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Veteran’s Choice Program Failed To Target Wait Times Even In Southern California

Kris Arciaga
Widowed while pregnant, Gloria Grijalva shares pictures of her husband with the couple's second son. U.S. Army veteran Charlie Grijalva committed suicide in 2014.
Veteran’s Choice Program Failed To Target Wait Times Even In Southern California
GUEST: Steve Walsh, KPBS General Assignment Reporter

This is KPBS Midday Edition I am Maureen Cavanaugh. In 2014 Congress passed the veterans access twice and accountability act to help shorten long wait times for veterans at the VA. Throughout the year KPBS and NPR and other public radio stations have looked at whether the law worked as advertised. As the man who helped implement the lockets set to take over as VA secretary. We look at how they spent billions to hire more doctors and nurses. Dad. Reporter: Charlie Grijalva was diagnosed with PTSD while he was an Army. In 2014 while Congress was debating how to fix long wait times at the VA he was in and. Valley -- Imperial Valley does a community with his wife Gloria. It's a small town so everybody knows each other. His mom went to school with my mom -- his dad lived two box away from my dad. Everybody knows each other. Reporter: Charlie had a history of suicidal thoughts after spending time in Afghanistan and Iraq. The VA tried to reach out. In 2014 his psychiatrist seems to get his prescription right but according to the VA records things started to go wrong. His psychiatrist left the VA that summer he missed an appointment with the nurse practitioner in September the VA renewed his medications over the phone and since wait times were so long they offered to let them see a Doctor outside the VA system under the new choice program. By December 2014 his medication had run out again and then it was the holidays. Grijalva had a young family and a new baby on the way. He insisted on giving his kids a magical Christmas. He said I want to do like we used to do as a kid. Play some Christmas music and have the kids decorate the tree and play some hot chocolate -- and have some hot chocolate. I said let's do it. Even though he was feeling the way he was he wanted that kind of Christmas for his kids. Reporter: a few days before Christmas his wife found him. He had hung himself a few hours after he had texted her I love you. He had told me when he was at his lowest. I don't want my kids to see this. I don't want to put my kids through any of this. Reporter: you can't say whether the VA would have saved his life but everyone agrees the system with its long wait times needed to be fixed. That's why Congress passed a law that was supposed to give VA hospitals the resources they need to help veterans like Grijalva see a Doctor. It was his job of top VA official to help use veterans choice money to help beef up the staff. Our goal is to get them the professionals that they need so that the choice money we wanted everybody to go out and execute on and to use that money as quickly as possible because we have a sense of crisis. Reporter: for the past several months KPBS and NPR have been looking at how the VA spent the 2.5 billion dollars in the choice law that was used to hire staff inside the VA. To give you a little Ellis -- illustration of what we found I took a car around Southern California. My first stop was the big VA in Los Angeles. We are out here -- this is the middle of the day it is very busy. Looked down here you see full parking lot and vets coming in and out for their appointments. We decided to come appear on the five from San Diego to take a look at where the VA decided to hire doctors and nurses. This is one of the busiest BAs in the country but they actually received fewer people than San Diego. There wait times have actually gotten worse over the last couple of years. So that is Los Angeles. LA is one of 33 hospitals around the country that the VA actually prioritize under veterans choice but it did not get a lot of new staff considering its size. Overall it's wait times have not come down. So back in the car my next stop is Long Beach about a half hour south of LA depending on the traffic. Wrapping up into our Southern California VA's of Long Beach it is getting late in the day but there are still plenty of cars in the parking lot. Long Beach is a growing VA. They received more people from the choice program then LA dead though among LA San Diego and Long Beach Long Beach is the smallest of the three. After two years the wait times have still gone up slightly. Looking around Southern California it is hard to see a pattern. The VA get IRD to every Southern California VA except -- for some reason -- San Diego. They had one of the longest times in the country if you need to see mental health specialists. San Diego asked for 40 mental health providers to tackle the wait times and was allowed to hire 24 people when the money first became available. When they came back a second year the acting chief of staff for mental health said they were told the money was all gone. At that point we heard that the funding had actually -- that had been received by the facility was not enough to cover both years. It was really only for FY 15. Reporter: so San Diego