美国国家公共电台 NPR VA Hospitals Still Struggling With Adding Staff Despite Billions From Choice Act（在线收听）

STEVE INSKEEP, HOST: 

An effort to help American veterans get medical care faster is not working. NPR and some of its member stations have investigated a multi-billion dollar U.S. government program for veterans. It is supposed to add more doctors, nurses and other medical staff at VA medical centers. The idea was that more staff would cut wait times, which sounds pretty simple, but it hasn't worked that way. So let's talk about this first with Steve Walsh, who's a reporter with our member station KPBS in San Diego. Hi, Steve.

STEVE WALSH, BYLINE: Hi, Steve.

INSKEEP: What's gone wrong?

WALSH: Well, so the VA got about $2.5 billion to hire new medical staff. One of our findings is that there was no real pattern to where those doctors and nurses and other staff were sent. So for example, wait times for mental health were really bad two years ago in San Diego. I think San Diego's VA would have gotten more help since, after all, the stakes were really high when you talk about mental health care.

INSKEEP: But they didn't get more help is what you're saying? That particular facility didn't get any more staff?

WALSH: Well, not as much as they thought they should get. And so think back to 2014 to patients like Charlie Grijalva. That's when the wait time scandal first hit. Grijalva was diagnosed with PTSD when he was still in the Army. He lived in Imperial Valley, a desert community about two hours from the VA hospital in San Diego.

INSKEEP: OK.

WALSH: I went out there, actually, to talk to his widow, Gloria.

GLORIA GRIJALVA: It's a small town, so everybody knows each other. His and my parents - his mom went to school with my mom. His dad lived, like, two blocks away from my dad. So everybody knows each other here.

WALSH: Grijalva had a history of suicidal thoughts after spending 18 months in Afghanistan and a year in Iraq. The VA tried to reach out. In early 2014, his wife says they seemed to have gotten his prescription right. Then his VA psychiatrist left that summer, he missed an appointment with a nurse practitioner in September. The VA renewed his medications over the phone and because San Diego's wait times were so long, they offered to let him see a doctor outside the VA system under the new Choice Program.

But in December 2014, his medication ran 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.

GRIJALVA: He was like, you know what? I want to do what we used to do as a kid and play some Christmas music and have the kids decorate the tree, drink hot chocolate. And even though he was still feeling the way he was, he wanted to have that kind of Christmas for his kids.

WALSH: A few days before Christmas, his wife found him. He'd hung himself a few hours after he texted her I love you.

GRIJALVA: 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.

WALSH: Now, you can't say whether the VA could have actually saved his life, but everyone agrees with long wait times like this, the system needed to be fixed.

INSKEEP: Painful story unfolding over years and wait times were one factor, one part of that story. Let's bring in another voice now. NPR's Quil Lawrence covers veterans issues and has for years. And, Quil, what was it that Congress tried to do about this problem?

QUIL LAWRENCE, BYLINE: They came up with basically two approaches. They spent about $10 billion to give some vets the choice to get care outside the VA.

INSKEEP: OK.

LAWRENCE: That's what they were talking about with Charlie Grijalva. They gave him a chance to see an outside mental health care provider. And then the part we're focusing on today is the about $2.5 billion they spent to hire new staff inside the VA to sort of beef up their ability to see more patients. Now, Dr. David Shulkin joined the VA after that law passed, but he's been overseeing the program since 2015. And we spoke to him several times last year about the Choice Program.

DAVID SHULKIN: Our goal is to get them the health care professionals that they need. So that the choice money, we wanted everybody to go out and execute on it and to use that money as quickly as possible 'cause we have a sense of crisis.

INSKEEP: Really interesting to hear this voice, Dr. David Shulkin, Quil Lawrence, because we're listening to a guy at the VA who's now been promoted. President Trump wants him to be promoted to run the VA. And he's saying this was the goal, to get more health professionals on the frontlines.

LAWRENCE: Right, and the $2.5 billion was supposed to give them a big bump in staffing. But when we looked at their data, we just didn't see it. We saw that they basically ended up hiring the same number of people with this $2.5 billion of VA Choice money, the same number you would have expected them to hire the following year without that money. We found that the new VA staff didn't really go to the medical centers that appeared to need it most, according to the data.

And the locations that got the staff weren't really more likely to improve than the locations that didn't get part of these $2.5 billion worth of new hires.

INSKEEP: Wow, OK, so this leads to some bottom line, questions. First for you, Steve Walsh, of KPBS, what's it look like at a Veterans Center that needed extra staff, lots of extra staff, and didn't get it?

WALSH: So we remember San Diego. It had one of the longest wait times in the country if you needed to see a mental health specialist. That was the problem with Charlie Grijalva, the vet who committed suicide back in 2014. San Diego asked for about 40 mental health providers to tackle its wait times. It was allowed to hire 24 people that first year. And then when they came back in 2016, they found out that all of the money had already been spent. So the pattern seems to be kind of all over the place.

What I did is I actually took a car ride around Southern California to look at some of the larger VAs. I first stopped in West Los Angeles, one of the largest and busiest VAs in the country. They were prioritized by the VA, though they received the least money of any of the VAs in Southern California. I actually went a half an hour away to Long Beach. They received more people, though both in Long Beach and LA, overall wait times have not come down over the last couple years.

INSKEEP: Wait a minute, that's the next bottom line question. Why wouldn't things at least improve in the places that did get a lot more staff?

LAWRENCE: So, Steve, the VA says that they got really a huge uptick in patients in the last year or two, which swamped some of the gains they made. But when we looked at their data, the VAs that they prioritized didn't seem to be the ones that did better. We saw VAs that they'd prioritized get fewer hires. For example, Dallas wasn't prioritized, LA was, and Dallas got almost three times more hires. If there was a data-driven method to how these choice hires went out, we just couldn't find it.

INSKEEP: And one more bottom line question, how could it be, as you say, that an extra $2.5 billion didn't actually lead to hiring that many more people?

LAWRENCE: There are a lot of factors that contribute to that. One might just be that there's a limited number of doctors and nurses. They're scarce around the country, so it doesn't matter how much money you pour into it. But we're going to talk about that at length this afternoon on All Things Considered.

INSKEEP: That's NPR's Quil Lawrence along with Steve Walsh of KPBS. Gentlemen, thanks very much.

LAWRENCE: Thank you, Steve.

WALSH: Thanks, Steve.