Good morning Legionnaires and veterans advocates, in the present day is Friday, November 2, 2018 which is All Souls Day, Cookie Monster Day, Nationwide Deviled Egg Day, and plan you Epitaph Day. (“Blogger, attorney, war reporter, husband, father and soldier. Somehow he managed to claw his way up to mediocrity in each endeavor.”)
This Day/weekend in Legion Historical past:
- Nov. 2, 1921: The primary American Legion Auxiliary Nationwide Conference concludes in Kansas Metropolis.
- Nov. 2, 1976: Jimmy Carter, a member of Americus, Ga., American Legion Publish 2, 1946 graduate of the U.S. Naval Academy and officer originally of the U.S. nuclear submarine program within the 1950s, is elected to function the 39th President of america.
- Nov. three, 1949: Newly elected American Legion Nationwide Commander George N. Craig’s homecoming occasion in Brazil, Ind., (inhabitants 9,000 on the time) features a parade that extends six miles in size and attracts greater than 30,000 guests. The occasion provides Commander Craig a nationwide media stage to advertise the Legion’s community-improvement “Build America Plan.” Craig, the primary nationwide commander whose service got here totally throughout World Conflict II, is honored by Gov. Henry F. Schricker who proclaims Nov. three as George N. Craig Day.
- Nov. four, 1980: Ronald Reagan, a U.S. Military Air Forces veteran throughout World Warfare II and a member of Palisades American Legion Submit 283 in Pacific Palisades, Calif., is elected 40th president of america. He goes on to serve two phrases and leads america via the guts of the Chilly Warfare, a mission that culminates with the tearing down of the Berlin Wall in 1987.
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Army Occasions: Fewer veterans have been homeless in 2018, after a worrisome rise final yr
By: Leo Shane III 19 hours in the past
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WASHINGTON — The variety of homeless veterans decreased by about 5 % this yr in line with new estimates from federal researchers, an encouraging turnaround after disappointing outcomes the yr earlier than.
Housing and City Improvement officers now estimate about 38,000 veterans throughout the nation arewithout secure housing on any given night time, roughly half the quantity on the streets in 2010.
The drop amongst feminine veterans within the final yr was much more vital. HUD officers estimated a 10 % drop in homelessness amongst that inhabitants, and credited the excellent news with continued dedication from federal, state and native leaders on the difficulty.
“Our nation’s approach to veterans’ homelessness is working,” stated HUD Secretary Ben Carson in a briefing with reporters on Thursday. “Nationally we’re seeing declines in the number of sheltered and unsheltered veterans … To date, 64 local communities and three states have effectively ended veterans homelessness.”
Carson credited a lot of the development on a collection of initiatives began underneath President Barack Obama, together with the HUD-VA Supportive Housing program. That effort connects housing vouchers with native charities to offer a holistic strategy to veterans bodily and monetary well being.
Regardless of the constructive information, veterans advocates say the quantity nonetheless exhibits vital room for enchancment.
“Down is always a good thing, especially given the affordable housing crisis we’re seeing in America today,” stated Kathryn Monet, chief government officer of the Nationwide Coalition for Homeless Veterans. “But we still have a sense that if leadership were more committed to this issue, we could have seen even bigger decreases.”
Monet stated federal funding for veterans homeless packages stays robust, however advocates fear that VA management in recent times has put much less emphasis on the difficulty than within the final administration.
In 2009, then VA Secretary Eric Shinseki introduced a division aim of ending veterans homelessness nationwide in 5 years. From 2010 to 2016, that quantity fell by greater than 35,000 people, virtually half of the homeless veterans inhabitants firstly of the push.
However final yr, VA officers acknowledged that reaching zero homeless veterans nationwide possible was not a sensible objective. The variety of homeless veterans elevated from 2016 to 2017 by a number of hundred individuals, breaking the streak of constructive leads to the trouble.
Carson and VA Secretary Robert Wilkie reiterated on Thursday that the departments want to finish homelessness amongst veterans “as soon as possible” somewhat than setting particular timelines.
The 2018 point-in-time rely estimate, gathered at the beginning of the yr, is the primary monitoring President Donald Trump’s time period in workplace.
Final yr, administration officers largely blamed the yearly improve on sharp rises in homelessness in a number of western states, most notably California. This yr, 33 states noticed a lower, together with California, which accounts for nearly 30 % of the nation’s homeless veterans inhabitants.
Wilkie, who’s scheduled to go to Los Angeles in coming days, stated officers there have spent the final yr growing focus and assets on the housing drawback. He’s hopeful that development will proceed sooner or later.
The complete point-in-time estimate is accessible at HUD’s site.
Army Occasions: ‘Better Call Saul’ actor confesses to chopping off his personal arm, mendacity about being a wounded struggle veteran
By: J.D. Simkins 20 hours in the past
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One of the crucial weird — and ugly — instances of stolen valor got here to mild this week when an actor who lately appeared on a well-liked TV present admitted to slicing off his personal arm and mendacity about being a wounded warfare veteran.
Todd Latourette, who most just lately appeared in season four of AMC’s “Breaking Bad” prequel collection, “Better Call Saul,” informed Albuquerque’s KOB four that he sawed off and cauterized his personal arm 17 years in the past out of desperation to earn extra appearing roles.
“I severed my hand with a Skilsaw,” he stated, including that he had stopped taking medicine for bipolar dysfunction on the time. “The state of my mind was a psychotic episode.”
