VA Secretary Robert Wilkie On Expanding Colorado Veteran Services, Not Allowing MMJ Prescriptions

Ryan Warner: Secretary Wilkie, thank you for being with us.

VA Secretary Robert Wilkie: Thank you for having me.

RW: I’d like to start with the VA Medical Center in Aurora. It opened shortly before you took office in 2018 — more than a billion dollars over budget, five years behind schedule. There were immediate criticisms that it was too small for the demand and federal lawmakers were so unhappy they stripped the VA of the authority to manage big projects like this. What are you doing to make sure veterans there are getting the care they need now?

SECRW: Well the great thing about Colorado is that it’s one of the fastest growing regions in the country when it comes to veterans. In the last year or so, I think our outpatient visits have grown by about 117,000 which means that we’re putting more resources into not only the Denver area but eastern Colorado. And the other side of the equation is something that I’ve been working on in the eight months here. And that is the Mission Act which is the largest, most comprehensive reform package in the history of the Department of Veterans Affairs, particularly for those veterans in rural areas of Colorado because it says if VA cannot provide a service that a veteran needs in a timely manner, then that veteran has the option to go outside of our VA and get that care.

RW: Now that of course means mounting a new relationship, a new system, a new software, and that’s no small task. I want to bring you this question from the congressman who represents Aurora where the regional VA hospital is located. So it comes from Jason Crow, a Democrat.

Jason Crow: We have repeatedly seen the administration suggest the idea of privatizing the Veterans Administration. How is the Secretary going to implement the new regulations of the Mission Act while maintaining the integrity of a stand-alone dedicated VA system?

SECRW: Well the great thing about veterans is they vote with their feet. If you look at the veterans’ satisfaction rate, we have numbers that we’ve never experienced in our history. Our veteran satisfaction rate when it comes to VA care sits around 89.7 percent. And I will go back to something that happened last year in December when the Annals of Internal Medicine said that VA healthcare is good or better than any healthcare in any region of the country.

RW: When it’s available.

SECRW: Well it is available most of the time. We do not sit separate and apart from the greater problems afflicting the American health system. America is wanting in terms of mental health professionals. America is wanting in terms of primary care physicians. America is wanting in terms of nurses. The turnover at VA is actually lower than it is in the private sector and for those in Colorado, we have same-day appointments not only for mental health but also for urgent care and that is a tremendous move forward from the way things have been in the last few years.

RW: A review by the U.S. Digital Service is concerned that the software the VA is developing to decide who’s eligible for private medical care is not going to work and could negatively affect the health care of some 75,000 veterans a day. That’s according to an investigation by ProPublica. What’s your take on that review?

SECRW: Well I will refute everything in that report. That’s an interesting report that was done without discussing any of the issues with any senior leader at the Department of Veterans Affairs, including the people who actually handle our information technology systems. For an outfit that’s supposed to be all about technology, about 90 percent of that report was about policy, which I think if you look at their charter, they were not competent to do. What I’m going to again fall back on is what our veterans are saying to us and our veterans are voting to use VA to go where people understand their culture and understand their language.

RW:  I understand the VA hospital here in Colorado is planning to open a new spinal cord injury unit this year.

SECRW: Yes.

RW: Secretary, just briefly tell me about the need for that kind of care.

SECRW: I’m the son of a gravely wounded combat soldier. The VA was originally established by President Lincoln to provide for those who were wounded in combat. Spinal cord injuries, for me, are the saddest aspects of this culture that we live in. Denver has been a leader and the University of Colorado has been a partner with the Denver VA in establishing new protocols for the treatment of spinal cord injuries. 

Denver will be the place where veterans throughout the western United States come for their care. I’ve visited the spinal cord injury center. There’s nothing like it. You can’t find things like this at Stanford or at Johns Hopkins and it’s absolutely vital considering the type of injuries that we are seeing on the modern battlefield. The modern battlefield, soldiers are surviving wounds that in my father’s day in Vietnam would have taken their lives but we still have not turned the corner in terms of the science on spinal cord injuries.

RW: And I suppose fundamentally giving people back movements and sensation.

SECRW: Absolutely. 

RW: Mm-hmm.

SECRW: Absolutely. Denver will be at the forefront of that not only in terms of the actual medical facilities but the rehabilitation facilities, the warm water pools, the electronic stimulation systems that we have and very proud of what is going on in Denver and we also have a partnership there with the Department of Defense.

RW: Now one other thing that Colorado is known for on the vanguard of is marijuana. 

SECRW: Yes.

RW: And in a recent interview you've said that opioid prescriptions provided by the VA have dropped 51 percent in just the last year.

SECRW: Yes.

RW: But at the same time, the VA does not plan on allowing medical marijuana prescriptions for veterans despite its track record to treat chronic pain. Is that simply a matter of the federal —

SECRW: Well it is the federal law and it’s simple. It’s very simple. It is the federal law. The other thing that I will say and I said this in testimony is this is not the 1960s. We still have no idea the effects of a more potent type of marijuana that we’re seeing in the country and I’m not going to be in the position to replace the opioids that we are dispensing with, with a drug that we still have no idea what kind of effects it has the brain. We are still really in the early stages of determining that impact. But as you said it is also against federal law and as long as it is against federal law, it is up to the Congress to change the way we do things.

RW: Recently the Trump Administration put a renewed focus on addressing veterans’ suicide. The President signed an executive order recently and the VA launched a campaign in seven states, including Colorado, called the Governor’s Challenge.

SECRW: Absolutely.

RW: Just briefly, before we go, how do you think it will make a difference?

SECRW: Well it is my honor to lead the president’s task force on suicide prevention. It is one of the great tragedies in America that every day 20 veterans take their lives and 14 of those 20 are outside of the VA. So what this does is not only opens the aperture in terms of research and whole health approach that includes a thorough evaluation of the mental health state of all of our veterans, but for me it opens the aperture when it comes to providing the resources to states and localities so they can help us. Give you an example.

RW: With the idea that they’re not all in the VA system, as you’ve said.

SECRW: Absolutely. In the state of Alaska, which is one place where many Americans go to separate themselves from society and there’s certainly parts in Colorado that I know of because of the time that I worked for a major Colorado company. They have a similar situation. But in Alaska, more than half of the veterans are outside of the VA. 

I went up there in October and asked the Alaska Federation of Natives to double the number of tribal VA representatives that they have to help us find those veterans. Are we going to get to zero? No because the majority of those who take their lives sadly are from the Vietnam era so some of our veterans have had problems that began building when Lyndon Johnson was president. We’re never going to be able to get to zero but I think with a whole of government approach and a closer relationship with the states and localities we can make a huge dent in this and I’m very honored that the president allowed me to lead that effort.

RW: We have just a few seconds. There was a report in the Washington Post that you might be vying to be the next Secretary of Defense.

SECRW: Well the only thing I’m vying for is to the best VA Secretary I can be and I will tell you I’ve seen this military life from many angles, as the son of a gravely wounded combat solider, as an officer in both—first the Navy and now the Air Force, and as a senior leader in the Pentagon. This is the world I grew up in. I go where they ask me to serve and I am very honored to walk into this building every day and carry forth what I belief is the most noble mission in the Federal government. 

RW: Thanks for being with us, Secretary.

SECRW: Alright, well thank you very much.