\n<\/p>\n
In a Boston V.A. hospital, six social workers are conducting phone and telehealth visits with veterans from a single, crowded room, clinicians say. In Kansas City, providers are planning patient care while facing each other across narrow, cafeteria-style tables in a large, open space, according to staff members.<\/p>\n
And in South Florida, psychiatric nurses have been treating veterans with mental health conditions in a hallway near a bathroom, sitting down with them in a makeshift medical bay jury-rigged out of filing cabinets and a translucent screen.<\/p>\n
\u201cPeople walking by can hear everything that\u2019s going on,\u201d said Bill Frogameni, an acute care psychiatric nurse at the Miami V.A. hospital and director of the local chapter of the National Nurses United union, referring to the patient intake setup in a V.A. facility in Homestead, Fla., outside Miami.<\/p>\n<\/div>\n<\/div>\n
\u201cThe nurses are triaging these patients asking standard questions: \u2018Do you feel like harming yourself or others? How long have you been feeling suicidal? Do you have a plan to harm yourself?\u2019\u201d Mr. Frogameni said. \u201cIt\u2019s very personal stuff.\u201d<\/p>\n<\/div>\n<\/div>\n
The cramped conditions are the result of President Trump\u2019s decision to rescind remote work arrangements for federal employees, reversing a policy that at the V.A. long predated the pandemic. Since Mr. Trump\u2019s order, the Department of Veterans Affairs has been scrambling to find adequate office space for tens of thousands of health care employees, even those who see most or all of their patients virtually, while maintaining the legal requirement of confidentiality.<\/p>\n
V.A. officials say the agency is handling its return to office responsibly, with the goal of improving care for veterans. While nearly 60,000 employees are being shifted into federal office space, another 45,000 have been allowed exemptions or extensions and can continue working from home for now. That includes a six- to eight-month pause for select clinicians categorized as \u201ctelemental health\u201d providers, according to V.A. documents.<\/p>\n
Staff members concerned about patient privacy can notify supervisors, who will give them what they need, said Peter Kasperowicz, a V.A. spokesman. If any staff members lack appropriate work space, he added, \u201cthat in itself is a violation of V.A.\u2019s return-to-in-office-work policy.\u201d<\/p>\n
But interviews with three dozen V.A. employees, internal agency documents and photographs provided to The New York Times from six V.A. facilities depict crowded or stopgap office spaces where clinicians say they are being asked to administer mental health treatment or discuss sensitive information in open settings where conversations can be overheard.<\/p>\n<\/div>\n<\/div>\n
Veterans have noticed the lack of privacy, clinicians say. They described patients newly hesitant to discuss issues like legal problems, substance abuse and intimate partner violence, limiting the effectiveness of their treatment. Some clinicians said they had trouble hearing patients over the phone or during video calls in their new, telemarketing-style work spaces.<\/p>\n
Providers have been instructed to use headphones, computer privacy screens and even convex mirrors to block veterans\u2019 view of other people in the room, documents and interviews show. In an internal memo, V.A. workers were told to prepare to work in crowded environments by avoiding strong perfumes or \u201cheating or consuming pungent foods\u201d while at their desks.<\/p>\n
Some providers told The Times that they are quitting or retiring early rather than work in conditions that jeopardize patient privacy or undertake long commutes just to talk to patients on video. The V.A. is already suffering from \u201csevere\u201d shortages of psychologists and psychiatrists, according to an agency report<\/a>.<\/p>\n<\/div>\n<\/div>\n \u201cThey were going to put us around conference tables with headsets and laptops,\u201d said Dr. Nicole Stromberg, 61, an addiction psychiatrist who retired on Thursday after 11 years at the V.A., much of it spent in leadership positions.<\/p>\n<\/div>\n<\/div>\n For the past five years, Dr. Stromberg has been working remotely, seeing around 500 veterans spread out across 35 counties in Michigan. She said terminating treatment with her patients has been so painful that she often leaves the sessions crying.<\/p>\n \u201cIt\u2019s really exhausting and really hard and not even what I want to do,\u201d she said. \u201cAnd I feel guilty, because I feel like doctors should be sticking it out until the end. That\u2019s the commitment we made.\u201d<\/p>\n The V.A. pioneered telehealth two decades ago to help reach its geographically dispersed patient population, hiring mental health providers for fully remote jobs to treat veterans in other counties or even states. During the first Trump administration, the V.A. aggressively expanded<\/a> its use of virtual mental health care, which it considered a successful innovation.