The actor did wind up touchdown quite a few smaller supporting roles afterward whereas sustaining a narrative that he had been wounded in fight abroad.
“The film industry obviously took a different angle,” he said. “I was different. And so they liked that.”
However the actor now says he realizes he was solely employed due to the continued deception, a revelation he stated is hard to stay with.
“I was dishonorable,” he told KOB 4. “I’m killing my career by doing this. If anyone thinks this was for personal edification, that’s not the case. I’m ousting myself from the New Mexico Film Industry. And gladly so, just to say what I’ve said.”
Latourette insisted he doesn’t anticipate anybody to forgive him, however does hope his expertise may be a lesson to another person battling a psychological sickness.
“The power is in your hands to take your medication in the morning, or at night,” he said. “This discourse of my life doesn’t need to necessarily be yours, because it happens quick… it happens quick.”
Latourette’s different on-screen appearances included the George Clooney and Ewan McGregor movie, “The Men Who Stare at Goats,” and the Netflix show, “Longmire.”
AP: Afghan ex-president Karzai welcomes Gitmo 5 into peace talks, sees post-war position for Taliban
By: Kathy Gannon, The Related Press 19 hours in the past
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KABUL, Afghanistan — Former Afghan president Hamid Karzai, who nonetheless wields appreciable affect in in the present day’s Afghanistan regardless of being out of workplace for 4 years, stated Thursday he welcomes the entry of 5 Taliban leaders who have been free of the U.S. army jail at Guantanamo Bay in 2014 into peace negotiations.
Karzai, who led the nation from 2001-2014, additionally stated he now helps talks between the Taliban and america — however solely as a step towards direct talks between the insurgents and a negotiating staff representing Afghans from throughout society.
He spoke to The Related Press on the grounds of the presidential palace, the place he lives together with his younger household and meets repeatedly with tribal leaders, Afghan authorities officers and overseas notables. Simply final week the U.S. ambassador to Afghanistan stopped by Karzai’s workplace, the place Karzai hooked up a number of circumstances to Washington’s efforts to discover a negotiated finish to the protracted battle.
He additionally has met with Washington’s new peace envoy Zalmay Khalilzad. Since Khalilzad’s appointment final month, peace efforts have accelerated.
The 5 former Guantanamo Taliban detainees __ a few of whom have disturbing pasts and all of whom have been near the hard-line founding father of the Taliban motion, Mullah Mohammed Omar __ have come out of the shadows to hitch the rebel group’s political workplace within the Center Japanese state of Qatar the place they are going to be concerned in peace negotiations. They have been launched in 2014 in trade for captured U.S. Military Sgt. Bowe Bergdahl.
The co-founder of the Taliban motion, Mullah Abdul Ghani Baradar, was launched from a Pakistani jail the place he had been since his arrest in 2010 in a joint U.S. and Pakistan operation. His launch had lengthy been demanded by the Taliban. It got here following Khalilzad’s journey to Pakistan final month, his first as a brand new peace envoy.
Baradar was reportedly arrested after looking for to start out peace talks with Karzai with out Pakistan’s involvement. Within the interview, Karzai accused each the U.S. and Pakistan of foiling talks with Baradar on the time. He additionally stated he made repeated makes an attempt to realize Baradar’s launch, however his efforts have been thwarted by each the U.S. and Pakistan.
Karzai’s last time period in energy was marked by a prickly relationship with the USA. He bitterly criticized Washington for steamrolling forward with improvement plans, with out consulting Afghans, who typically discovered tasks unusable or inconceivable to take care of. He brazenly fought with the U.S. army over techniques, like night-time raids that infuriated Afghans, secret prisons and using drones, saying it strengthened the Taliban and weakened his authorities.
Karzai stated he nonetheless has reservations about Washington’s intentions because it seeks to discover a negotiated exit to 17 years of conflict, however welcomed Khalilzad within the position of peace maker.
“I believe he has all the right tools to conduct this if he is given freedom by the U.S. government to act toward peace and peace building in Afghanistan,” he stated.
Karzai has a historical past with Khalilzad, who was U.S. President George Bush’s particular envoy to Afghanistan following the 2001 collapse of the Taliban-ruled authorities. Khalilzad, who later served because the U.S. ambassador, was a robust proponent of Karzai for president of the primary post-Taliban authorities.
Nonetheless, Karzai advised The AP that Afghans are watching this newest peace initiative.
An opponent of direct U.S. talks with the Taliban when he was Afghanistan’s president, Karzai now sees it as a necessity as a result of the Taliban at present management giant swaths of the nation. In a report launched Thursday, Washington’s personal Particular Inspector Basic on Afghan Reconstruction (SIGAR) stated the federal government has ceded much more territory to insurgents and now controls simply over 50 % of the nation.
“The Taliban are Afghans and no doubt they control a great part of Afghan territory and that’s a fact of life,” stated Karzai. “Afghanistan and the rest of the world must live with that, therefore a negotiation with them is necessary and good. Let the Americans talk to them.”
Foremost amongst them is a warning to Washington towards making offers with neighbor Pakistan, which most Afghans blame for a lot of of their troubles and whom they accuse of aiding and giving sanctuary to Taliban insurgents.
Whilst president Karzai loudly accused Washington of being in cahoots with Islamabad to maintain Afghanistan destabilized to additional their very own pursuits — Washington to control its foes Iran, Russia and China and Pakistan to maintain Afghanistan as a shopper state.
