Questions Raised Over VA Nominee’s Lack of Managerial Experience
WASHINGTON — Navy Rear Adm. Ronny Jackson, MD, was thrust into the spotlight with his nomination as VA secretary late last month, raising questions about the qualifications he would bring to the position.
Advocacy groups and lawmakers appeared thrown for a loop by President Donald Trump’s choice. Senate Committee on Veterans’ Affairs Chairman Sen. Johnny Isakson (R-GA) said that he looks forward “to meeting Admiral Jackson and learning more about him.”
Pending his confirmation by the Senate, Trump’s personal physician would replace David Shulkin, MD, who was fired. Robert Wilkie, the Under Secretary of Defense for Personnel and Readiness, will serve as acting secretary in the interim.
Jackson has served as White House physician during the past three administrations and was the appointed physician to the president for Barack Obama and serves in the same position for Trump.
Jackson would come to the role with experience as a military physician. After completing his medical residency in the military in 2004, he was assigned as clinical faculty in the Emergency Medicine Residency Program at the Naval Hospital in Portsmouth, Virginia. In 2005, he joined the 2nd Marines, Combat Logistics Regiment 25, in Camp Lejeune. He deployed to Iraq as the emergency medicine physician in charge of resuscitative medicine for a forward deployed Surgical Shock Trauma Platoon in Taqaddum, Iraq, his biography states.
His lack of managerial of a large organization created controversy over the nomination. Former CIA Director John Brennan tweeted that he was “a terrific doctor and Navy officer,” but that “he has neither the experience nor the credentials to run the very large and complex VA.” A day after his dismissal, Shulkin, in an appearance on CNN, offered his personal support for Jackson, however.
“I also know Dr. Jackson. He’s a friend of mine. I have considerable respect for him. He is a great public servant,” Shulkin said. “I will do everything that I can to help Dr. Jackson succeed in this position. This is a tough position.”
The day after nominating Jackson, Trump suggested he wanted veterans to have greater access to private care. “We want them to have choice, so that they can run to a private doctor and take care of it, and it’s going to get done,” he said.
Jackson’s position on how much access veterans should have to outside care, which has been a source of ongoing debate, was not publicly known at the time of his nomination. His views on community care will likely be key for many lawmakers, particularly Democrats, who fear that VA could go down the path of privatization with the wrong leader.
“Over the coming weeks, I will carefully review Dr. Jackson’s qualifications to determine whether he has the best interests of our Veterans at heart or whether he, like many in the Trump administration, wants to push VA down the dangerous path of privatization,” emphasized Sen. Tammy Duckworth (D-IL) in a statement. “I will also review whether a currently-serving active duty military officer is eligible to serve as a politically appointed Cabinet Secretary. The next VA Secretary must be able to protect the department from becoming consumed by partisan politics.”
Duckworth, a retired Army lieutenant colonel and Iraq war veteran, suffered severe combat wounds, losing both of her legs and damaging her right arm.
Meanwhile, some veterans’ groups also voiced concerns about the direction of the VA.
Paralyzed Veterans of America Executive Director Carl Blake said that his organization is “deeply disappointed by the departure of Dr. David Shulkin as Secretary of Veterans Affairs.”
“The VA has a broad mission and the Secretary must be someone who is eminently qualified to lead the nation’s second largest cabinet agency. In particular, reforming VA’s health care system to better serve the needs of veterans and their families is of great importance. We encourage the Senate Committee on Veterans’ Affairs to take these concerns very seriously as it considers Admiral Jackson’s nomination,” Blake said.
Disabled American Veterans Commander Delphine Metcalf-Foster said, said meanwhile, that the organization expects “the next Secretary to continue the path set by VA, Congress and veterans organizations in recent years to strengthen the VA health care system…”
“While we look forward to learning more about the qualifications and views of the new nominee, we are extremely concerned about the existing leadership vacuum in VA. At a time of critical negotiations over the future of veterans health care reform, VA today has no Secretary, no Under Secretary of Health or Benefits, and the named Acting Secretary has no background in health care and no apparent experience working in or with the Department,” explained Metcalf-Foster.
Vietnam Veterans of America National President John Rowan said that Shulkin “will be missed” and that his organization looks forward “to an equally productive relationship with Dr. Ronny Jackson.”
Changes at VA
If confirmed, Jackson will step in at a key time for VA. In addition to the debate over the Choice program, Shulkin had also announced prior to his dismissal a restructuring initiative that would include redesign of the VISN system. It was unclear how that would be impacted by the leadership change.
Shortly before he was fired, Shulkin discussed those plans when responding to a recent VA Office of Inspector General (OIG) report on multiple problems at the Washington DC VAMC, which he called “unacceptable.”
Underlying all of it, according to the OIG, was “excessive vacancies in leadership positions and other pervasive staffing issues across multiple departments.”
Noting that the issues at that facility are not isolated to one VAMC, Shulkin said the VA was embarking on “restructuring efforts.”
“The VISN model was put in place 20 years ago, a very innovative model that has served VA well,” he pointed out. “But, like every business, the times change, the needs change, and it’s time for us to look at how we operate our networks differently.”
In terms of the systemwide restructuring, Shulkin had also said overhaul efforts would include unannounced on-site audits at all VA facilities by an independent healthcare organization from the private sector.
Legislation that would streamline VA’s community care programs into one program and expand VA’s caregiver program to veterans of all eras was signed into law earlier this month..
The good news from a recent consultant study is that, overall, the VA healthcare system is generally equal or better than others when inpatient and outpatient quality is measured.