The Trump Administration Is Leaving the Nation’s Emergency Backup Hospital System on the Sidelines

The Trump administration is leaving untapped reinforcements and supplies from the U.S. Department of Veterans Affairs, even as many hospitals are struggling with a crush of coronavirus patients.

The VA serves 9 million veterans through 170 hospitals and more than 1,000 clinics, but it’s also legally designated as the country’s backup health system in an emergency. As part of the National Disaster Medical System, the VA has deployed doctors and equipment to disasters and emergencies in recent instances such as Hurricane Maria and the Pulse nightclub shooting in Orlando, Florida. The VA system has 13,000 acute care beds, including 1,800 intensive care unit beds.

But for the coronavirus pandemic, VA Secretary Robert Wilkie told lawmakers this week that the agency won’t spring into action on its own. Instead of responding to pleas for help from states and cities, Wilkie said he’s waiting for direction from the Department of Health and Human Services or the Federal Emergency Management Agency.

And those calls, for the most part, haven’t come. HHS hasn’t asked the VA for significant help with the coronavirus pandemic. FEMA did not take a leading role in the government’s response until last Friday, and it has yet to involve the VA either.

“VA stands ready to support civilian health care systems in the event those systems encounter capacity issues,” press secretary Christina Mandreucci said. “At this time, VA has not received specific requests from FEMA for assistance.”

The White House referred questions to the VA. The VA referred a question about taking directions from HHS and FEMA to those agencies. HHS referred questions to FEMA, and FEMA referred questions to the VA.

The VA has fielded a handful of limited tasks. It asked 12 health technicians and nursing assistants to volunteer to help HHS and the Centers for Disease Control and Prevention with coronavirus screenings for two weeks in February. The agency sent 14 medical technicians to help HHS with screenings at an Air Force base in California where evacuees from the Diamond Princess cruise ship were being quarantined. And a spokeswoman for CalVet, the state’s veterans agency, told ProPublica that the VA emergency manager in the region has helped provide supplies such as N95 masks.

Lawmakers are frustrated to see the VA largely sitting on its hands as the crisis escalates.

“It is unconscionable that HHS has not utilized every tool it has to address the real suffering of individuals in this nation and called upon VA,” Sen. Jon Tester of Montana, the ranking Democrat on the Senate Veterans’ Affairs committee, said in a March 25 letter to HHS Secretary Alex Azar. “States, communities and patients are already suffering as a result of HHS’s inaction. Get them help now.”

According to the VA’s pandemic plan released on Friday, the agency’s role in the governmentwide response may include helping emergency responders with protective gear, screening and training; helping to staff FEMA’s operations teams; dispatching advisers to state and local public health authorities; supplying medicines and equipment; and helping with burials.

The stimulus deal that the Senate passed late Wednesday includes $27 billion for HHS to reimburse the VA for providing care to the general public. That’s on top of $20 billion to help the VA care for veterans.

Just a month ago, at a House budget hearing, Wilkie declined additional funding. “Right now I don’t see a need for us,” he said. “We are set.”

The VA held its first planning meeting on the coronavirus on Jan. 22, the day after the first case was confirmed in the U.S., according to the agency’s response to an inspector general report released Thursday. But the department did not implement measures until two days after the World Health Organization formally declared a pandemic, on March 11. The VA did not issue guidance on screening patients until March 16.

Wilkie abruptly fired his deputy last month and is under investigation by the VA’s inspector general for allegedly seeking damaging information about a congressional staffer who said she was sexually assaulted at a VA hospital. (He denies doing so.) Wilkie took time off in recent weeks and has taken a back seat at White House task force meetings. Since joining the White House’s Coronavirus Task Force on March 2, Wilkie has spoken publicly only once, on March 18. (Mandreucci said Wilkie has attended 20 task force meetings.) At that time, Wilkie said the VA was preparing to join the disaster response but had not yet engaged.

“We are the buttress force in case that FEMA or HHS calls upon us to deploy medical professionals across the country to meet crises,” Wilkie said. “We plan for that every day. We are gaming out emergency preparedness scenarios. And we stand ready, when the president needs us, to expand our mission.”

Wilkie told Politico the VA was preparing to deploy 3,000 doctors, nurses and other emergency workers but had no timeline.

The VA’s role as the country’s emergency medical backup was first established by Congress in 1982 and is known as the agency’s “Fourth Mission.” (The first three missions are sometimes identified as care, training and research, and other times as health, benefits and memorials.) This month, a description of this Fourth Mission was suddenly scrubbed from the website of the VA’s Office of Emergency Management. Mandreucci noted it appeared on a different page.

The VA’s ability to support FEMA could be limited by demands from its own patients, who are largely older and part of the demographic that’s most vulnerable to the coronavirus. As of Friday, the VA had 571 patients who tested positive and nine who have died.

The VA’s inspector general said in a report on Thursday that health center leaders reported concerns about running out of medicines and protective gear. Leaders at the VA hospitals in Durham, North Carolina, and Detroit said they needed more ventilators. The inspector general’s report said 43% of the facility leaders surveyed planned to share ICU beds or protective gear with local providers.

“That assistance is dependent upon the availability of resources and funding, and consistency with VA’s mission to provide priority services to veterans,” Wilkie said in a March 23 letter to lawmakers.

This article was originally published in ProPublica. It has been republished under the Creative Commons license.  ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for their newsletter.