The results of the White House investigation of VA health care were released late Friday evening, and they paint a bleak picture.
The review says VA leadership is not prepared to deliver effective day-to-day management and is marked by an inherent lack of responsiveness.
The president ordered the investigation after reports that some VA managers lied about how long veterans waited for health care, hiding the fact that many couldn't get appointments for months.
President Obama sent his deputy White House chief of staff Rob Nabors to be his eyes and ears at the VA, and his report combines scathing criticism with ideas on moving the VA forward.
Nabors began his six-week study with a personal visit to the Phoenix VA, where 18 veterans died waiting for care. But his conclusions apply nationwide.
Nabors describes a "corrosive culture" marked "by poor management," "distrust between some VA employees and management," "a history of retaliation toward employees" and "a lack of accountability."
His recommendations include several changes.
He would scrap the stated goal of making appointments within 14 days, an unrealistic goal that encouraged false reports and hidden wait times.
He would update the VA software program for scheduling called VISTA, a program first used in 1985.
Nabors also calls for the VA to hire more doctors and nurses, and build more physical space that will be needed for veterans in the future.
During Nabor's time at the VA, there's been an executive shake up. Secretary Eric Shinseki, two of the department's top health officials and the VA's chief lawyer have all been asked to resign.
Perhaps most important to veterans right now is that the VA is also reporting an unprecedented number of new appointments, 182,000 since the scandal began. That's a sign of a new, serious effort to get veterans into care but it's also a sign of just how backlogged the medical system had become.