WASHINGTON — A year after the Inland Northwest became the testing ground for a new computer system that promised to revolutionize veterans' health care, leaders at the Department of Veterans Affairs had received grave warnings from staff at Spokane's VA hospital and evidence that flaws in the software had contributed to serious patient harm.
The officials in charge of implementing the $10 billion electronic health record system, however, told Congress and the public they knew of no such harm and they launched the software at additional clinics and hospitals in the Northwest and in central Ohio. The VA was set to do the same at larger, more complex hospitals in Seattle, Portland and Boise until The Spokesman-Review reported in June 2022 that the agency's own internal watchdog, the VA Office of Inspector General, had uncovered evidence that patients had been harmed — and that VA leaders knew about it.
On the night of Jan. 24, President Donald Trump fired Mike Missal, the man who oversaw that pivotal report along with more than a dozen others regarding the computer system in his role as VA inspector general. His dismissal came as part of a mass firing of nearly all of the presidentially appointed inspectors general, despite the new administration's professed goal of eliminating the waste, fraud and abuse that IGs are charged with rooting out.
On Friday, every Democrat on the Senate VA Committee sent a letter asking Trump to reverse Missal's firing.
"I think it's pretty devastating for the federal government," Missal said of the mass firing. "I think it's harmful to transparency and it's also going to impact the accountability of government officials. You're less likely to be able to hold people accountable if you don't have truly nonpartisan, independent IG offices."
Sen. Patty Murray, a Washington Democrat who leads her party on the Appropriations Committee and also sits on the VA Committee, said Americans "should ask themselves why Trump is so hell-bent on firing the people whose job it is to tackle corruption in government."
"Mike Missal served honorably for eight years under Republican and Democratic presidents, rooting out waste, fraud, and corruption at the VA and identifying over $37 billion in taxpayer savings — that is, until Donald Trump senselessly and illegally fired him alongside other nonpartisan government watchdogs last week in the dead of night," Murray said in a statement. "Missal's firing was yet another lawless action by a lawless president that will hurt veterans and taxpayers who deserve a transparent and accountable VA."
Like at least 16 other IGs who were fired at the same time, Missal said he received an email from Trump's director of presidential personnel, Sergio Gor, saying only that "due to changing priorities," he was "terminated, effective immediately."
When reporters asked Trump about the mass firing aboard Air Force One on Saturday, the president falsely claimed that it was "a very common thing to do" and pointed out that he hadn't fired the Justice Department IG, Michael Horowitz, while complimenting a critical report Horowitz had issued on Jim Comey, a former FBI director and Trump foe.
"I don't know them, but some people thought that some were unfair or some were not doing the job," Trump said, adding that he didn't plan to replace the sacked IGs with loyalists.
As of Thursday, his administration had not provided a list of the ousted IGs or explained the firings, as required by law.
"There doesn't seem to be any rhyme or reason to who was fired and who was not fired," said Glenn Fine, who served as IG at the Justice Department and acting IG at the Defense Department in the Clinton, Bush, Obama and Trump administrations. " Mike Missal, for example, was a terrific IG. He issued hard-hitting reports in both presidential administrations. He was independent and effective, so it's not clear why he was fired and others were not."
Other than Horowitz, the only cabinet-level IG not fired by Trump was Joseph Cuffari at the Department of Homeland Security, who has been accused of abusing his authority and wasting more than $800,000 in taxpayer dollars. An investigation by the Council of the Inspectors General on Integrity and Efficiency, a group of his fellow IGs, substantiated those claims in September.
Mark Greenblatt, who was fired as inspector general of the Interior Department on Jan. 24, chaired that council until the end of 2024. In an interview, he said that most of the 73 IG positions in the federal government aren't appointed by the president and thus can't be fired directly, but Trump had sacked most of the presidentially appointed IGs, a total of 17 people covering 18 agencies.
"The thing that keeps me up at night is the potential politicization of the inspector general positions," said Greenblatt, adding that he was especially concerned about Gor's email citing "changing priorities."
"That is troubling because IGs are not supposed to be connected to priorities of any administration," Greenblatt said. "These are designed to be long-term positions that withstand changes in presidential administrations, specifically to insulate them from political winds changing."
The Project on Government Oversight, an independent, nonpartisan watchdog group, called for Joe Biden to fire Cuffari, but the outgoing president declined to do so. Faith Williams, director of the effective and accountable government program at the organization, said that while it's unclear why Cuffari and Horowitz remain on the job, "My guess is that Trump likes their work more than some others'."
Williams said that although the worst-case scenario would be Trump replacing Missal and the other fired IGs with loyalists who would do his bidding, even dedicated, nonpartisan investigators may feel that they can't freely do their jobs if the threat of being arbitrarily fired hangs over their heads.
The mass firing, a quintessential "Friday news dump" whose timing suggested the administration wanted to minimize attention from Congress and the public, drew criticism from Democrats and some Republicans when they returned to the Capitol this week. In a letter to Trump on Tuesday, Senate Judiciary Committee Chair Chuck Grassley, R- Iowa, and the committee's top Democrat, Sen. Dick Durbin of Illinois, pointed out that the mass firing violated a law that requires 30 days' notice and a "substantive rationale" before removing an IG.
Congress passed that law in 2022, after Grassley cited the firing of agency watchdogs by President Barack Obama and by Trump in his first term without sufficient explanation. Friday's mass firing was nearly unprecedented, however, according to Fine, a fellow at the Brookings Institution, a nonpartisan think tank.
