By PAUL DE LA GARZA, Times Staff Writer
Published January 14, 2005
WASHINGTON - The biggest challenge facing the Department of Veterans Affairs is a growing demand for services, especially with the "exacerbated types of injuries" out of Iraq, outgoing VA Secretary Anthony Principi said Thursday.
In a wide-ranging interview in his offices overlooking the White House, Principi touched on the computer debacle at the VA hospital in St. Petersburg, the transformation of medical care for the nation's 25-million veterans and what he sees as his accomplishments in the past four years.
"This is not my father's VA. Not your father's VA," Principi said. "It's a great VA health care system, providing a lot of good care, and I think that story needs to be told when we make mistakes."
As VA secretary since 2001, Principi has overseen the nation's second-largest federal bureaucracy, with 230,000 employees and an annual budget of $71-billion. Last month, President Bush named Jim Nicholson, U.S. ambassador to the Vatican, as his nominee to replace Principi.
In discussing the challenges that await his successor, Principi said the biggest one is the growing number of veterans the VA serves, along with delivering quality services, such as health care and other benefits, in a timely manner. In 1998, Congress changed the criteria on who qualifies for health care benefits. The number of veterans eligible jumped from 3-million to 25-million. Of that number, about 5-million veterans actually use the VA for medical care.
Principi said the challenge to meet the demand for VA services is compounded by guerrilla tactics in Iraq that include roadside bombs and suicide bombers - coupled with advances in battlefield medicine that keep soldiers alive - that have resulted in injuries that are more pronounced than in previous wars. "In old wars, you have amputations, you have spinal cord injuries," the secretary said. And those were occasional, he said. Now "in this war, most of those who are coming back injured are coming back that way."
The VA has responded, Principi said, by setting up centers of excellence across the country that specialize in multiple traumas.
To meet demand for VA services, Principi said the VA also is contracting more and more with the private sector.
Principi was reluctant to talk about the computer woes at Bay Pines VA Medical Center, citing an ongoing criminal investigation by the VA inspector general and the Justice Department. The VA tested the pilot computer at Bay Pines, but after spending nearly $300-million, Principi killed the project last summer because it did not work.
The trial computer, known as the Core Financial and Logistics System, was the target of multiple federal inquiries and congressional hearings. Principi said that because of CoreFLS, he now reviews every contract put out to bid by the VA. "CoreFLS reminded me that perhaps I needed to take it to a higher level to make sure," he said. "I learned late - my fault - that things were not going as well as they should be, and that's when I got involved and that's when I decided to put a halt to it."
Principi also addressed the changing nature of the way the VA provides health care services to the nation's veterans. He noted the shift from large VA hospitals to smaller outpatient clinics. "The VA was built at a time when medical care was synonymous with hospital care. Not the case anymore. Medical care is outpatient care, it's drug therapy, it's technology."
He said the VA has now opened close to 200 outpatient clinics and is planning to build another 156. "Yes, I think we have clearly made the transformation, the transition from hospital-centric care to patient-focused care," Principi said.
He insisted the VA has changed for the better since the end of the Vietnam War, "when Vietnam veterans felt that the VA was totally nonresponsive to their needs."
Under his tenure, Principi said, the VA budget has increased dramatically and veterans don't have to wait as long to see a doctor or have applications for VA benefits processed. "You're going to have people who are going to fall through the cracks and mistakes are going to be made," he said, "and I think the key there is how do you respond to those mistakes, what kind of processes do you put in place."