“We will in an extremely forceful way oppose any deals between the U.S. and Pakistan on Afghanistan and Afghan destiny,” stated Karzai including that peace negotiations additionally have to contain regional powers, most notably Russia and China in addition to neighbors together with Iran.
“Afghans just want peace and a sovereign country and they want to be left alone to their own, to make a living and to do better in their lives,” he stated.
Army.com: Military Beneath Secretary: Feminine Rangers Will Not Develop into a Recruiting Device
1 Nov 2018
Army.com | By Matthew Cox
The U.S. Military’s new wave of recruiting advertisements will present troopers firing mortars, launching drones and clearing rooms. However don’t search for them to function ladies incomes Ranger Tabs or becoming a member of the infantry for the primary time within the service’s historical past.
In early October, the Military’s senior management introduced the launch of a brand new recruiting strategydesigned to energise accessions after it turned obvious that the service had fallen in need of assembly its annual recruiting objective for the final yr.
The brand new technique will add tons of of recruiters and strengthen recruiting efforts in 22 main cities. The Military additionally just lately launched a brand new advert marketing campaign dubbed “Warriors Wanted,” which options brief, dynamic movies of troopers in motion on social media and cable networks.
However the Military’s new recruiting technique to date doesn’t embrace a plan to showcase any of the 19 feminine troopers who’ve graduated from Ranger Faculty, a grueling 62-day infantry management course infamous for pushing college students to their bodily and psychological limits, Underneath Secretary of the Military Ryan McCarthy informed Army.com on an Oct. 30 recruiting journey to Philadelphia.
Incomes the coveted black-and-gold Ranger Tab is an honor that has eluded many male troopers because the course was based greater than 60 years in the past. On common, solely about 40 % of troopers graduate from Ranger Faculty.
McCarthy stated he was pleased with the successes ladies have achieved beneath the Military’s gender integration effort, the results of a 2013 directive from then-Protection Secretary Leon Panetta that required the providers to open all fight jobs to ladies.
“The thing that is wonderful about this experience is we have produced 19 female graduates [of Ranger School]; they have all met or exceeded the standard of the toughest combat leadership school in the world,” stated McCarthy, a graduate of the course who served within the 75th Ranger Regiment in the course of the early days of fight in Afghanistan.
“And what we have done here is increase the pool of talented people as opposed to meeting a gender-integration target. It’s one of the things I love about the Army. We don’t spike the football. We don’t have to.”
McCarthy met the newest feminine Ranger Faculty graduate — Capt. Sidney Jaques of the 75th Ranger Regiment — on the October 26 Ranger commencement ceremony at Fort Benning, Georgia.
“I didn’t exit of my means, however we walked down there on the wooden chips, congratulating everyone and I noticed the deputy commander of the Regiment, who I do know, and he grabbed me and stated, ‘hey, I want you to meet her,’ ” McCarthy stated. “I went over I gave her a coin, I put my arm around her, got a photo. And I did it with … about 60 of the 100-some-odd graduates.”
McCarthy acknowledged conflicting views in how a lot public consideration to provide a soldier like Jaques.
“A part of me says, ‘well, we could put her on a commercial,’ and the opposite a part of me says ‘well, why would I do that?’ ” he said. “If something, you already know what I need to do together with her — I need to put her on an airplane and ship her on a deployment.”
Along with Ranger Faculty, 394 ladies have commencement from the preliminary coaching programs for infantry and armor assignments. Of the quantity, 65 feminine troopers have graduated from Armor Primary Officer Management Course and 52 have graduated from Infantry Primary Officer Management Course, based on Megan Reed, a spokeswoman for Coaching and Doctrine Command.
On the enlisted aspect, 167 females have graduated from infantry one-station unit coaching, 67 from armor crewman OSUT and 43 from cavalry scout OSUT, Reed stated.
As of Oct. 15, the Military has 830 feminine troopers in infantry, armor and fire-support specialist occupations, in response to Elizabeth Chamberlain, a spokeswoman for the Military.
One of many Military’s ‘Warriors Wanted’ advertisements does present ladies in a fight position. The Oct. 29 video begins with a feminine soldier driving in a car calling for an artillery hearth mission right into a radio after which cuts to troopers loading and firing howitzers.
Nevertheless it’s a pointy distinction from a current Marine Corpsrecruiting advert from 2017 that begins with a younger woman in grade faculty and exhibits how her “fighting spirit” guided her by way of the challenges of fight coaching within the Marines to the tough realities of the battlefield.
To date at the very least two feminine Marines have graduated the punishing Infantry Officers Course at Quantico, Virginia out of the 40 who’ve volunteered to tackle the 13-week course because it was first opened to ladies in 2012. The second feminine accomplished the course in June, intently following the primary feminine to graduate the course in September 2017.
In November of final yr, the Marine Corps modified the importance of the exhausting fight endurance check that happens on the primary day of IOC from a move/fail requirement to an unscored occasion.
The backbreaking check, which requires Marines to march miles carrying greater than 80 kilos of kit and full an impediment course that features 20-foot rope climbs and an eight-foot bar impediment, stopped most of the females from advancing past the primary day. Prime Marine officers have emphasised that the change to the course had nothing to do with the feminine officers trying it.
A feminine Marine sergeant just lately accomplished the extremely aggressive Part Two of Marine Corps Forces Particular Operations Command’s Evaluation and Choice course however was handed over for choice to proceed on with MARSOC coaching. She is now leaving the Marine Corps.
