Trump’s executive orders cause ‘chaos’ at the VA, some staffers say

The Hampton VA Medical Center did not return a request for comment about specific changes at the facility. Regarding the broader implementation of the “gender ideology” executive order, VA spokesperson Peter Kasperowicz said in an email that “there will be no changes to services and benefits for Veterans and VA beneficiaries until a formal order is issued by VA’s Office of the Secretary.” Kasperowicz added, “All Veterans and VA beneficiaries will always be welcome at all VA facilities to receive the benefits and services they have earned under the law.”

All of the VA employees who spoke with NBC News — many of whom requested anonymity out of a fear that they could be targeted by the new administration for speaking to the media — described receiving a flurry of emails over the last two weeks with confusing information about whether they could resign from their jobs or directing them to freeze or rescind employment offers for, in many cases, chronically understaffed hospitals. 

Many of the employees, particularly those who work in VA medical centers, said the executive orders have already negatively affected staff morale. But their worst fears, they said, are that the shakeup will ultimately hurt the veterans they serve. 

“There are instances where we’ve gotten official messaging to one effect, and then, three hours later, gotten official messaging reversing that,” said a Texas psychologist who has worked for the VA for more than a decade. “It’s just very disorienting and scary in the sense of, what does all this mean for VA health care in general and the mission that we serve? Will veterans still be able to get what they need after all this has shaken out?”

The effects of the hiring freeze and ‘return to work’

VA hospitals have experienced severe staffing shortages — particularly for physicians, nurses and psychologists — for at least five years, according to an August report from the VA’s inspector general. 

Several VA employees told NBC News they fear Trump’s directives that the federal government freeze hiring and terminate remote work could exacerbate those shortages.

A human resources specialist for the southeast region of the Veterans Health Administration said her team had a spreadsheet of 400 people who had received tentative or official job offers, including for registered nurses and radiology technologists. (Tentative offers require that applicants go through a background check and drug test, for example, while applicants with official offers have completed those steps and are given a start date.) 

On Jan. 21, a day after the hiring freeze, the specialist said supervisors directed her team to rescind all of those offers with a template letter that ended, “We hope this information serves you well and provides you a path for reaching your career goals,” according to a copy of the letter that the specialist shared with NBC News. 

“Of course, the next day, I’m waking up to very upset people, and we’re being told from higher-level individuals, ‘Do not engage,’” the specialist said. Then, on Jan. 24, supervisors told her team that about half of those positions were exempt, and they could proceed with the hiring process, she said. On Wednesday, supervisors told her team that more candidates would be added to the exempt list, but they have not been told how many, she said.

She fears the policy flip-flopping combined with the fact that VA positions generally pay less on average than comparable positions in the private sector will make hiring more difficult.

“Most people, especially coming to the VA, want to come and help our veterans,” she said. “They’re not in it for the money. … And I think it’s going to make it that much harder to hire these positions that were already in short supply.”

Sheila Elliott, who has been a pharmacist at the Hampton VA Medical Center for 35 years and is president of a local union chapter for federal employees, said the freeze could affect whether a new VA clinic in Chesapeake, Virginia, can open in April as planned.

Many of the job offers for that clinic, some of which would’ve been union positions, were rescinded. Some of the candidates whose offers weren’t rescinded, Elliott said, declined the offers in part due to the recent instability.

“It’s my understanding that some of the people who had agreed to come to the VA don’t want to come there because of all of the chaos,” Elliott said. “So that impacts the veterans’ care.”

Kasperowicz said the department worked with the White House and the Office of Personnel Management “to exempt from the hiring freeze more than 300,000 essential positions that provide health care and other vital services” and shared a link to a news release that includes a list of nearly 40 exempt positions, including psychologists, physical therapists and police officers. 

The Texas psychologist is part of a fully virtual team, spread from Virginia to Washington state, that is tasked with supporting short-staffed clinics in Texas. Trump’s return-to-work directive instructs the heads of all agencies to “take all necessary steps to terminate remote work arrangements and require employees to return to work in-person at their respective duty stations on a full-time basis, provided that the department and agency heads shall make exemptions they deem necessary.” The psychologist said she has received no further communication about how, if at all, this would affect her and her colleagues.

“We don’t have an office to go back to,” she said. 

She currently sees 30 patients a week and treats veterans for a variety of mental health conditions. If any of her colleagues left or were eliminated, she said, it would increase wait times for veterans to receive care. 

“That was kind of the horror that we all had when we actually got the ‘Fork in the Road’ email,” she said, referencing the Trump administration’s resignation offer to some federal employees. “Do they really want people to take this? Because it is absolutely going to harm veterans’ access to care.” 

