CHARLOTTE, N.C. — President Obama on Tuesday promised several thousand military veterans that he would fulfill his “sacred trust” to those returning from America’s wars by overhauling a dysfunctional health care system, even as a new report documented “unacceptable and troubling lapses” in medical treatment.
Addressing the American Legion’s national convention three months after a scandal rocked the Department of Veterans Affairs and forced the resignation of the agency’s leader, Mr. Obama said he had “made real progress” in improving services and getting patients off waiting lists. But he added that he was “very cleareyed about the problems that still are there” and about the need to “regain the trust” of veterans.
“What we’ve come to learn is that the misconduct we’ve seen at too many facilities — with long wait times and veterans denied care and folks cooking the books — is outrageous and inexcusable,” Mr. Obama said to polite, though not enthusiastic, applause. “We are going to get to the bottom of these problems. We’re going to fix what is wrong. We are going to do right by you and do right by your families. And that is a solid pledge and commitment I’m making to you here.”
President Obama delivered remarks at the national convention of the American Legion.CreditGabriella Demczuk/The New York TimesMr. Obama’s speech came less than an hour before the inspector general at the Department of Veterans Affairs released a report on long delays and falsified waiting lists at the veterans medical center in Phoenix, where whistle-blowers this spring alleged that 40 veterans had died because of delays in care.
The report found no direct connection between delays and patient deaths. “While the case reviews in this report document poor quality of care, we are unable to conclusively assert that the absence of timely quality care caused the deaths of these veterans,” it said.
But the report concluded that the Phoenix center was plagued by long waits and cover-ups. One veteran waited nine weeks for a biopsy to confirm lung cancer, according to the report. Another waited 10 months for a doctor to check spreading splotches for melanoma.
Waiting times for classes on anger management and coping ran two months. Individual psychotherapy required waits of “several” months. A suicidal veteran, fresh out of a psychiatric hospital, waited 12 weeks for a follow-up visit with a mental health nurse.
In an attempt to appear to meet the agency’s goal of scheduling appointments within 14 days, the report said, workers manipulated more than 3,500 appointments, either by canceling and rescheduling them, or by keeping paper records in desk drawers for weeks before entering them in computers. Investigators found misplaced paperwork for dozens of veterans whose appointments were never scheduled, including a stack under some “old rotten food.”
The report said hospital administrators were aware of such practices. When Dr. Christopher Burke, the chief of primary care services, was asked by another veterans center why the waiting times in Phoenix were so low, he responded in an email: “Not sure how to answer this. Can I just say smoke and mirrors?”
The director of the Phoenix medical center, Sharon Helman, and two other officials there have been placed on paid leave pending the investigation. The inspector general’s office is also examining 93 other veterans medical facilities, and “while most are still ongoing, these investigations confirmed wait time manipulations were prevalent,” the report said.
After the initial allegations, Eric Shinseki resigned as secretary of Veterans Affairs, and Mr. Obama replaced him with Robert A. McDonald, a former chief executive of Procter & Gamble. Congress passed and the president signed a $16 billion bill to fix the veterans health care system by hiring more providers to shorten waiting times, making it easier to fire officials for poor performance and allowing veterans to use other health care providers if they cannot obtain prompt attention.
Accompanied by Mr. McDonald, the president used his visit to the American Legion convention to announce several additional steps, using his executive authority, to make it easier for veterans to receive mental health care and to lower their housing costs. Among other things, members of the military leaving service will be automatically enrolled in the department’s transition program, rather than having to seek it out themselves or requiring referrals.
The department will test expanded peer support for mental health, conduct studies on early detection of post-traumatic stress and suicidal thoughts, and extend suicide prevention and mental health training for health care providers, chaplains and others who work with veterans. The Obama administration will also team up with banks to make it easier for active-duty service members to reduce mortgage interest rates.
The volatile politics of the Veterans Affairs scandal was evident as the president landed in Charlotte, where he was met on the tarmac by Senator Kay Hagan, a Democrat who is locked in a tight race for re-election this fall in a state that Mr. Obama won in 2008 but lost four years later. Days earlier, Ms. Hagan said the Obama administration had “not yet done enough to earn the lasting trust of our veterans.” On the tarmac, she moved to shake Mr. Obama’s hand; he kissed her on the cheek.
Critics said not enough has been done to establish accountability for the failures, and some said the new report papered over the impact of the misconduct by discounting its relationship to patient deaths.
Dr. Sam Foote, a retired V.A. physician who was among the first to raise alarms, noted that one patient cited by the report died of heart failure after waiting four months for a pacemaker. “How can you say that’s not linked to delays?” he said. “Pacemakers save lives. That’s why we use them.” He added: “This report is just a way for the V.A. to keep themselves out of trouble. It’s not an accurate representation of what happened.”
Representative Jeff Miller, Republican of Florida, the chairman of the Veterans Affairs Committee, said the report painted “a very disturbing picture” even if the deaths could not be definitively attributed to negligence. He said the fact that the report’s conclusions about the 40 deaths were leaked in advance showed that V.A. officials were trying to avoid responsibility.
“The V.A. scandal was caused by bureaucrats who chose to whitewash or conceal the department’s problems,” he said. “The fact that some department officials are still engaging in similar practices underscores the dire need for real accountability throughout the organization.”