In the meantime, Military senior leaders in addition to Ranger instructors have maintained that the requirements for Ranger Faculty have remained unchanged.
In Aug. 2015, then Capt. Kristen Griest and 1st Lt. Shaye Haver, an AH-64 Apache helicopter pilot from Arizona, made historical past by turning into the primary ladies to efficiently full the Ranger course.
Throughout its three-phases, Ranger college students discover ways to function in three environments — woodlands in Fort Benning, mountainous terrain in Dahlonega, Georgia, and coastal swamp at Camp Rudder in Eglin Air Pressure Base, Florida.
Neither Griest nor Haver earned their tabs of their first try on the course. Like lots of their fellow male college students, they have been invited to start out over after failing the primary part of the course twice.
About 34 % of scholars who enter Ranger Faculty recycle at the least one part of the course, including to the scholar’s bodily and psychological fatigue, Military officers say. Historically, solely 25 % make it by means of Ranger Faculty with none recycles, based on faculty officers.
“This school damn near killed me 20 years ago,” McCarthy stated.
However McCarthy stated the Military made a acutely aware determination that it will not flip the successes of those ladies right into a advertising software for the Military.
“It’s very onerous to do as a result of we might love to try this, [and] part of me would love to try this, the opposite a part of me says ‘it’s flat out flawed,” he stated.
“These women don’t want to be treated differently … they just want to do the job.”
Stripes: ProPublica report: VA’s $10 billion data system software program alternative isn’t going properly
ARNSDORF | ProPublica | Revealed: November 1, 2018
When senators requested Veterans Affairs Secretary Robert Wilkie in September concerning the three Trump supporters who’ve been quietly shaping the company’s agenda from the president’s Mar-a-Lago resort, he minimized his interactions with the trio, saying they’d had a single assembly on a seemingly dry topic: digital medical data.
As unexciting as which may appear, it’s a topic that may form the company for many years to return. The VA gave a software program firm a $10 billion no-bid contract to exchange the company’s data system. The brand new system is meant to synchronize with knowledge from different suppliers, because the VA more and more sends veterans to non-public docs as an alternative of treating them in-house.
Whereas Wilkie’s feedback to the Senate made it sound just like the so-called Mar-a-Lago Crowd — a physician, a lawyer and an leisure government with no U.S. army or authorities backgrounds — opposed the data transition, they really championed it, highlighting the difficulty to the incoming Trump White Home and making it their prime focus, 4 former officers stated.
Wilkie advised senators the Mar-a-Lago Crowd is not in touch with VA leaders. However this system they backed continues to be hurtling ahead — and never going easily. A current progress report by the software program firm rated this system’s alert degree as “yellow trending towards red.”
The story of what’s gone incorrect with the trouble emerges from a whole lot of pages of inner paperwork and dozens of interviews with present and former officers, congressional employees and out of doors specialists. The Mar-a-Lago Crowd and the White Home annoyed efforts to rent a professional chief to run the challenge, based on interviews. The individuals now in cost haven’t any expertise in well being care. They’ve gone towards professional recommendation. They usually have been consumed by infighting. A key lawmaker has referred to as this system’s management “deteriorating and rudderless.”
The VA justified the no-bid contract on the idea that it will create “seamless care” for veterans shifting between the army, the VA and the personal sector. As initially articulated, “seamless care” meant enhancing medical outcomes and chopping prices by serving to docs make extra knowledgeable selections.
However Wilkie and his staff not speak about “seamless care.” As an alternative, they are saying the brand new system will let VA docs entry data from the army — a functionality that to a big extent already existed. Some docs who raised concern about this new path have been faraway from the undertaking.
VA spokesman Curt Cashour declined to reply particular questions, saying that “efforts thus far have been successful and we are confident they will continue to be successful.” The White Home didn’t present solutions to an inventory of questions. A consultant for the Mar-a-Lago trio declined to remark. The corporate offering the brand new software program, Cerner, declined to remark, however despatched an e mail to veterans teams warning about about “negative media coverage, including a piece from ProPublica that we anticipate being published this week.”
Because the VA strikes forward with this system, it’s more and more following the lead of the Protection Division, which is already putting in the identical software program at its personal hospitals. However the DOD’s program isn’t going nicely, both: When 4 army amenities examined the software program, it routed orders incorrectly in order that lab exams went unfulfilled, and customers swamped the assistance desk with greater than 14,000 hassle tickets. An official DOD evaluate in April stated the software program put sufferers’ well being in danger by offering inaccurate medical knowledge and delaying care.
Individuals who need to shield the VA’s government-run veterans well being system worry an analogous failure at a VA hospital might strengthen the political forces that need to privatize veterans’ care.
“It scares the hell out of me,” stated Ken Kizer, who’s extensively credited with rehabilitating the VA well being system as its chief within the 1990s. “I don’t think the VA, given other issues, has the luxury to have something that doesn’t work.”
The software program is meant to launch in March 2020.
The Trump White Home’s curiosity in reworking the VA’s digital well being data originated at Mar-a-Lago on Dec. 28, 2016. The president-elect requested Ike Perlmutter — the Marvel Leisure chairman, who belongs to Trump’s Palm Seashore membership and contributed $5 million to an excellent PAC supporting his candidacy — for assist delivering on his marketing campaign guarantees to veterans. Perlmutter enlisted two pals: Bruce Moskowitz, a West Palm Seashore doctor; and Marc Sherman, a lawyer who serves as an skilled witness in monetary disputes. Perlmutter, Moskowitz and Sherman turned recognized to VA officers because the Mar-a-Lago Crowd.