<\/p>\n But mandating that federal employees work from the office has been a priority for Elon Musk and his so-called Department of Government Efficiency \u2014 in part, the billionaire explained in a Wall Street Journal opinion essay<\/a> he cowrote shortly after the election, because it \u201cwould result in a wave of voluntary terminations that we welcome.\u201d<\/p>\n Mr. Kasperowicz characterized the current pushback as coming from \u201ca small but vocal minority\u201d of V.A. employees who were \u201ctelling tall tales in a desperate attempt to avoid returning to the office at all costs.\u201d<\/p>\n<\/div>\n<\/div>\n Referring to the photographs provided to The Times, he disputed that patient confidentiality was being violated and said that in each location, clinicians could get access to private offices when needed.<\/p>\n \u201cThe central \u2014 and false \u2014 premise of your hit piece is that V.A. employees are improperly discussing sensitive info in crowded spaces,\u201d he said. \u201cThese photos show the opposite of that. They actually undermine the false narrative The New York Times is trying to push.\u201d<\/p>\n Mr. Kasperowicz said no sensitive information was discussed in the medical bay in the Florida facility, which he described as \u201cappropriately private.\u201d He acknowledged issues at two V.A. facilities highlighted by The Times but said officials had worked to resolve them.<\/p>\n In Michigan, for instance, Mr. Kasperowicz confirmed that officials at a clinic outside Grand Rapids had learned on April 16 of a \u201csmall group of telehealth providers performing virtual visits in a converted conference room.\u201d But he said that, 12 days after the situation came to light, the providers had been given access to smaller private spaces for sensitive exchanges.<\/p>\n The agency was \u201cno longer a job where the status quo is to phone it in from home,\u201d he added.<\/p>\n A White House spokeswoman said that the return-to-office mandate would mean \u201cbetter services for our veterans.\u201d<\/p>\n<\/div>\n<\/div>\n \u201cMany private companies are ending remote work because numerous studies show that employees are more productive and collaborative in-person,\u201d Anna Kelly, the spokeswoman, wrote in a statement.<\/p>\n Deadlines for returning to office were set for April and May. At the time of the executive order<\/a>, more than 20 percent of the V.A.\u2019s staff had been working remotely.<\/p>\n The anticipated impact of the return-to-office mandate on V.A. mental health prompted protests from medical and professional organizations after an initial Times report<\/a> in March.<\/p>\n In an April 11 letter, the chief executive of the National Association of Social Workers warned<\/a> V.A. Secretary Doug Collins that providers working in such spaces were \u201cat serious risk of violating HIPAA regulations and other federal privacy laws.\u201d<\/p>\n<\/div>\n<\/div>\n \u201cThese conditions create profound ethical concerns and could endanger the professional licensure of V.A. social workers,\u201d Anthony Estreet wrote.<\/p>\n Leaders of the American Psychiatric Association and American Psychological Association also appealed<\/a> to Mr. Collins, asking that mental health providers be exempted from the return-to-work order lest they quit, leaving their patients stranded without care.<\/p>\n Jennifer Mensik Kennedy, the president of the American Nurses Association, said many nurses have approached her to report overcrowded conditions that risked violating patient privacy laws.<\/p>\n \u201cThere\u2019s not enough office space,\u201d she said. \u201cPeople are doubled up. People are working in hallways.\u201d<\/p>\n The V.A.\u2019s expansion of telehealth in Mr. Trump\u2019s first term has helped veterans, said Dr. Harold Kudler, who served as the agency\u2019s chief consultant for mental health services from 2014 to 2018.<\/p>\n By 2023, virtual care<\/a> made up 54 percent of mental health visits. Studies showed that teletherapy had lowered the cost<\/a> of care and reduced wait times<\/a> by an average of 25 days. A study of rural veterans found a 22 percent reduction in the likelihood of suicidal behavior<\/a> among those provided care over video tablets.<\/p>\n Dr. Kudler, who is now in private practice, said in his conversations with current V.A. personnel that many had expressed \u201cdespair\u201d about \u201cabrupt and unreasoning change.\u201d<\/p>\n \u201cOnce you break that system that way, it\u2019s going to be a very long time coming back,\u201d he said.<\/p>\n<\/div>\n<\/div>\n Alarms have sounded from within the agency about return-to-office mandates. Kevin Galpin, a top V.A. official who oversees teletherapy, wrote in a memo last month that clinicians require \u201cprivate, secure and therapeutic office spaces\u201d to deliver care, and that open-plan work stations \u201care inconsistent with this guidance,\u201d according to a copy reviewed by The Times. (Mr. Galpin declined to comment.)<\/p>\n In interviews, V.A. clinicians described a chaotic spring, as two large waves of employees were given deadlines to report to a federal office space. Some described having to work out of hallways or split offices the size of closets. Many spoke on the condition of anonymity out of fear of retribution.