiarelli, the retired vice chief, has, at this point, almost dedicated his life to trying to get a better understanding of PTSD, the demands on the system that requires TBI, traumatic brain injuries and so forth. And everybody in the medical profession, be it Medicare, military or VA, is just now learning to deal with this.

GJELTENWell, I should point out that we tried to get Gen. Chiarelli on this program, but he is now running a brain research institute and has…

DAVISYeah, One Mind.

GJELTEN…been very busy with that. Ed O'Keefe, you wanted to make a point?

O'KEEFEI just wanted to point out to listeners who may not be familiar with the system, just remember, while any military veteran's eligible for VA, not all of them use it. It's not automatic. And I think the caller was pointing out that, you know, every individual makes their individual decision. Yes. They could use Medicare, they could use a VA facility, they could go to the doctor right down the street. Just important to point out.

GJELTENLet's go to Craig now, who is on the line from Bethesda, Md. Hello, Craig. Thanks for calling "The Diane Rehm Show."

CRAIGCan you hear me?

GJELTENYeah, Craig, you're on the air.

CRAIGYeah, I'm a 30-year veteran physician, Air Force Academy, reviewed thousands of VA records and I think VA care is great, but like any system, has pluses and minuses -- I have a cold -- and can't really be matched by the private sector. You know, I think the Secretary Shinseki's done a good job drilling down from the top, tackling those laws and I think I have a couple suggestions.

CRAIGOne is that the executives need to get more input from the patients, like they've been talking about on the air. And the V.A. has a very good hotline system, it has 20,000 or 30,000 calls a year, which aren't really looked at closely because they need more doctors in the medical healthcare inspections team. They have one or two doctors, three doctors maybe in there. And that's why it's taking so long to look at those 400 guests so it should boost that healthcare inspections team and do (unintelligible).

GJELTENOkay.

CRAIGAnd then a couple other things, give Shinseki's staff the tools to move his staff around. They also should eliminate the unwritten negative whistleblower system. I used to have patients visit with me or staff visit me offsite, when I did site visits because they're afraid of the whistleblower system.

GJELTENSo are you saying there should be more opportunities for whistleblowers?

CRAIGYeah, because the staff is petrified. That's why that Dr. (unintelligible) was retired. And they don't -- they can't -- it's a huge -- and Shinseki's coming from the top down. He's going to get there, but you just got to give him some time.

GJELTENAll right. Thanks very much. Peter Gaytan?

GAYTANI think it's key to focus on what that caller just mentioned about the protection of VA whistleblowers. You have to keep in mind these whistleblowers are bringing to attention major problems within the VA healthcare system. They're doing it because they're passionate about the mission of the VA. VA is full of dedicated employees who work very hard, overtime, to address the needs of the patients of the V.A. facility.

GAYTANSo we've got to understand that these allegations that are coming to light are because VA employees care about the service they're providing. They care about the job they've been given. They care about the patients who come to them and say I need help. So these whistleblowers are very brave and they do need to be protected because that is the only way that conversations like this existed. We're taking an hour of your time to talk about an issue that should an American issue.

GAYTANIt's not a military issue or a veteran issue. The care of our veterans in this country is an American issue. And we all have an obligation. And these whistleblowers should be thanked for what they're doing.

GJELTENNow, another comment that the last caller -- another suggestion that last caller made is that there should be more opportunities for the VA to hear from the patients, to hear suggestions from the patients. That sounds like an area where the Legion could help.

GAYTANYes, sir, it is. And I mentioned our System Worth Saving taskforce. Just last week we went to Phoenix and we spent four hours in a Legion hall with a town hall meeting of veteran patients. Four hours, our staff and volunteers listened to the local veterans and their family members telling us the problems that they have at VA. And some of them telling us how great it is. And that's what we need to focus on. Identify the problems, look at the best practices and make sure that's system wide.

GJELTENOkay. Let's go now to Carol, who's on the line from Louisville, Ky. Carol, thanks for calling "The Diane Rehm Show."

CAROLThank you for taking my call. I'm a veteran. I left the service in 2006. I am a surgeon. My father was a combat veteran, my brother is a combat veteran, still on active duty. I worked in a VA hospital for about 18 months. And I saw things regarding access to care that really disturbed me. At every point that I tried to make improvements I was thwarted. It was like banging my head against a brick wall. Because it was not us in the clinic that were having the problem, it was people, as has been pointed out over and over again, at the senior management level.