Their first act was to arrange a summit of well being care executives to advise Trump on the VA’s future. Gathered at Mar-a-Lago a number of days earlier than New Yr’s, the executives introduced up changing the VA’s digital well being data, based on 4 individuals acquainted with the assembly.
The VA pioneered this know-how within the 1970s and 1980s, with a homegrown platform often known as VistA. VistA was (and stays) fashionable with docs as a result of it was tailored to their wants. However through the years, the VA struggled to retain coders who might maintain the software program updated. In the meantime, the personal well being care business coalesced round data techniques constructed by a handful of software program corporations. In 2015, the DOD determined to undertake one in every of these business methods, made by Cerner.
For a few years, the VA and lawmakers had agonized over what to do with VistA. The VA and the DOD had tried earlier than to unify their well being data, solely to surrender after 4 years and $1 billion. Altering platforms is extraordinarily disruptive — it prices billions of dollars, results in drops in productiveness and may trigger docs to give up in frustration. Personal hospital methods can justify these prices as a result of the business platforms are designed to help billing. However the VA is totally different. In 2016, the VA commissioned an outdoor evaluation that concluded adopting a business platform provided no profit over upgrading VistA, in response to six present and former officers.
Jared Kushner, Trump’s son-in-law, was within the December 2016 Mar-a-Lago assembly and is shut with Perlmutter. To Kushner, it appeared apparent that the VA ought to go to a business vendor, and it must be the identical one because the DOD, based on 4 individuals who mentioned the matter with him. “Kushner basically said it seems like low-hanging fruit, seems easy, seems like a no-brainer,” a former senior administration official stated.
Kushner declined to be interviewed. As he recounted it to congressional interns final yr (in line with a recording obtained by Wired): “We said, ‘Guys, we want a solution to get us on one system, this is absolutely crazy.’ They came back in two weeks with something that made a lot of sense.”
Kushner figured that placing each departments on the identical system would imply that army medical data would routinely comply with service members to the VA. However the DOD and the VA already had pc packages permitting them to share data. On the similar time, in response to business specialists, utilizing the identical vendor doesn’t mechanically give docs all of the medical info they could want. “None of us knew at the time,” a former official who labored on the challenge stated. “We thought it made perfect sense, until we looked under the hood. The premise of all of this is incorrect.”
The VA had been getting ready for a aggressive bidding course of for a brand new software program vendor, three former officers stated. However now that Kushner needed to place the VA on the identical system because the DOD, the one vendor that would do the job was the one the DOD had already picked. That may imply giving Cerner — a Missouri-based firm with about 26,000 staff and greater than $5 billion in annual income — an enormous no-bid contract.
To bypass aggressive bidding, federal laws required the company to formally clarify how the general public would profit. So in a declaration signed on June 1, 2017, then-Secretary David Shulkin outlined the general public profit as “seamless health care for the nation’s veterans.” A single widespread platform, Shulkin wrote, “will result in improved medical outcomes, improved patient safety, and a consistent patient-physician relationship” by standardizing how docs deal with a given situation, giving them entry to sufferers’ full medical historical past, and aiding them with big-data insights from throughout all the system.
Trump hailed the choice as “one of the biggest wins for our veterans in decades.”
“For decades the federal government has struggled to accomplish something that should be very, very simple,” Trump stated on June 5, 2017. “I’m very proud to say that we are finally taking steps to solve this situation once and for all. … No more complications.”
Understanding how robust the challenge can be, Shulkin and his group needed to discover a chief info officer with expertise main a software program transition like this. The VA acquired two search companies to work professional bono and the headhunters got here again with a number of extremely certified candidates, in response to three individuals with direct information of the method.
However the Presidential Personnel Workplace rejected them, the individuals stated. In a single case, the White Home stated its vetting turned up a court-martial through the candidate’s army service, however the candidate stated that wasn’t true. In different instances, the White Home by no means gave a purpose. As an alternative, the individuals accustomed to the method stated, the White Home proposed individuals who hadn’t labored in well being care info know-how however had labored on the Trump marketing campaign.
One other of the candidates recruited by the headhunters was Jonathan Manis, who was the CIO of Sutter Well being in Northern California. Manis, 56, had led software program implementations at two giant hospital techniques and is a veteran. He stated he was excited concerning the alternative and interviewed with a number of VA officers.
However then he heard from Moskowitz, the West Palm Seashore doctor. Manis stated he didn’t perceive Moskowitz’s position, however he might inform his opinion was essential, or else he wouldn’t have been on the telephone.
After that dialog, Manis withdrew. He stated the politics on the VA appeared too risky for him to uproot his life and take an enormous pay reduce for a job which may not final. “I understood this was going to be a difficult mission, and as long as we were all committed, I wanted to lead it,” he stated. “But if this thing was bouncing around so much and people were in and out, that instability, given the compensation and the unknowns, was too much for me.”