<\/p>\n A social worker who treats homeless veterans in California said she was placed with a dozen other staff members in a windowless mailroom that was so crowded with undelivered packages that she had to move boxes to reach her cubicle.<\/p>\n In Ohio, the V.A. asked more than 70 telehealth providers to start working out of a suburban office park, but many were unable to log into the V.A.\u2019s computer system, according to an employee. Mr. Kasperowicz said that internet equipment there had failed and that workers have been allowed to work from home while repairs are made.<\/p>\n Many clinicians said the changes had prompted them to start looking for jobs outside the agency, which often pay significantly higher salaries.<\/p>\n Dr. Anil Kulangara and Dr. Catherine Shim, married psychiatrists who had been treating patients remotely at the American Lake clinic in Tacoma, Wash., said they were deeply discouraged on April 14, when they reported to the office spaces they had been assigned.<\/p>\n \u201cIt seemed a little unreal, almost laughable,\u201d Dr. Kulangara said. They weren\u2019t given keys for the building or the office, which still contained the belongings of previous occupants. When they were able to get in, they discovered that the I.T. setup would not allow them to see patients, so they raced home, they said.<\/p>\n \u201cAt no point in this did anyone explain why this was important to do, other than to comply\u201d with an executive order, Dr. Kulangara said. \u201cWe tried. It\u2019s not worth it, and it doesn\u2019t make any sense. It was such an obvious harm to us and to our patients and no one seemed willing to push back.\u201d<\/p>\n Both doctors officially resigned last week, citing the discontinuation of remote work as the reason. Though both have received offers for new jobs, Dr. Kulangara said, \u201cwe have been literally sick to our stomachs thinking of what is going to happen to our patients,\u201d a combined case load of more than 500 veterans suffering from PTSD, sexual trauma and severe mental illness.<\/p>\n<\/div>\n<\/div>\n In total, 10 clinicians told The Times that they had left their jobs, or were in the process of leaving, because of the changes.<\/p>\n One psychiatrist said she decided to quit as soon as she learned she would have to see patients over a video link from an open-plan office. Finding a new job was easy: Within weeks, she said, she had three offers, including one that paid 20 percent more than the V.A.<\/p>\n Another psychiatrist practicing in Virginia, who was hired for a fully remote position, said she has accepted a new job in the private sector rather than commute to a V.A. building to conduct virtual treatment, which would restrict the time she spends with her young children.<\/p>\n The psychiatrist said it took less than two weeks to find a new job. But she is torn about the decision, because it means terminating treatment with 600 veterans who need care.<\/p>\n \u201cI\u2019m angry,\u201d she said. \u201cI have one patient on hospice \u2014 he is recounting trauma, he only has a few months left to live, and I don\u2019t think he will be rescheduled before he passes.\u201d<\/p>\n<\/div>\n<\/div>\n The Trump administration has said it plans to eliminate 80,000 V.A. jobs<\/a>, or roughly one-sixth of the total work force, but officials say the layoffs will target administrative and support staff and will have no affect on patient care.<\/p>\n Dr. Stromberg, the psychiatrist from Michigan, said her anxiety began mounting when V.A. clinicians were told to remove Pride flags and stop using pronoun identifiers. As an administrator, she had supported D.E.I. programs, so she feared she would be targeted in the layoffs.<\/p>\n<\/div>\n<\/div>\n The return-to-office order, she said, left her little choice but to retire early.<\/p>\n Six weeks ago, she began telling patients that she was terminating their treatment. They are mostly veterans who returned from war with undiagnosed PTSD and struggle with addiction, she said; by her estimate, a quarter of them have already made suicide attempts. And it is unlikely that her position will be filled after her departure, she said.<\/p>\n \u201cTermination is difficult anyway,\u201d she said. \u201cA psychiatrist and a patient, it\u2019s an oddly intimate relationship.\u201d<\/p>\n<\/div>\n<\/div>\n Nearly all of them have responded with hurt and confusion, Dr. Stromberg said: Their sessions were virtual, so why did it matter where she was? She reminds them of the executive order<\/a> that Mr. Trump signed on Jan. 20, phasing out remote work for federal employees, one of his first official acts.<\/p>\n \u201cThis was not an easy decision,\u201d she said. \u201cIt\u2019s not the right one for my patients. And it\u2019s one I\u2019m really feeling forced to make.\u201d<\/p>\n Kitty Bennett, Susan C. Beachy and Kirsten Noyes contributed research.<\/p>\n<\/div>\n<\/div>\nAlarms From Within<\/h2>\n<\/div>\n<\/div>\n
Difficult Goodbyes<\/h2>\n<\/div>\n<\/div>\n