did not get everything that it asked for and Los Angeles did not get as much as you would think for it signs and needs. It was a pattern we found around the country to find out just how hard it would be to target wait times when you have a system as fast as the VA. 20 me now is Steve Walsh. Hello. David talking is Trump's nominee to had the VA. He has been serving as secretary of health since 2015. Was at his job to make sure that the vets choice program is working. Basically it was. He was a surprise choice. Nobody -- I heard the press conference driving into work with Donald Trump announcing that it was going to be him. I almost drove off the road. Nobody was talking about putting him in charge. Especially when you look at -- let me back up a little bit. Here is a Trump tweet about the VA from Christmas 2015. He said our greatest veterans are being treated very badly because of corruption and incompetence at the VA. That will stop. I will fix this quickly. So then he comes back and David Shulkin will be probably his most high-profile holdover from the Obama administration. When you did a report on the wait time problem at the VA what did David Shulkin tell you about what -- how he thought the program is working. He thought that they have made a lot of changes. In fact there is a little bit of news. Just yesterday the VA Inspector General came out with a large sweeping report looking at how the veterans choice was looking at -- Limited and they have been working on this since back in May and early spring looking at some of the problems with the rollout and they have basically concerned desk confirmed a lot of what we were saying that the wait times were long and they did not go much into this 2.5 alien dollars -- billion dollars that was spent for hiring. David Shulkin said this was spent largely just before the to cover . Remember the scandal here. People were saying veterans are dying on waiting list we need to take action. Congress acted within a couple of months to pass the law and gave the VA only 90 days to implement. Speed was of the at the since essence and wait times were the issue. Shulkin defended the way they did it and said we sent this out to every VA -- pretty much every VA in the country and had them design their own plan and how they wanted to spend the money so we sent it everywhere which is fine I'm sure even though we have seen so many VA's that did not have long wait times. I am sure those doctors and nurses are doing something important. I'm sure they are's Dean patients but when you dole out the money that way it is hard to tackle that specific issue. To you or anywhere that you've read has Shulkin shouldered any of the blame for this lack of improvement and wait times. Certainly has shouldered some of the blame. A lot of the critics -- a huge critic of the way that the VA was operating and they are upset that this money was not targeted more specifically. And he has taken the blame on the other hand. We are seeing a lot of veteran Scripps were actually interested. Having the head of the VA right now stay on and be a holdover they have like's how this has rolled out. They have seen changes at the VA and they have seen this program starting to kick in somewhat as well as other reforms that were happening late in the Obama administration and they were interested in seeing a little bit more continuity. So you told us that you almost drove off the road when he heard that David Shulkin was Donald Trump's pick you had the VA. Does this explain this quest for continuity that the program that has not been an overnight success does seem to be working. It is working and it is not working. It is not a quick fix. What we are talking about is a long reform there are several bills out there back in March where we are looking at making changes and taking this authority back from the VA. We are talking about the partners like HealthNet. They are not making the partners. They are talking about taking a back into the VA's they would have a better handle on how it would work. In the and the VA found that about 53% of the vets still had to wait for them 45 days to see an appointment. David show comparisons -- David Shulkin faces his confirmation hearing tomorrow. What do you expect There is a larger philosophical issue that is out there how much care does the DA -- VA do it internally and how much do they sent to Alex -- outside doctors. You know the whole notion that any vet who wants to go outside we will make it like Medicaid or Medicare and if you want to go outside and see your doctor the VA will just pay for it. Veterans choice was not that broad mostly because the VA and lawmakers were concerned that this could be incredibly expensive to just hire out doctors in the community. We will find out what Shulkin fits in and that model . He's and raised -- embrace the whole choice model sending people to outside doctors but will he embrace wholesale go ahead and send people to outside doctors a lot of veterans groups and lawmakers are very skeptical and they do not want to see the existing system breakdown. They want to see a robust VA system and they are concerned I -- that they could be robbing a lot of money from the system. I have been speaking with Steve Walsh. Thank you. --