Whereas VA officers stated they discovered the Mar-a-Lago Crowd’s enter unhelpful, their very own interactions with Cerner and out of doors specialists raised new considerations. At one assembly, in accordance with three individuals current, Cerner representatives gave a flashy presentation about how nicely their software program would share knowledge with personal suppliers. However Shulkin, a training doctor, noticed by means of the gross sales pitch: They have been speaking solely about prescription knowledge, not something near the lab reviews and pictures that make up a affected person’s full chart. Shulkin minimize off the assembly, the individuals stated, and informed the Cerner representatives to return again with one thing actual.
“I didn’t want to allow Cerner to think they had achieved this contract and it was for their standard product,” Shulkin stated in an interview. “I was really looking to advance the field much further than that.”
The top of Cerner’s authorities division, Travis Dalton, declined to be interviewed. In an Oct. 30 weblog publish on the corporate’s web site, Dalton stated: “Cerner and the are committed to applying commercial best practices, as well as any lessons learned from our DoD experience. … The VA has unique challenges and it’s critical that end-users and stakeholders are engaged throughout the implementation process.”
In September 2017, the VA convened a panel of business specialists who made clear that Cerner’s off-the-shelf product wouldn’t by itself obtain the VA’s objective of “seamless care,” in accordance with a presentation from the assembly. The presentation featured nameless excerpts from interviews with hospital executives who’d led software program transitions, with warnings reminiscent of:
“Assume the vendor will fail miserably.”
“Vendors are doing a B-/C+ job in thinking through safety.”
“No vendor covers it all.”
Attaining “seamless care” — the idea for the VA’s no-bid contract with Cerner — would take rather more than Kushner’s imaginative and prescient of synchronizing data between the DOD and the VA. Seamless care, in response to Shulkin’s declaration, meant tapping into all the info in a veteran’s “single, accurate, lifetime health record” to routinely recommend potential diagnoses and care plans. The doc referred to as it “computerized decision support.”
However Cerner’s product didn’t do this. Its software program was primarily designed to assist personal hospitals invoice insurance coverage corporations, a perform that the VA, as the only payer, had little use for. “Cerner is about getting the right documentation so health care systems can bill and make money,” stated Heather Woodward-Hagg, a former director of the VA Middle for Utilized Techniques Engineering. “VA is different. The focus of the VA’s electronic medical record is never about clinical documentation to support billing. It’s about giving the information to the provider at the right time to inform the best care. There are true risks to patients if they don’t do this right.”
Woodward-Hagg had been a part of efforts on the VA to show knowledge from digital well being data into helpful and dependable insights for docs. In the long run, the efforts have been deserted due to the expectation that Cerner would make them redundant, eight present and former officers stated. That turned out to be incorrect, as a result of Cerner doesn’t have these options or they’re very restricted, specialists stated.
Stan Huff, the chief medical informatics officer at Intermountain Healthcare in Salt Lake Metropolis, was among the many specialists consulted by the VA. “All of the advice I gave to the VA was, if you install Cerner as an off-the-shelf product, your clinicians are going to be extremely unhappy and everybody is going to ask why did you spend billions of dollars for a crappy system,” Huff stated. Supplied with a VA documentshowing how officers responded to his feedback, Huff stated, “I don’t think they took action based on what I told them.”
Shulkin delayed signing the Cerner contract to conduct extra vetting. Moskowitz joined in a January 2018 session the place White Home and VA officers mentioned the Cerner contract with business specialists; a marketing consultant’s report summarizing the assembly incorrectly recognized Moskowitz as an “Other Federal Government” participant.
Earlier than Shulkin might finalize the contract, Trump fired him. A number of weeks later, the VA received a brand new appearing CIO: a former marketing campaign staffer named Camilo Sandoval. Sandoval had no expertise in well being IT. However he did have a daily every day name with Perlmutter and stored a spreadsheet to trace tasks for him, 4 present and former officers stated. He would now oversee the data overhaul.
After Shulkin’s departure, the White Home and the Mar-a-Lago Crowd needed recent eyes to evaluation the Cerner contract. There was even speak of getting Sherman turn into a short lived authorities worker to hold out the evaluate, two former officers stated, however he declined.
As an alternative, the White Home reassigned an official named Genevieve Morris from the Division of Well being and Human Providers to the VA. Wilkie (then appearing secretary) signed the Cerner contract in Might 2018, and Morris took over the workplace in control of implementing it. She had labored on software program implementations in small outpatient settings as a private-sector advisor, however she had by no means led something on a big scale.
The business specialists whom the VA had consulted emphasised that clinicians want to steer this system since they’re the individuals who’ll even have to make use of the software program. “These initiatives should be regarded as clinical projects, not IT or technical projects,” stated Thomas Payne, the medical director of IT providers at UW Drugs in Seattle.
However tensions flared up between the VA’s medical management and Morris’ implementation workplace. “I got dismissed from working on this because I would say ‘this is a problem.’ They don’t want to hear about any problems,” stated Stephan Fihn, a former director of medical system improvement and analysis who retired from the company in February.
When Morris’ workplace did attempt to recruit clinicians to the trouble, clinicians would say they couldn’t spare the time for worry of lacking or delaying appointments, in response to a July e-mail amongst VA officers engaged on this system. In one other e-mail, one in every of Morris’ deputies warned that until they secured the help of medical management, “We will fail.”
Officers additionally started encountering extra shortcomings in Cerner’s product. It didn’t include options for a number of the VA’s core specialties, akin to Agent Orange publicity, spinal twine damage and post-traumatic stress dysfunction, as a result of these circumstances aren’t widespread within the common inhabitants. “Cerner’s focus is on management of their products, where VA’s focus is broader and encompasses activities that fall outside of the products Cerner will provide,” Ash Zenooz, a VA radiologist who turned the chief medical officer engaged on the implementation, cautioned in a program administration plan.
