East Orange VA hospital loses staff as veterans face delayed surgery

VA watchdog: 97% of hospitals reported severe doctor shortages

John Falchetto was a survivor: in Vietnam, his river gunboat came under devastating rocket fire, and he was the only one to make it out alive. This February, Falchetto, who had just turned 80, began having piercing stomach pains and was in distress for days before he went to the VA medical center in East Orange, New Jersey, arriving on the evening of Feb. 12. Doctors noted abdominal pain, vomiting and diarrhea, and a CT scan suggested his appendix had not only burst but had become gangrenous, his gut so filled with bacteria and pus that tissue was dying. Doctors described the scan results as “worrisome” and wrote that he needed surgery immediately. But, as one physician noted, there was a “lack of OR capability.” That night, the hospital’s operating room was closed.

Months earlier, the hospital’s ventilation system had malfunctioned and the repair team was short-staffed. Falchetto lay in the emergency room for seven hours, his life in the balance, ProPublica reported. At about midnight, East Orange arranged for his transfer to the VA hospital in Manhattan, less than an hour away, but instead of arranging an emergency transfer, administrators scheduled the move for when the transport unit began its morning shift around 7. Falchetto reached Manhattan on the morning of Feb. 13, about 12 hours after he arrived at East Orange. Manhattan surgeons operated immediately, noting “perforated appendicitis with gross fecal spillage.” They also recognized sepsis, a life-threatening reaction to infection. Falchetto never recovered: doctors documented “worsening septic shock,” and he suffered a catastrophic heart attack a week later. With little brain activity, he was transferred to hospice and died on March 7.

It is impossible to say for certain whether short-staffing caused Falchetto’s death, ProPublica reported. He was severely ill when he arrived at East Orange and may have died even with proper, timely treatment, but he did not get that treatment. “If I were the family, I’d sue everyone,” one of the doctors involved in Falchetto’s case told ProPublica. “He should have been operated on immediately.” His brother Tony, who had known his brother had appendicitis but had not known the operating room was closed, reacted with a single word: “Oh my god.”

East Orange sits inside the Department of Veterans Affairs, which ProPublica described as a behemoth agency tracing its roots to the Civil War — the country’s largest healthcare system and one of its most effective, providing 9 million veterans what is essentially socialized medicine, often for free, with government-employed doctors, nurses and other staff. Despite occasional scandals and persistent short-staffing, studies have shown that the VA, where doctors coordinate with one another and have deep expertise in veterans’ needs, has better outcomes than private care. In his second term, Trump has moved aggressively to upend that system, ProPublica reported, embracing a decades-long conservative campaign to shift veterans toward private doctors and hospitals. Under Trump, the VA has increasingly acted like an insurer, paying doctors in the community for veterans’ care; the reasoning, as the outlet described it, was that this would let the government cut thousands of needless bureaucrats while giving veterans more choices if the VA cannot provide the care. ProPublica and other outlets have previously detailed problems with particular areas of VA care under Trump, such as mental health; the outlet’s new reporting suggests far more care for veterans is being put at risk.

Those events sit inside wider staffing losses at East Orange and its affiliated New Jersey facilities, which lost nearly a tenth of the staff they had when Trump took office. A VA watchdog report shows the number of job categories with “severe shortages” at East Orange tripled over the past two years, from around 30 to roughly 90. On the list are oncologists, radiologists, surgeons, cardiologists, anesthesiologists, critical care doctors, nurses, mechanics and cleaners. “It’s scary,” one East Orange administrator said in a meeting this year. “We have no one.”

The agency-wide figures run in the same direction. According to the VA’s watchdog, nearly all VA hospitals — 97% — reported severe shortages of doctors, though the agency argues the report, titled in part “Staffing Shortages,” is about shortages of candidates rather than actual staffing. The VA’s own data showed 3,800 fewer doctors, nurses and other “mission critical” staff six months after Trump entered the White House than at the start of his term; the losses made up a small percentage of overall employees, but the drop compounded longstanding shortages and contrasted sharply with a hiring spree under President Joe Biden that had begun to address them. By the time of a later congressional hearing by Secretary Doug Collins, the gap had reached about 5,100, a 3.4% drop — under Biden, by contrast, the VA had been staffing up. Two months after an earlier hearing, the agency announced the loss of nearly 30,000 staffers. “VA is headed in the right direction,” Collins said in a statement announcing the losses. Many of the front-line workers who quit in the administration’s early days were never replaced; instead, the VA eliminated thousands of open positions, including doctors’, nurses’ and other providers’ jobs. The administration has denied that it is hurting veterans’ care. “There’s actually an excitement about what’s going on,” Collins, a former personal lawyer for Trump, said in congressional testimony this spring.