Kasperowicz said the VA’s policy “is to bring as many employees back to the office as space permits” and that the VA “will make accommodations as needed to ensure employees have enough space to work and will always ensure that Veterans’ access to benefits and services remains uninterrupted as employees return to in-person work.” 

Effects on ‘life or death’ research 

In addition to effects on the everyday health care services veterans need, the administration’s rapid policy changes could affect research conducted through the VA.

A cancer researcher who runs five studies with terminally ill patients, both virtual studies and in-person at a VA hospital, said her team could be laid off by the end of the year. They work on temporary contracts, and some of those are due to expire next month. On Wednesday, the human resources department in Washington, D.C., that oversees their hiring said their contracts would not be renewed, she said. She added that her leadership team is trying to request exemptions and has encouraged her team to write impact statements to the HR department, which is under the umbrella of the Office of Personnel Management. 

If their contracts are eliminated, it could have catastrophic consequences for some of the veterans in their studies, which are specifically for “end-of-life” patients, who have no other options, she said. It could also affect the VA’s ability to improve veterans’ care in the future.

“If we have one study that a lot of these at-risk patients are doing really well on, the VA could turn that into a standard of care and could cover that in the future,” she said. “But for now, we can’t get to that point if there’s no research that can be conducted. And for some of these patients, if we’re not there to make sure that they’re getting the care that they need, it could be a life-or-death situation.”

Though that uncertainty has been difficult, the researcher described the Trump administration’s attempted cuts to research funding provided through the National Institutes of Health as “the biggest blow.” 

Her team’s VA funding was cut prior to Trump taking office, resulting in nearly half of her already small team being laid off, and many of their studies are at least partially funded by the NIH. 

The NIH cuts were temporarily blocked by a judge this week, but if they go through, the researcher said, it will affect their studies, which use drugs that cost thousands of dollars per administration. 

“That money is not going to get covered by the VA — that money gets covered by the NIH,” she said. “So now that’s another source of unknown.”

A ‘systematic attack’ on LGBTQ people

Brinkmeyer was one of only a few providers who reported rapid changes to their hospital’s LGBTQ-related messaging to veterans. Other VA employees told NBC News that their hospitals have said Trump’s order related to “gender ideology” means they cannot have their pronouns in their email signature and there will be no more LGBTQ-related training for new staff, but care for patients would remain unaffected until further guidance is issued, according to internal emails one employee shared with NBC News. 

However, one veteran has already noticed changes that they said will affect their care. Lindsay Church, who uses they/them pronouns and served in the Navy for four years, said that early this month their VA medical record reflected their gender identity, which is nonbinary. However, about a week ago, it changed to only show their “birth sex,” according to a photo of the record, which they shared with NBC News.

“I’m devastated,” said Church, who lives in the Chicago area and serves as executive director for Minority Veterans of America, a nonprofit dedicated to advancing equity for underrepresented veterans. They added that their doctors will no longer be “given the full picture” of who they are and, they fear, may be required to refer to them by their birth sex.  

“I am concerned and scared to go back to VA and continue to get my care,” they said. “I’m concerned about all of the implications of these executive orders to my everyday experiences when I go to the VA. Can I even go to the bathroom appropriately without being concerned about harassment?”

A social worker in Virginia who has worked for the VA and the military for 20 years collectively said she treated LGBTQ service members during “don’t ask, don’t tell,” and that the last few weeks have felt scarier than that. 

“We found ways to provide care to our LGBTQ+ shipmates,” she recalled of the “don’t ask, don’t tell” era. “It was not always easy. It involved a lot of coded language and a lot of creative documentation, but you found ways. This is different, because it is an all-out systematic attack. It feels like more than erased. It feels like they are being forcibly removed.”

On Wednesday, VA Secretary Doug Collins announced a new VA policy that prohibits the display of any flag other than the U.S. flag and a handful of other governmental flags. The guidance rescinds a memorandum issued last year that allowed VA facilities to fly the rainbow flag during LGBTQ Pride Month in June. 

The day before, Brinkmeyer said the assistant for the chief of mental health at the Hampton VA told her to take down her pride flag magnet, which is on the frame of her office door. 

She took it down, she said, but then she and a colleague put theirs back up once he walked away. 

“I wanted to show that I’m not giving in and to still have something affirming in the department,” she said. She left it there at the end of her last day, she said, because the psychology trainees have told her they like to see it in the hall, especially after everything else was taken down.