Zenooz’s report famous that Cerner’s incomplete plan emigrate affected person knowledge “provides opportunity for patient safety issues.” The DOD proposed transferring just one to 3 years of affected person data to the brand new system, 5 present and former officers stated — undermining the premise of a unified lifetime medical historical past.
Morris voiced these considerations however confronted inner rivals, three present and former officers stated. Sandoval opposed her as a result of he needed to be the one to steer the challenge. The identical was true of John Windom, who had led the contract negotiations, and of Wealthy Stone, the appearing head of the VA’s well being division. The officers stated that Sandoval, Windom and Stone met to debate countering Morris, and that Windom undermined Morris by blocking info from reaching her. Windom declined to remark; Sandoval and Stone didn’t reply to requests for interviews.
In August, the VA spent no less than $874,000 on a kickoff occasion in Missouri, the place Cerner is headquartered. Morris and Windom squabbled over stage time and walk-on songs, and she or he clashed with Sandoval and Stone over how a lot they might take part, two former officers stated. They introduced a convoluted group chart that couldn’t paper over the facility wrestle.
The week after, Zenooz give up. Morris adopted three days later. She’d lasted lower than two months.
The management struggles raised alarms on a Home subcommittee organized to supervise the Cerner implementation. “It would be a tragedy for the program to be undermined by personality conflicts and bureaucratic power struggles before it even begins in earnest,” the subcommittee’s chairman, Indiana Republican Jim Banks, stated in an Aug. 24 letter to Wilkie.
However that’s precisely what was occurring. With Morris gone, Windom was again in cost. Windom additionally led the contract negotiations for the DOD; Cashour, the VA spokesman, stated Windom “has been with the effort since its inception and has the necessary expertise and institutional knowledge to lead this initiative effectively.” Due to his acquisitions background, Windom thinks concerning the undertaking when it comes to “cost, schedule and performance objectives.” Windom has no background in well being care, and different officers say his concentrate on schedule and price range might come on the expense of getting a product that achieves “seamless care.”
Windom was within the September 2017 assembly with business specialists once they stated it was essential for the clinicians who will use the software program to be those who lead the implementation. However Windom has curbed enter from clinicians, six present and former officers stated. “The emphasis has always been, ‘Let’s get Cerner in your office so that you can put the data in,’” stated Frank Opelka, a medical director for well being coverage on the American School of Surgeons whom the VA has consulted on this system. “The VA has an excellent group of folks, and they were being pushed to the sidelines.”
Windom is technically a placeholder, however at a September subcommittee listening to, he made clear he needs to maintain the job. Requested who on the VA is primarily accountable for the venture, Windom answered, “My ego would say me.”
Regardless of the current resignations, Windom insisted his workplace was as much as the duty. “We feel like we at this time have no gaps in leadership or subject matter expertise,” he stated.
Banks, the subcommittee chairman, pressed him on that, asking if anybody within the workplace overseeing the digital data modernization challenge had managed a software program “implementation in a large health system to its completion.”
Not one of the authorities staff had. However Windom answered “yes,” explaining that he was getting the required experience from consulting agency Booz Allen Hamilton. A Booz Allen spokesman declined to say who these specialists are. And 4 individuals acquainted with the association stated a lot of the work was being executed by junior employees who don’t have the experience Banks was asking about.
Inside the VA, the three positions that oversee Windom — deputy secretary, chief info officer and beneath secretary for well being — have all been vacant for months.
For CIO, Trump nominated James Gfrerer, who has a cybersecurity background however no well being care expertise. Requested concerning the Cerner implementation at his affirmation listening to, Gfrerer stated, “Clinicians will have to go through a substantial, rigorous process to conform their workflows to the IT systems.”
That’s backward, in line with business specialists: The know-how is meant to assist the docs do their jobs, not impose practices on them which may not be applicable. “You don’t come in and say, ‘We have these workflows and templates in the private sector and you should use them,’ because they probably aren’t as good as what VA has,” a former senior VA well being IT doctor stated. “Veterans will suffer.”
Gfrerer’s affirmation acquired held up amid the Supreme Courtroom nomination and marketing campaign season. Within the meantime, the place continues to be held by Sandoval, the Mar-a-Lago ally.
The appearing well being chief, Stone, met with two members of the Mar-a-Lago Crowd earlier than taking the job, in line with three individuals who mentioned the assembly with him. Stone advised the individuals he paid his personal method and listened to the Mar-a-Lago Crowd’s enter however felt no obligation to take course from them.
Wilkie stated he’s not conscious of any ongoing contacts with the Mar-a-Lago Crowd. (One other one that was near the trio, former appearing secretary Peter O’Rourke, lately left the company.) However Wilkie has not offered paperwork or answered questions in response to a number of congressional inquiries. The rating Democrat on the Home veterans committee, Tim Walz of Minnesota, referred to as it “a transparent attempt to stonewall.”
Wilkie advised Stone to focus much less on the Cerner transition, and Stone has advised different officers he has to select his battles, in accordance with two individuals acquainted with the matter.