ProPublica attributed the departures to a series of administration actions. Days after Donald Trump said in an Oval Office photo op shortly after his inauguration, “We love our veterans. We are going to take good care of them,” a leaked memo showed the administration considering sweeping job cuts at the agency. “Things need to change,” warned Collins, Trump’s new VA secretary, in a video message to staff. After pushback from veterans groups and others, the administration retreated from the threat of mass layoffs, and ProPublica reported that it found another route to shrinking the VA: if appointees could not lay off employees, they would make work conditions so untenable that staff would leave on their own. The agency canceled the contracts of the VA’s unions, citing national security concerns; ordered remote staffers back to the office; let Elon Musk’s Department of Government Efficiency require weekly reports of what employees had accomplished; and offered early retirement packages and other incentives to quit. An internal agency watchdog wrote that the return-to-office edict caused a “system shock” at East Orange, where outdated infrastructure and long-mothballed rooms could not handle the influx. In 2023, before becoming Trump’s chief of the Office of Management and Budget, Russell Vought said of federal employees: “We want to put them in trauma.” “We want them to not want to go to work.”

One medical provider at East Orange, who rattled off a list of edicts, said: “You’re this little person, and the full weight of the federal government was on you. It felt like bullying. It was very, very stressful.” VA leadership had said front-line medical workers would be immune from any cuts. That May, Collins told Congress: “We’re going to maintain VA’s mission-essential jobs, like doctors, nurses, claims processors, while phasing out nonessential roles, like interior designers and other things — DEI.” Six months into the administration, East Orange was down five psychologists, two of its four general surgeons and 18 nurses, among others, according to data obtained through a public records request. Officials also canceled the VA’s employee satisfaction survey, and under Trump the department did not use for more than a year a pay authority that Biden-era legislation signed in January 2025 had allowed the VA to give top specialty doctors more than the standard government rate.

The operating room became the most visible casualty. East Orange was built 70 years ago, and the mechanics who kept the building running were quitting as the remaining staff picked up the load. “Severely understaffed” before Trump, as Irvin Webb, an air systems technician who left the VA in May 2025, described his department, repairs took longer after the departures. One doctor calculated that the operating room has been down nine times over the past year, compared with once the year before. After an air flow malfunction in December contaminated surgical instruments, the room was out of action for roughly three weeks. It reopened for planned surgeries but remained closed for emergency and off-hours surgery for more than another month. Last week, as ProPublica prepared to publish, a doctor at East Orange said a backup generator had failed and the operating room was closed yet again.

A second death followed a different shortage. Dennis, a 72-year-old Vietnam veteran, had advanced colorectal cancer that was causing rectal bleeding. Radiation could have reduced his bleeding and pain and might also have given him more time. But after the medical physicist who calibrated the hospital’s radiation machines quit, East Orange suspended radiation treatment for months. His case was transferred to the Community Care program, which routes veterans to private providers, in early August. East Orange’s Community Care office was also losing staff and was overwhelmed with requests. Weeks passed as Dennis waited, even as his doctors messaged at least five times that Dennis needed to be seen, as one put it, “ASAP.” He received a consultation for Sept. 12, the first step toward radiation. He died on Sept. 4.

A half dozen oncologists and surgeons told ProPublica that delaying treatment by more than a month and a half was problematic and that the delays almost certainly made his last weeks more painful. One said he gives patients in that condition radiation “within hours.” ProPublica is withholding the veteran’s last name at the request of his family, which wants to maintain their privacy. Administrators at East Orange have said the volume of Community Care referrals keeps climbing: “That volume just keeps going up,” one said at a meeting last November. The reason for the increase, she explained: “We just do not have the providers to provide the care.”

Capacity contracted as well. That winter, staff were told by email that because of “urgent nurse staffing levels,” eight of the hospital’s roughly 60 general admission beds were being taken out of service. “That was a big chunk of our beds,” one of East Orange’s doctors said. “I don’t recall ever having to close that many.” Without beds, veterans often “stay in the emergency room, which is not ideal,” the doctor explained. Studies have shown that leaving patients in the ER is dangerous and results in higher mortality rates.

The VA’s nearby nursing home, which the agency calls a community living center, raised the starkest alarm. A message to staff on April 10 warned of an “extreme shortage of CLC nursing staff with an imminent risk to patient care.” The number of veterans allowed at the facility was cut from 192 to 180, then to 170, which meant, per the source’s account, that veterans who qualified for spots would be mostly turned away. Typically, the East Orange hospital could function as a kind of temporary overflow facility for the nursing home, and the nursing home could do the same for East Orange, taking patients when the hospital was full; now neither could handle any more. On May 20, a notice went out saying the hospital could not accept patients from the nursing home that day, and 17 veterans who needed admission were housed in the emergency room instead. Other hospitals sometimes do the same, but at East Orange the practice went from rare to “far more common,” one doctor involved recalled, and the veterans were stuck there at least a day. “They’re in bed all day,” said the doctor. “It’s essentially a cot.”