CAROLMedical directors, division chiefs, department chiefs who have a set idea of what is going to happen. They've been doing it for 30 or 40 years. And they are not going to change. They are unwilling to listen to the ideas and the experiences of -- many of the people that are coming into work at the VA are actually veterans who are medically trained themselves. They don't want to change. And unless you get rid of a lot of those people, I don't see it changing very soon.

GJELTENCarol -- that's Carol speaking to us from Louisville, Ky. I'm Tom Gjelten and this is "The Diane Rehm Show." Carol, if you're still with us, are you still at the V.A. or still working at the VA?

CAROLNo, I'm not. I left the VA.

GJELTENAnd what happened when you tried to bring these problems to the attention of the upper management?

CAROLI was thwarted at every turn. I was, basically, disrespected. I was told that I was being out of line. I was told that I was being difficult. And basically received, after initially receiving excellent reviews for my services, quickly I became a pariah.

GJELTENOkay. All right. Well, thanks for sharing that experience with us. Ed O'Keefe, I mean, what would explain why this particular agency would have all these issues at the senior management level? I mean, to some extent you made the point earlier that the V.A. is a huge bureaucracy and all big bureaucracies have management problems. But is there something sort of unique about these senior management issues at the VA, do you think?

O'KEEFEWell, I mean, when you have 300,000 plus employees about 900 branch offices, you're going to run into internal politics. And I think that's just been part of it. And that there's also some concern that these regional directors that exist for the different regions of the VA perhaps have been given too much autonomy and don't have a good enough connection or the leash isn't short enough when it comes to Washington's oversight of those guys.

O'KEEFEThat perhaps things have been happening down in the field, as have been discussed here, that if we're known by people here in Washington, would have been fixed years ago. And just the culture of it, the idea that, you know, you have one place that reports up to one other place, that eventually reports to Washington and to people here who are concerned about this, that that stuff has been allowed to permeate.

GJELTENPeter, Carol is mentioning exactly the issue that you've been trying to focus on all morning, which is these upper management issues.

GAYTANYes. And we need to go back to -- we're talking about the lack of communication. We just heard from a VA employee who says there are problems with the system. There are things that are wrong that need to be fixed. And then we are questioning if leadership here at central office in Washington, DC, is aware how systemic this problem is, how far it goes down to VA.

GAYTANWell, I'll tell you right now, there was a memo issued in April 2010, by an undersecretary right under the undersecretary of health. And in this memo, it is admitted by VA that -- and I'll quote, "It has come to my attention that in order to improve scores on assorted access measures certain facilities have adopted use of inappropriate scheduling practices, sometimes referred to as gaming strategies." That is exact verbiage from a memo, an internal memo, with Department of Veterans Affairs, here in Washington, DC.

GAYTANSo leadership here in 2010, not only knew about it, but sent a memo out to VA system wide saying we know it's doing it. We know you're doing this. Do not do it.

GJELTENOkay. Ed O'Keefe, before wind up here, let's just look ahead a little bit. The president has sent, as you mentioned, his deputy chief of staff, Rob Nabors, to Phoenix. What's likely to come out of that? And when are we going to see this IG report?

O'KEEFEWell, the -- Mr. Nabors and Secretary Shinseki have to report back to the president by about this time next week with some initial information on how they're getting the situation under control. The inspector general report might not come until August because they've got to visit this facility in Phoenix and then these more than two dozen other facilities as well. On Capitol Hill, you've seen the House already vote on this one bill.

O'KEEFEThe Senate is expected to, at least at the committee level, begin taking it up. I think it'll be difficult for Democratic leaders in the Senate to ignore this and not do something. Because the White House hasn't, at least so far, signaled that they're opposed to this measure, I would suspect it would continue moving forward. And that would give Secretary Shinseki one valuable tool, the ability to address these concerns with mid-level managers.

O'KEEFEBut the bigger question will be does interest in this sustain itself here in Washington, especially with elections approaching? I think the longer it does, the more changes we'll see.

GJELTENWell, here at "The Diane Rehm Show" we're going to make sure that this issue stays in the public consciousness. My guests this hour have been Peter Gaytan, executive director of the American Legion, Ed O'Keefe, from The Washington Post and Col. M. Thomas Davis, from the Center for a New American Security. I'm Tom Gjelten. Thanks for listening.