Sam Foote tinkered with Erector sets and electronics as a boy, and studied physics and calculus in college, planning to become an aerospace engineer like his father, who built satellite radar guidance systems. But his father warned that, with man already on the moon, interest and funding for space programs would wane. Instead, Foote chose internal medicine and trained in the late 1970s.
"As an internist you're a puzzle solver," he says. "I like to think of myself as a human engineer. I troubleshoot human systems."
He worked for nearly a quarter-century for the Veterans Affairs health care system in Phoenix. In recent years, he and his colleagues had struggled to meet rising demand, but a deeper problem emerged: too many veterans not getting the care they needed. Last year Foote examined the Phoenix VA health care system as he might a patient, and he arrived at a troubling diagnosis: The system itself was sick, and was killing veterans it was supposed to heal. He wrote letters to the VA Office of the Inspector General charging that Phoenix-area veterans had died waiting months for care, hidden on secret waiting lists. Then he reached out to the media.
Igniting a Firestorm
Foote couldn't have imagined the fallout. Whistleblowers at VA facilities around the country alleged similar wrongdoing, and the inspector general launched dozens of investigations, which found the same problems nationwide: 57,000 veterans had been waiting more than three months for an initial appointment, and another 64,000 veterans had requested an appointment over the past decade but weren't on the wait list. They had either fallen through the cracks or been kept on secret lists to make the facilities appear more efficient.
The crisis in veterans' health care hit older Americans hard. Of the nation's 22 million veterans — whose average age is 62 — more than a quarter use VA facilities for some or all of their health care. As of 2011, even after nearly a decade of war in Iraq and Afghanistan, veterans 45 years and older accounted for 86 percent of those enrolled in VA health care.
With the scandal in full boil, retired Gen. Eric Shinseki resigned as the secretary of Veterans Affairs, and President Barack Obama nominated former Procter & Gamble CEO Bob McDonald, a West Point graduate, to replace him and clean up the enormous bureaucracy, which has more than 300,000 full-time employees. Congress enacted some stopgap measures and approved the hiring of more doctors and nurses. The scandal has also sparked a broader discussion about how the country should care for its veterans, in a time of soaring health care costs and with a new generation of veterans wounded in Iraq and Afghanistan.
Now 61 and a few months into his retirement, Foote sits on a living room couch reading another story about the VA crisis in his morning paper. A nearby shelf is crowded with family pictures. The home, where he's lived for nearly three decades, is an adobe-style ranch just outside Phoenix. In recent years, Foote had been looking forward to retirement. So far, as the man whose accusations led to so much turmoil, he hasn't found much relaxation. "It hasn't been your average take-it-easy, carefree retirement," he says.
Foote says health concerns, including lingering asthma problems, and retaliation from the VA forced his retirement a year earlier than he'd hoped. But being near retirement age also made it easier for him to be a whistleblower. "It's a huge risk," Foote says. "I was one of the few people who knew enough about it, and if they retaliated I could retire a little early." He had started at the Phoenix VA in the early 1980s, fresh from medical school. After a brief sojourn in private practice, he returned to the VA in 1990.