On the current subcommittee listening to, some lawmakers appeared so troubled by the VA’s efficiency that they contemplated whether or not the DOD must be answerable for the Cerner implementation in each departments. The Pentagon seemed into it, however company legal professionals decided they lacked the statutory authority to take over, in response to two individuals accustomed to the discussions.
As an alternative, Wilkie and Protection Secretary James Mattis issued a joint statementpromising to cooperate on the Cerner implementation. The departments, they stated, are “jointly committed to implementing a single, seamlessly integrated electronic health record” that “maximizes commercial health record interoperability.”
Whereas not an outright DOD takeover, the assertion was revealing as to how Wilkie and Mattis are interested by the challenge. In contrast with the unique objective of “seamless care,” solely the phrase “seamless” survived — Wilkie and Mattis’ assertion emphasizes computer systems as an alternative of docs and sufferers. In one other signal of this strategy, the 2 departments shaped a joint steering committee that doesn’t have any clinicians on it, in accordance with its constitution.
“If they think they’re implementing a computer program, they’re on a path to failure,” stated Taylor Davis of the analysis agency KLAS. KLAS surveys greater than 50 of the nation’s prime hospital techniques to determine what makes software program implementations profitable or not. He stated he’s provided to share these outcomes with the VA, however they haven’t taken him up on it.
Lawmakers and company officers are nonetheless haggling over group charts to determine on paper how the 2 departments will collaborate on the Cerner implementation. However in apply, Wilkie has already determined to comply with the DOD’s lead, in accordance with seven present and former officers. He labored for Mattis earlier than coming to the VA, and he introduced a crew of Pentagon officers with him. Cerner has additionally pushed for the VA to attract from employees who labored on the DOD’s implementation, an individual conversant in the talks stated.
The 2 well being techniques, nevertheless, are vastly totally different. The army principally treats younger, wholesome individuals with acute accidents. The VA offers long-term care to an growing older inhabitants with complicated, persistent sicknesses. Final yr, the VA had about 615,000 inpatient visits and 109 million outpatient visits, in contrast with 226,300 inpatient visits and 41.four million outpatient visits at army amenities. “VA has different needs than DOD does,” Phil Roe, the chairman of the Home veterans committee and a Tennessee Republican, stated on the current listening to, in response to the suggestion that the DOD may take over. “They serve different patients. The VA system is gargantuan compared to what DOD is doing.”
For these causes, business specialists warned Windom towards placing the very same software program in each departments, in line with the notes of an individual current for the assembly, which occurred in January. At the moment, Windom stated he accepted that recommendation. However now, Windom needs 70 % of the VA’s software program configurations to be the identical as those that the DOD used, in response to an Oct. 23 slide deck.
Cerner constructed its value and schedule estimates on the idea that the VA’s implementation would match DOD’s, based on officers and paperwork, so adjusting this system for the VA might result in delays and overruns. The VA has already elevated its estimate of the undertaking’s value by $300 million to $16.1 billion, two individuals briefed on the matter stated.
However Windom’s strategy might result in a system that isn’t suited to the VA’s medical calls for, as business specialists and VA docs have warned him. To assist handle this query, the VA requested Cerner to match the 2 departments’ wants. However Cerner didn’t do this, and it stated it wanted extra info to evaluate the VA, based on Cerner’s report.
Apart from their appropriateness for the VA, the DOD’s configurations didn’t even work on the division. The preliminary check of the Cerner system at 4 army hospitals final yr was a failure. Docs have been educated on a special model of the software program than the one which obtained deployed, two individuals with direct information of the rollout stated. Orders for checks or drugs didn’t get fulfilled as a result of the software program routed them to the incorrect place. Customers submitted 14,383 hassle tickets in 11 months, overwhelming the assistance desk’s capability to reply. Docs handed round items of paper as an alternative.
An official assessment deemed the software program “neither operationally effective nor operationally suitable.” Customers have been capable of accomplish solely 56 % of the 197 duties that have been examined. The system scored 37 out of 100 for usability — a rating of 70 or above was thought-about acceptable. Docs and nurses needed to work additional time or see fewer sufferers due to delays and bugs within the software program. They didn’t belief the info they have been getting, which the report stated “could jeopardize patient safety.” Employees reported 53 “critical deficiencies,” most of which have been “potential patient safety concerns,” based on the report. A Pentagon spokeswoman stated, “We continue to review and improve training, change management, and workflow adoption activities to deliver safe, quality care.” In a weblog publish on its web site, Cerner stated outcomes have improved on the DOD’s preliminary check websites. “Though some have portrayed the report’s findings as a setback for the program, these reports accomplished exactly what we intended,” Dalton stated within the submit. “We will continue to work with them to optimize and improve the system throughout the lifespan of the program.”
The VA is repeating at the least a few of the DOD’s errors, six present and former officers stated. For instance, in an inventory of “lessons learned” obtained by ProPublica, the VA stated it can topic hassle tickets to fewer layers than on the DOD, routing them on to Cerner. However the VA didn’t handle the overwhelming quantity of tickets or the shortage of on-site help.
Extra basically, 5 officers stated the DOD’s rollout failed due to the way it was managed. The duty was unfold throughout three totally different models, recognized internally as “the three-headed monster”: an implementation workplace, led by contracting officers; the well being division; and the IT division. That’s the identical setup the VA has now.
“It’s a lesson VA has yet to learn,” an individual engaged on the undertaking stated, “and a lot of us are concerned they’re going to go down the same road and experience the same adverse health outcomes that DOD experienced.”