By last spring, managers at East Orange were sending increasingly dire alarms internally; one email in March, just a few days after Falchetto died, warned that the shortages were preventing proper care. The crises then came in quick succession. Both of the hospital’s orthopedic surgeons left, and the wound-care team fell from three specialized nurses to one, who had to commute dozens of miles between the hospital, its satellite clinics and the nursing home; “I’m not going to have time for anything,” she told colleagues. A veteran who arrived with a diabetic ulcer on his left foot had records showing the wound “significantly increased in size” after he had not been seen by a wound care specialist. Standard tests for blood clots were unavailable for most of the year because there were no technicians, and cardiac tests for veterans arriving with chest pains could not be obtained for months. The hospital had no vascular techs for most of this year, and the team that helps oncology patients navigate treatment was down to one nurse. One doctor said: “Care has gotten worse for the patients. The services available. The wait times. We’re not providing the care that we wish we could.” Another, who recently quit, said it “felt dangerous practicing in a place like that” and that the situation was “something you don’t want on your conscience.”

VA employees across the country told ProPublica they are seeing similar problems. In Albuquerque, New Mexico, short-staffing forced the hospital to take many of its beds offline and stopped it from operating on severe heart attacks. Surgeries on lungs and spines have been suspended for months at the VA hospital near St. Petersburg, Florida. At both hospitals, government reports found the private care program was overwhelmed and understaffed, further fueling delays. At the Minneapolis VA, surgeries and other critical care have been delayed; a notice on a bulletin board in May read “No SOD coverage” — no surgeon on duty — “until further notice,” and radiation treatment was suspended after one of the machine’s operators quit. A Minneapolis doctor said that meant putting a veteran with cancer-riddled bones on a rattling ambulance ride every day instead of wheeling him down the hall, and that each bump on the winter roads caused the veteran excruciating pain: “It was miserable.” A longtime oncologist who works with VA hospitals around the country said care is “collapsing from the inside.”

The VA did not make Collins or the East Orange leadership available for interviews, ProPublica said, and did not address the specifics it had shared about care. In a general statement, agency spokesperson Quinn Slaven said care has improved under Trump: “This Administration is solely focused on measuring VA’s success by how well it serves Veterans.” Slaven cited a record number of appointments for both direct and private care over roughly the past year, and said East Orange was outperforming private hospitals on certain metrics, such as diabetes care and some cancer screenings. He also said more appointments were completed at the hospital in fiscal year 2025, which ran from October 2024 through September last year, than in any year of the Biden administration, and noted that the private care program began under the first Trump administration and was also embraced by the Biden administration. Citing privacy law, the VA said it could not address individual cases without a waiver from the patient or a family member; none of the family members ProPublica spoke with chose to sign one. At a congressional hearing, Collins testified that “There is nothing they cannot hire.” If hospitals need a doctor, “they hire the doctor.” A spokesperson said the eliminated healthcare provider jobs were simply “not needed.”

Collins visited a VA campus near East Orange on a late August morning, touring the chaplains’ unit, described as “severely understaffed” in an internal presentation, and the residential PTSD unit. The event was not open to the media, and according to staff and a veteran who were there, Collins sped through the visit and did not stay long to speak with veterans. On his way out he stopped with Willie Johnson, a veteran who uses a wheelchair and has no legs. “He just thanked me for my service and gave me one of these,” Johnson said, showing a commemorative coin reading “Secretary of Veterans Affairs, Douglas A. Collins.” Asked whether he had noticed changes in care since Trump returned to office, Johnson said: “Oh yes,” noting that even food had gotten worse. The next day, an email told staff that a “particularly meaningful part” of the visit was the opportunity to recognize the service of five employees with Collins’ coin, among them the head of the maintenance department. Separately, a veteran at one of East Orange’s campuses who wrote to Trump to complain about short-staffing received a one-page response signed by the president: “Every American owes our veterans an eternal debt of gratitude,” and under his leadership, they “will always have the loyalty, respect, and support they have earned and so dearly deserve.”

Recruiting has been affected as well. Nearly 4 in 10 of the roughly 2,000 doctors offered VA jobs from January through March last year rejected them, ProPublica reported, quadruple the rate of doctors rejecting offers during the same period in 2024. Soon after, Collins imposed staffing caps without announcement. The strain is visible in the accounts of staff who remain. “People are falling through the cracks, and now they’re not getting help,” said one primary care physician at a VA clinic in Missouri. “I’ve been working from 6 a.m. to 10 p.m.,” she said, adding that she had been “near suicidal.” ProPublica’s story, reported by Eric Umansky with data reporting by Joel Jacobs, is based on internal documents, emails, agency data, recordings and interviews with more than two dozen current and former VA staffers, along with veterans and their families.