In a brief interview at the Capitol on Thursday, Durbin said that aside from writing a letter, "there isn't much else" Congress can do about the mass firing, "outside of a courtroom."
Sen. Richard Blumenthal of Connecticut, the top Democrat on the Senate VA Committee, called the mass firing "beyond outrageous" and said Democrats could use the annual appropriations process to hold the administration accountable for it. He added that he hoped the VA Committee, which generally avoids the partisan rancor of other panels, "will be bipartisan in resisting this illegal firing."
"For the sake of veterans, I hope that all of the communities affected will rise up, literally, and demand that he be restored to his post. The VA is too important for a Trump loyalist to be kowtowing to the billionaires or others who may seek to take advantage of our veterans," he said.
The electronic health record system was developed by Cerner Corp. under a $10 billion contract awarded by the first Trump administration in 2018 without a bidding process. Cerner was acquired by the tech giant Oracle in 2022 and is now known as Oracle Health. Larry Ellison, Oracle's founder and chairman, is a major donor to Trump and other Republicans.
Sen. Jerry Moran, the Kansas Republican who chairs the VA Committee, said he has appreciated Missal's work and didn't know why he was fired, but the senator said he didn't have a plan to resist the move.
"The law requires a 30-day notice, but there's no enforcement mechanism that I know of," Moran said. "No statute is words on paper. It's more than that. So it would be appropriate to have the 30-day notice and explanation."
Greenblatt said that because members of Congress are the biggest consumers of IG reports, they have a stake in the offices remaining independent.
"They have all of their regular arsenal available to them," he said of lawmakers. "The question is whether they want to use any of it."
Some GOP lawmakers have defended the firing unequivocally. Sen. Tim Sheehy, a newly elected Republican from Montana, said the move was "well within the president's rights."
"Reagan did it, and the reality is the problems at the VA far outdate the IG being fired and they far outdate Trump," Sheehy said. "You've got to hold people accountable there, and if that means firing some people and replacing them with folks who are going to put the veteran first, then that's what we've got to do."
Asked if he knew of any reason that Missal wouldn't fit that bill, Sheehy said he had "no idea who he is," but added, "All I know is the VA is not working well, and if we have to fire people to fix it, then that's what we've got to do."
After Congress passed a law establishing IG offices throughout the federal government during the Carter administration in 1978, President Ronald Reagan dismissed all of them when he took office in 1981. Lawmakers in both parties decried the move, Reagan reinstated many of the fired IGs and no such mass firing happened again until last week, said Fine, the former Justice Department and Pentagon watchdog.
According to data obtained by The Spokesman-Review through a Freedom of Information Act Request, as of Dec. 16, internal VA reviews had found 2,575 cases of patient harm related to the new system at the clinics and hospitals where the department launched it despite the warnings from Spokane, where it had contributed to more than 1,900 additional cases of harm.
While VA safety experts classified most of those cases of harm as "minor," resulting in no long-term impact to a patient's health, they include 45 cases of "major" harm and 10 cases of "catastrophic" harm, with the latter category defined as "death or major permanent loss of function." By halting the system's rollout in larger hospitals that treat more complex conditions, the IG's report may have prevented wider harm to veterans.
Missal was confirmed by the Senate in April 2016 and served from the end of the Obama administration through the first Trump administration and Biden's tenure. In an interview, he said he strove to have a professional relationship with each VA secretary even as his office issued reports that sometimes implicated top officials.
"It's not up to us to decide whether something is a good policy or bad policy, but rather, is it being implemented as the agency would want?" Missal said. "It works best if there's mutual trust that we're each trying to do our jobs here, and we're each trying to help the agency improve. At the end of the day, we're all trying to make sure the veterans get the benefits and services that they deserve."
In addition to his office's reports on that system, Missal led investigations of sexual abuse, medical malpractice and fraudulent use of taxpayer dollars. According to his most recent semiannual report to Congress, Missal's office published 180 reports in the previous six months that identified $5.1 billion in misspent funds and resulted in 137 arrests.
His office also worked with the U.S. Attorney's Office for the Eastern District of Washington to investigate fraudulent billing for spinal surgeries that endangered patients at Providence and MultiCare hospitals in Walla Walla and Spokane between 2013 and 2021.
In his confirmation hearing on Jan. 21, Trump's nominee to lead the VA, Doug Collins, told the Senate VA Committee, "I'm one of those that believes in gathering a lot of input and then making a decision, so if you're having input from an inspector general who's looking out for the best interests of what VA is for, then I'll be working with them and I'll look forward to it."
Collins also told senators he would look into restarting the record system's deployment ahead of the schedule set by the Biden administration, which planned the next launches in mid-2026.
Missal said he's proud of the oversight work his team did on the health record system — which will be continued by his former deputy, David Case, who is now the acting VA inspector general — calling it "a textbook example of effective, independent oversight."
"I didn't have a chance to tell them anything, because I literally was fired on a Friday night, but my hope is that they continue to conduct meaningful, independent oversight," he said of his former colleagues. "Work will continue. I think the concern is what happens next. I don't think anybody thinks this is the end of their approach to IG offices."
Orion Donovan Smith's work is funded in part by members of the Spokane community via the Community Journalism and Civic Engagement Fund. This story can be republished by other organizations for free under a Creative Commons license. For more information on this, please contact our newspaper's managing editor.
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