Veterans health care 101: Why is Obama's VA chief in the hot seat?

Veterans Affairs Secretary Eric Shinseki faces a House subpoena and mounting calls to step down. The concerns: that some VA hospitals are misrepresenting wait times for veterans to get doctors' appointments – and that patients are dying in the meantime.

Secretary Eric Shinseki faces mounting calls to resign amid reports that Department of Veterans Administration (VA) offices around the country falsified reports about how long patients are waiting to get appointments to see physicians – and that some military veterans may have died while waiting for care at a Phoenix VA hospital. The VA provides health services for about 9 million veterans a year at 1,700 hospitals, clinics, and community centers. 

On Thursday, a House panel voted to subpoena Secretary Shinseki and department e-mails about activities at the Phoenix VA. The Veterans Affairs Committee's action ramps up the pressure on the secretary and President Obama, who continues to express confidence in the VA chief.

Here is what alleged to have gone wrong, and who's trying to get to the bottom of it.

Have veterans really died waiting for care at a VA hospital?

That is the claim of physician Sam Foote, who worked at the Phoenix VA for 24 years. Recently retired, Dr. Foote took his allegations to CNN in late April. He alleges that the Phoenix VA – in a bid to show officials in Washington that its backlog of cases is diminishing, a top goal of the national headquarters – created a “secret” list of 1,400 to 1,600 military veterans waiting to see a primary care doctor. 

The list is alleged to make it appear as if vets had been waiting for care for a couple of weeks, rather than the months they had actually been waiting for doctors' appointments. “It would give the appearance that they were improving greatly the waiting times, when in fact they were not,” Foote told CNN at the time. “So then when they did that, they would report to Washington, ‘Oh yeah. We’re making our appointments within 10 days, within the 14-day frame,’ when in reality it had been six, nine, in some cases 21 months.”

The figure that 40 veterans in Phoenix died while awaiting care comes from Foote. “That’s correct. The number’s actually higher,” he said to CNN. “I would say that 40 – there’s more than that that I know of – but 40’s probably a good number.”

The head of the Phoenix VA, Sharon Helman, has denied that there is a secret list, saying its electronic wait list is above board and that the Phoenix VA “has showed significant improvement in the last two years, which is attributable to increased budget, staffing, efficiency, and infrastructure.” 

Are such allegations confined to the Phoenix VA?

No. Similar charges have surfaced among Veterans Administration offices elsewhere in the country. VA hospital workers in Fort Collins, Colo., recently went public with claims that their bosses had instructed them to falsify appointment records to make patients' wait times to get appointments appear shorter than they actually are.

In early April, the Department of Veterans Affairs' internal review concluded that delays in consultations for patients seeking cancer treatment may have contributed to the deaths of 23 veterans and compromised the recoveries of at least another 50.

How does the VA respond to all of this?

The VA's inspector general in Washington has recently launched an investigation into the Phoenix VA. 

The VA “takes any allegations about patient care or employee misconduct very seriously,” says spokesman Drew Brookie. “If the VA Office of the Inspector General’s investigation substantiates allegations of employee misconduct, swift and appropriate action will be taken.”

Might ‘swift and appropriate action’ include the resignation of Secretary Shinseki?

Several Republican lawmakers, as well as the American Legion, are now calling for Shinseki to step down. A year ago, the American Legion had defended Shinseki's efforts to improve the VA. This is the first time since 1978 the veterans' group has publicly called for an official to resign. 

Officials with Iraq and Afghanistan Veterans of America (IAVA), representing 270,000 member veterans and civilians, say they are polling members to determine whether to ask for the secretary's resignation. 

“Hopefully we’ll be in a position to share that relatively soon,” says Derek Bennet, IAVA’s chief of staff. “Everything we hear coming out of the VA is bad news, and it only seems to be getting worse.”

Asked May 7 if he plans to step down, Mr. Shinseki told NPR, “Let’s see what the inspector general comes back with.”

“The Secretary knows there is more work to do,” the VA's Mr. Brookie said in a statement to the Monitor on May 7. “Secretary Shinseki has dedicated his life to his fellow veterans, and nobody is more committed to completing the work that lies ahead.” 

The VA secretary can expect tough questions from lawmakers on the Senate Veterans Affairs Committee, where he is expected to appear May 15.