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Earlier this year, doctors at Veterans Affairs hospitals in Pennsylvania sounded an alarm. Sweeping cuts imposed by the Trump administration, they told higher-ups in an email, were causing “severe and immediate impacts,” including to “life-saving cancer trials.”
The email said more than 1,000 veterans would lose access to treatment for diseases ranging from metastatic head and neck cancers, to kidney disease, to traumatic brain injuries.
“Enrollment in clinical trials is stopping,” the email warned, “meaning veterans lose access to therapies.”
The administration reversed some of its decisions, allowing some trials to continue for now. Still, other research, including the trials for treating head and neck cancer, has been stalled.
President Donald Trump has long promised to prioritize veterans.
“We love our veterans,” he said in February. “We are going to take good care of them.”
After the Department of Veterans Affairs began shedding employees and contracts, Trump’s pick to run the agency, Secretary Doug Collins, pledged, “Veterans are going to notice a change for the better.”
But dozens of internal emails obtained by ProPublica reveal a far different reality. Doctors and others at VA hospitals and clinics across the country have been sending often desperate messages to headquarters detailing how cuts will harm veterans’ care. The VA provides health care to roughly 9 million veterans.
In March, VA officials across the country warned that a critical resource — databases for tracking cancer — would no longer be kept up to date. As officials in the Pacific Northwest explained, the Department of Government Efficiency was moving to kill its contract with the outside company that maintained and ran its cancer registry, where information on the treatment of patients is collected and analyzed. DOGE had marked it for “immediate termination.”
The VA in Detroit raised a similar alarm in an email, warning of the “inability to track oncology treatment and recurrences.” The emails obtained by ProPublica detail a wide variety of disruptions. In Colorado, for instance, layoffs to social workers were causing homeless veterans waiting for temporary housing to go without help.
The warnings, sent as part of a longstanding system at the VA to alert higher-ups of problems, paint a portrait of chaotic retrenchment at an agency that just three years ago was mandated by Congress through the PACT Act to expand care and benefits for veterans facing cancer and other issues after exposure to Agent Orange, burn pits or other toxins.
Doctors and other health care providers across the VA have been left scrambling and short-staffed amid an ever-shifting series of cuts, hiring freezes and other edicts from the White House.
The upheaval laid bare in the emails is particularly striking because the cuts so far would be dwarfed by the dramatic downsizing in staff and shift in priorities the administration has said is coming.
The VA has cut just a few thousand staffers this year. But the administration has said it plans to eliminate at least 70,000 through layoffs and voluntary buyouts within the coming months. The agency, which is the largest integrated health care system in the U.S., currently has nearly 500,000 employees, most of whom work in one of the VA’s 170 hospitals and nearly 1,200 clinics.
Despite an expanded role mandated by Congress through the PACT Act, administration officials have said their goal is to trim the agency to the size it was before the legislation passed.
“The Biden Administration understood what it meant to pay for the cost of war; it seems the Trump Administration does not,” said Rep. Mark Takano, a California Democrat and chief author of the PACT Act.
Documents obtained by ProPublica show DOGE officials working at the VA in March prepared an outline to “transform” the agency that focused on ways to consolidate operations and introduce artificial intelligence tools to handle benefits claims. One DOGE document proposed closing 17 hospitals — and perhaps a dozen more.
VA press secretary Pete Kasperowicz told ProPublica that there would be no hospital closures. “Just because a VA employee wrote something down, doesn’t make it VA policy,” he said in a written statement. But he did say that use of AI will be a big part of what he called VA’s “reform” efforts.
Kasperowicz dismissed the idea that the emails obtained by ProPublica show chaos.
“The only thing these reports show is that VA has a robust and well-functioning system to flag potential issues and quickly fix them so we can provide the best possible care to Veterans,” he wrote.
DOGE did not respond to requests for comment.
The White House released a budget proposal last week that calls for a 4% increase in the VA’s budget. That total includes more money for medical care, though a portion of that would be used to pay for veterans to seek care outside the VA medical system.
More answers to the VA’s larger plans may come today, when Collins is scheduled to testify before the Senate Veterans Committee, his first hearing on Capitol Hill since coming into office.
David Shulkin, who headed the VA in Trump’s first term, said the administration is too focused on cuts rather than communicating a strategy for improving care for vets.
“I think it’s very, very hard to be successful with the approach that they’re taking,” Shulkin told ProPublica.
One way local VA officials have tried to limit the damage has been by sending warnings — formally known as an issue brief — to higher-ups. And sometimes it works.
After officials in Los Angeles warned that “all chemotherapy” would stop unless Washington backed off killing a service contract, the VA reversed its decision.
And, amid growing scrutiny, the administration also made some researchers in Pennsylvania and elsewhere exempt from cuts. The laid-off social workers who helped homeless vets in Colorado were also brought back after about a month away from their jobs. Kasperowicz said that four social workers were affected but “their caseload was temporarily redistributed to other members of the homeless team.”
The warnings from officials across the country underscore how the comparatively modest cuts so far are already affecting the work of the VA’s medical system, with the study and treatment of cancer cited in multiple warnings to agency leadership.
“We have absolutely felt the impact of the chaos all around us. We’re already losing people,“ said one senior researcher, who spoke to ProPublica anonymously for fear of retaliation.
Referring to studies, he added: “We’re going to be losing things that can’t restart.”
And while Kasperowicz told ProPublica that the issues in Pennsylvania have been resolved, locals there said that’s not the case and that the impact is ongoing.
In Pittsburgh, two trials to treat veterans with advanced head and neck cancer, which officials in March had warned were at risk because of hiring freezes, have still not started, according to Alanna Caffas, who heads a Pittsburgh nonprofit, the Veterans Health Foundation, that partners with the VA on research.
“It’s insane,” Caffas said. “These veterans should be able to get access to research treatments, but they can’t.”
A third trial there, to help veterans with opioid addiction, wasn’t halted. Instead, it was hobbled by layoffs of key team members, according to Caffas and another person involved in the research.
Regarding the issues with cancer registries, Kasperowicz said there had been “no effect on patients.” He added that the VA is moving to create a national contract to administer those registries.
Rosie Torres, founder of Burn Pits 360, the veterans advocacy group that also pushed hard for the legislation, called the emails showing impeded cancer treatment a “crisis in the making” and “gutwrenching.”
That the decisions are being made without input from the communities of vets they affect is worse, she added.
“If they are killing contracts that may affect the delivery of care, then we have a right to know,” she said.
Last week, as the second Trump administration marked its first 100 days in office, Collins celebrated what he described as its achievements.
In a recorded address, he said that under his stewardship the VA processed record numbers of benefit claims, ended “divisive” spending on diversity initiatives and redirected millions of agency dollars from “non-mission-critical” programs back toward services to benefit veterans.
“We will not stop working to put veterans first,” he wrote in an accompanying op-ed.
Others say Collins has done no such thing. Instead of focusing on veterans, said one VA oncologist, “we’re spending an enormous amount of time preparing for a staffing catastrophe.”
“Veterans’ lives are on the line,” the doctor said. “Let us go back to work and take care of them.”
Alex Mierjeski contributed research, and Joel Jacobs contributed reporting.