Congress passed the Veterans Choice law in 2014 to lower wait times for patients seeking care from the Veterans Health Administration. A year-long investigation by KPBS, NPR and other public media outlets revealed that the law often failed to work as intended.

Related: Veterans Choice Medical Program Troubled From Start

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Veterans Choice was designed for veterans like Charlie Grijalva, who was diagnosed with post-traumatic stress disorder (PTSD) when he was still in the army. His case illustrates the toll that VA staffing shortages and delays in treatment can have on vulnerable veterans.

Back in 2014, Grijalva lived with his wife, Gloria, in Imperial Valley, about two hours from the VA hospital in San Diego.

After spending 18 months deployed in Afghanistan and a year in Iraq, Charlie Grijalva started having suicidal thoughts.

Kris Arciaga
Gloria Grijalva describes the months leading up to the suicide of her husband in 2014.

The VA tried to reach out to him. Early in 2014, his wife said, Grijalva’s health-care providers at the VA had put him on prescription medication that seemed to alleviate his symptoms. By summer, though, his psychiatrist had left the VA and Grijalva was transferred to a nurse practitioner. He missed an appointment in September 2014, according to records provided by the VA, but the new provider agreed to refill his prescription over the phone.

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Related: Inspector General Review Of The Implementation Of The Veterans Choice Program

Medication ran out

Because San Diego’s wait times were so long, under the new Veterans Choice program, Grijalva qualified to see a private doctor outside the VA system. Grijalva had an initial consultation with a private psychiatrist near his home. But then in December 2014, his medication ran out.

Grijalva had a young family and a new baby on the way. His wife said he insisted on giving his kids a magical Christmas.

Kris Arciaga
Charlie Grijalva, making cookies at Christmas with his children in 2014.

“He said, you know, ‘I want to do what I did as a kid,’ ” she said. “Play some Christmas music, have the kids decorate the tree, drink hot chocolate. . . Even though he was feeling the way he was, he wanted to have that kind of Christmas for his kids.”

But it wasn’t to be. A few days before Christmas, his wife found his body. He had hanged himself a few hours after he had texted her “I love you.”

“He has told me when he was at his lowest that — ‘Didn’t want my kids to see me like this . . . I don’t want to put my kids through this,’ ” she said.

One last appointment

His VA records show Grijalva went to one last appointment at the VA in San Diego in December. A refill of his medication arrived just before his death. Around the time of his death, the VA was just beginning to implement theVeterans Choice and Accountability Act. Congress passed the law in August 2014 specifically to give the VA system the resources to cut down on the long wait times at VA hospitals around the country. The long waits which had made headlines that summer.

Part of the law was designed to allow veterans to go outside the VA system to see a private doctor, providing the veteran had to wait more than 30 days for care or lived more than 45 miles from a VA facility. Another part of the law included more than $2.5 billion to tackle wait times by allowing the VA to add staff at its hospitals.

“Our goal is to get them the health professionals that they need,” said David Shulkin, undersecretary of health at the Veterans Administration. “So that the choice money. We wanted everybody to go out and execute on it. And to use that money as quickly as possible because we have a sense of crisis."

Trump’s pick to become VA secretary

Shulkin joined the VA after Veterans Choice passed. He was there as the last of the money was being allocated to hospitals around the country. The White House recently announced that Shulkin is President Donald Trump’s pick to become the new VA secretary, making him one of the highest-profile holdovers from the Obama administration.

The KPBS and NPR investigation of VA facilities in Southern California found no discernible pattern in how the VA actually spent the money earmarked for hiring. The VA says 5 percent of $2.5 billion was held so they could give priority to 33 VA hospital systems around the country. In fact, every Southern California VA medical center was given priority except San Diego’s.

Review Of Implementation Of The Veterans Choice Program
Report shows that veterans faced barriers accessing medical care through Choice during its first 11 months of implementation.
To view PDF files, download Acrobat Reader.

Yet in 2014, if a veteran needed to see a mental health specialist, San Diego had one of the longest wait times in the country. San Diego originally asked for 40 mental health providers to tackle its wait times. It was allowed to hire 24 people the first year.

When San Diego made its funding request the second year, the money was all gone, said Dr. Niloofar Afari, the acting chief of staff for Mental Health.

“At that point, we heard that the funding that had been received by the facility was not enough to cover both years. It was really only for FY ’15,” she said.

Mental health professionals

So San Diego didn't get everything it asked for, at least when it came to mental health professionals. Overall, among the four VA hospitals in Southern California, San Diego received the second most staff positions under the Veterans Choice law — 144 people. On the other hand, Los Angeles received the fewest new positions — 108 — despite being one of the largest VA hospital systems in the country and having significant issues with wait times.

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Loma Linda, the smallest of the four VA centers in Southern California, received the most staff positions — 215. But two years later, the number of veterans waiting more than 30 days for an appointment at Loma Linda has actually increased in all three major categories tracked by the VA.

This scenario is repeated around the country. KPBS and its partners at NPR found nearly every VA in the country received at least some money from the Veterans Choice program to hire staff, whether or not patients faced longer-than-average wait times in 2014.

Wait times started to come down

In the last several months, the wait times to see a mental health provider in San Diego have finally started to come down, although more veterans are waiting longer than 30 days to see a mental health provider in San Diego than when the law passed in 2014.

Overall, the time it takes a veteran to see a provider has not come down nationwide. Shulkin attributes some of the lack of progress to an overall spike in the number of veterans who have sought VA care over the past two years.

With Shulkin now scheduled to be elevated to VA Secretary, the experience with the Veterans Choice law illustrates just how difficult it can be to tackle a problem like wait times in a system as vast as the VA.