The new rules, obtained by the Guardian, also apply to psychologists, dentists and a host of other occupations. They have already gone into effect in at least some VA medical centers.
Medical staff are still required to treat veterans regardless of race, color, religion and sex, and all veterans remain entitled to treatment. But individual workers are now free to decline to care for patients based on personal characteristics not explicitly prohibited by federal law.
Language requiring healthcare professionals to care for veterans regardless of their politics and marital status has been explicitly eliminated.
Doctors and other medical staff can also be barred from working at VA hospitals based on their marital status, political party affiliation or union activity, documents reviewed by the Guardian show. The changes also affect chiropractors, certified nurse practitioners, optometrists, podiatrists, licensed clinical social workers and speech therapists.
In making the changes, VA officials cite the president’s 30 January executive order titled “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government”. The primary purpose of the executive order was to strip most government protections from transgender people. The VA has since ceased providing most gender-affirming care and forbidden a long list of words, including “gender affirming” and “transgender”, from clinical settings.
Medical experts said the implications of rule changes uncovered by the Guardian could be far-reaching.
They “seem to open the door to discrimination on the basis of anything that is not legally protected”, said Dr Kenneth Kizer, the VA’s top healthcare official during the Clinton administration. He said the changes open up the possibility that doctors could refuse to treat veterans based on their “reason for seeking care – including allegations of rape and sexual assault – current or past political party affiliation or political activity, and personal behavior such as alcohol or marijuana use”.
The Department of Veterans Affairs is the nation’s largest integrated hospital system, with more than 170 hospitals and more than 1,000 clinics. It employs 26,000 doctors and serves 9 million patients annually.
In an emailed response to questions, the VA press secretary, Peter Kasperowicz, did not dispute that the new rules allowed doctors to refuse to treat veteran patients based on their beliefs or that physicians could be dismissed based on their marital status or political affiliation, but said “all eligible veterans will always be welcome at VA and will always receive the benefits and services they’ve earned under the law”.
He said the rule changes were nothing more than “a formality”, but confirmed that they were made to comply with Trump’s executive order. Kasperowicz also said the revisions were necessary to “ensure VA policy comports with federal law”. He did not say which federal law or laws required these changes.
Until the recent changes, VA hospitals’ bylaws said that medical staff could not discriminate against patients “on the basis of race, age, color, sex, religion, national origin, politics, marital status or disability in any employment matter”. Now, several of those items – including “national origin,” “politics” and “marital status” – have been removed from that list.
Similarly, the bylaw on “decisions regarding medical staff membership” no longer forbids VA hospitals from discriminating against candidates for staff positions based on national origin, sexual orientation, marital status, membership in a labor organization or “lawful political party affiliation”.
Dr Arthur Caplan, founding head of the division of medical ethics at New York University’s Grossman School of Medicine, called the new rules “extremely disturbing and unethical”.
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