WASHINGTON — After officials from the Department of Veterans Affairs on Wednesday confirmed four deaths have been linked to a new computer system first deployed in Spokane, senators threatened consequences for the company being paid $10 billion for the system.
In a Senate Veterans Affairs Committee hearing on Wednesday, senators said VA officials had informed them a day earlier that problems with the electronic health record system — developed by a company called Oracle Cerner and launched in Spokane in October 2020 — had contributed to six incidents of “catastrophic harm,” four of which resulted in the death of a veteran.
While the lawmakers and witnesses didn’t identify the deceased veterans, Sen. Richard Blumenthal, D-Conn., said one of them was a patient at Spokane’s Mann-Grandstaff VA Medical Center and the other three died in central Ohio, where the Oracle Cerner system was launched in April 2022. Two nonfatal cases of catastrophic harm occurred in the Inland Northwest.
Sen. Patty Murray, a Democrat who holds Congress’ purse strings as chair of the Senate Appropriations Committee, called the risks to patient safety caused by flaws in the system “totally unacceptable” and threatened to withhold funding for the project unless they are fixed.
“At the end of the day, what I care about is getting this right for our veterans, and I do not believe that more money is what is going to solve this problem,” Murray said, adding that until she sees proof that the system is working safely, she was “not sure it makes sense … to continue to fully fund the budget request for this system.”
Last week, the VA sent Congress a report that identified 14 “key safety issues” with the system, the result of an “assess and address” period that began in October when the department postponed the system’s launch at other sites until June 2023.
At the same time, the VA mailed letters to notify more than 71,000 veterans that their health care may have been delayed or disrupted by problems with the Oracle Cerner system. After pledging the system’s rollout wouldn’t continue until problems identified in Spokane were fixed, VA leaders chose to launch it at Walla Walla’s VA hospital in March 2022, in Ohio a month later and in southern Oregon in June 2022.
In January, a group of House Republicans — including Reps. Cathy McMorris Rodgers of Spokane and Dan Newhouse of Sunnyside — introduced a bill that would block the system’s rollout for a time.
In a hearing on March 7, Rep. Matt Rosendale of Montana, the GOP chair of a House subcommittee charged with oversight of VA technology modernization, said the department should allow the hospitals and clinics that have adopted the Oracle Cerner system to revert to the system still being used at all other VA facilities, at least until it finds a safe, reliable new option.
On Wednesday, Sen. Jon Tester of Montana, the Democratic chairman of the Senate VA panel, said all options should be on the table except for scrapping the effort to upgrade the VA’s record system. While both the Oracle Cerner system and the VA’s existing, homegrown system have their roots in the 1980s, the tech giant Oracle has promised to revamp its system after it acquired Cerner in a deal worth $28.3 billion in June 2022.
Rosendale is widely expected to challenge Tester in 2024 to a rematch of their 2018 Senate race, injecting politics into an issue that has so far remained largely nonpartisan. In his opening remarks on Wednesday, Tester took a shot at the Trump administration for giving Cerner a $10 billion contract without going through a competitive bidding process, saying the company now known as Oracle Cerner has been “abusing the taxpayers.”
“There’s been a number of screw-ups,” Tester said, including poor leadership within the VA and a lack of coordination between the VA and the Defense Department, which bought a similar Cerner system in 2015.
He also blamed a poorly written contract for letting Oracle Cerner off the hook when its system caused harm to veterans and only lightly penalizing the company when it failed to meet contractual obligations for “uptime,” the percentage of time when the system is fully operational.
Despite roughly 500 incidents in which the system was partly or completely unusable between September 2020 and June 2022, as FedScoop reported, Tester said Oracle Cerner had refunded the government only about $325,000 of the $4.4 billion it has received for the project as penalties for poor performance.
Tester pushed the VA’s top contracting officer, Michael Parrish, to renegotiate a contract that “will be more favorable to the American taxpayer” when it expires May 17. “That’s absolutely the plan,” Parrish replied.
In a hearing that was otherwise sympathetic to the employees at Mann-Grandstaff and other hospitals and clinics affected by the new system, Sen. Marsha Blackburn, R-Tenn., stood out for her pointed accusation that VA employees have stubbornly resisted the effort to adopt.
“Why do they not want to do this?” Blackburn asked. “I have never in my life seen such resistance to modernizing a program. You’ve got a vendor sitting right next to you. They’re making a good faith effort to bring something forward. Why can you not tell employees, ‘This is your job. If you don’t want to do this, go work somewhere else’?”
With the exception of Sen. Tommy Tuberville, R-Ala., who used his time to grill the witnesses about an unrelated abortion issue, the committee’s Republican and Democratic members worked largely in concert as they questioned a panel that included VA health care chief Shereef Elnahal and Neil Evans, who took over three weeks earlier for the departed director of the VA’s Oracle Cerner rollout.
While the issue has mostly avoided partisanship, it may not escape political considerations as Congress hurtles toward the 2024 elections. In an interview before the hearing on Wednesday, Cole Lyle, executive director of the veterans advocacy group Mission Roll Call and a former GOP congressional staffer, said the fate of the Oracle Cerner system presents a vexing choice for lawmakers like Murray and Tester in charge of its funding and oversight.
“If it gets canceled entirely, obviously that presents a political issue for a lot of different people, just because we’ve put so much money into this program and it will have effectively been wasted,” Lyle said. “But on the other hand, if we keep throwing good money after bad and these issues don’t get fixed and veterans continue to experience harm as a result of technical issues with the program, that is unacceptable and creates its own political risk.”
In a recent Mission Roll Call survey of 8,840 self-identified veterans conducted online and by text message, Lyle said, 83% said the VA’s Oracle Cerner project should remain paused until the system is improved, while only 16% said it should be canceled entirely, as Rosendale has proposed.
At the same time, Lyle cautioned that lawmakers could fall victim to the “sunk cost fallacy,” reluctant to scrap the project because of the money already spent. While Tester said Congress has so far paid Oracle Cerner $4.4 billion for the system, an independent cost estimate by the Institute for Defense Analyses in October projected the total cost of the modernization effort could near $50 billion over 28 years.
Notwithstanding the problems caused by the Oracle Cerner system, a 2018 study by the RAND Corporation found the VA generally delivers higher-quality health care than private providers. Studies have estimated that medical errors cause as many as 400,000 deaths each year in the United States.
As a federal agency, the VA is also subject to transparency requirements — including oversight by Congress and the Government Accountability Office — that don’t apply to the rest of the U.S. health care system.