Administration’s review of military funds to the country is at center of broadening probe
President Trump on Monday suggested a link between his delay of military aid to Ukraine and what he said were concerns about corruption in the country, but he denied threatening to withhold the support if Kiev didn’t pursue an investigation of Joe Biden, his potential 2020 opponent.
“It’s very important to talk about corruption,” Mr. Trump said at a United Nations event. “If you don’t talk about corruption, why would you give money to a country that you think is corrupt?”
Later in the day, he said he didn’t draw that connection in a call with the president of Ukraine in July. “I did not make a statement that you have to do this or I won’t give you aid,” he said. “I didn’t put any pressure on them whatsoever.” But, he added: “I think it would probably, possibly have been OK if I did.”
Congress in fall 2018 had agreed to send $250 million to Ukraine to defend it against Russian aggression. But this summer, the president and his advisers, including then-national security adviser John Bolton and Defense Secretary Mark Esper, began discussing putting a hold on the funds while the administration reviewed them, a senior administration official said. In July, the administration decided to do just that, people familiar with the matter said.
On July 25, Mr. Trump in a phone call urged Ukrainian President Volodymyr Zelensky to work with his lawyer, Rudy Giuliani, on a probe that would produce information about Mr. Biden and his son, The Wall Street Journal reported. Mr. Giuliani had met with an official from the Ukrainian prosecutor general’s office the previous month to discuss such a probe.
Messrs. Trump and Giuliani have pressed for an inquiry into Mr. Biden’s anticorruption efforts in Ukraine while he was vice president and while his son Hunter Biden had business interests there. Ukraine’s prosecutor general at the time said earlier this year he had no evidence of wrongdoing by Mr. Biden or his son. On Saturday, Joe Biden said he had never discussed with his son any overseas business dealings and accused Mr. Trump of abusing his office.
The administration’s reason for putting a hold on the Ukraine funds—which for weeks this summer proved elusive to lawmakers who were eager for answers—is at the center of the expanding investigation on Capitol Hill into whether there was any connection between the review of foreign aid and efforts by the president and Mr. Giuliani to urge Ukraine to investigate Mr. Biden. The examination of Mr. Trump’s dealings with his Ukrainian counterpart is likely to escalate this week as Congress continues to probe a whistleblower complaint concerning Mr. Trump, an aspect of which involves the Ukraine call, according to a person familiar with the matter.
Ukrainian officials earlier this month expressed concern to U.S. senators that the aid had been held up as a penalty for resisting that pressure. “They worried the aid that was being cut off to Ukraine by the president was a consequence for their unwillingness at the time to investigate the Bidens,” said Sen. Chris Murphy (D., Conn.), who earlier this month met in Ukraine with Mr. Zelensky and other officials.
The Ukrainian Embassy in Washington didn’t respond to a request for comment on Mr. Murphy’s remarks.
BIDENS IN UKRAINE: AN EXPLAINER
Joe Biden served as the Obama administration’s point person on relations with Ukraine and rooting out bureaucratic corruption, a role he took on shortly after Russia invaded the country in 2014.
Around that time, Mr. Biden’s son Hunter took a board position with a Ukrainian natural-gas extraction company, Burisma Holdings Ltd., which some anticorruption advocates feared would undermine the elder Mr. Biden’s work. The White House said at the time that Hunter Biden’s work didn’t create a conflict of interest.
One of the targets of Mr. Biden’s ire, and that of most Western diplomats, was Ukraine’s prosecutor general, Viktor Shokin, who they said wasn’t doing enough to weed out corruption. The owner of Mr. Biden’s company, Burisma, had been under the scrutiny of prosecutors, and President Trump and his personal lawyer, Rudy Giuliani, have suggested that Mr. Biden’s interest in having Mr. Shokin fired was motivated by his trying to protect his son. But Mr. Shokin had dragged his feet on the investigations into Burisma’s owner, and the probe into the company was no longer active when Mr. Shokin was removed from office in 2016.
Yuriy Lutsenko, Ukraine’s prosecutor general at the time, said earlier this year he had no evidence of wrongdoing by Mr. Biden or his son. Mr. Biden said he had never discussed with his son any overseas business dealings.
On Monday, Senate Minority Leader Chuck Schumer (D., N.Y.) called on Majority Leader Mitch McConnell (R., Ky.) to launch an investigation touching on who directed the suspension of aid, saying it should be part of a broader probe. Mr. McConnell, speaking on the Senate floor, said he urged the administration to release its hold on the aid “throughout July, August and early September,” adding that he twice urged Mr. Esper to do so and made a similar plea to Secretary of State Mike Pompeo.
The Democratic chairmen of the House foreign affairs, intelligence and oversight committees also sent a letter to Mr. Pompeo threatening to issue a subpoena if the department didn’t begin turning over related documents. The State Department didn’t respond to a request for comment.
For weeks, as lawmakers lobbied Mr. Trump to release the Ukraine money personally and called officials across his administration, they kept getting shifting responses, according to multiple interviews over the past few weeks.
Mr. Trump himself told some lawmakers that other countries weren’t spending enough to bolster Ukraine, according to a person familiar with the matter. On Monday, Mr. Trump reiterated that complaint.
Others in the administration offered different explanations. On Sept. 3, Vice President Mike Pence, who had met a day earlier with Mr. Zelensky, said that in the meeting, “as President Trump had me make clear, we have great concerns about issues of corruption.”
That day, a bipartisan group of senators in a letter to acting White House chief of staff Mick Mulvaney and the Office of Management and Budget said the funding was “crucial to the long term stability of Ukraine” and urged them to immediately release the funds.
Senate Foreign Relations Committee members were also receiving muddled answers. “There was a lot of consternation about why this was held up and what was going on,” said Sen. Chris Coons (D., Del.), a member of the panel. “I don’t remember ever hearing a clear response about what the holdup was.”
Fed up, senators coalesced around an amendment that Sen. Dick Durbin (D., Ill.) had sought to attach to a fiscal 2020 defense-spending bill to force the release of funds to Ukraine. The day before the Senate Appropriations Committee was scheduled to vote, the White House released the military aid, along with $142 million in State Department funds.
Democrats are now raising questions about whether the president successfully enlisted others in the Trump administration to carry out the pressure campaign on Ukraine. The U.S. Embassy in Ukraine told Mr. Murphy earlier this month that it wasn’t involved in demanding the Ukrainian president mount an investigation, a statement that Mr. Murphy took as a sign that diplomats had refused to get involved because they believed such conduct was improper.
From Obamacare to nurses stockpiling medicine, health care has become a jury-rigged mess.
The nurses were hiding drugs above a ceiling tile in the hospital — not because they were secreting away narcotics, but because the hospital pharmacy was slow, and they didn’t want patients to have to wait. I first heard about it from Karen Feinstein, the president and chief executive of the Jewish Healthcare Foundation, who reported it at a board meeting several years ago. I wasn’t surprised: Hiding common medications is a workaround, an example of circumventing onerous rules to make sure patients get even basic care.
Workarounds are legion in the American health care system, to the extent that ECRI (formerly the Emergency Care Research Institute) listed them fourth among its list of top 10 patient safety concerns for health care organizations in 2018. Workarounds, the group writes, are an adaptive response — or perhaps one should say maladaptive response — to “a real or perceived barrier or system flaw.”
Staff use workarounds because they save valuable time. According to Anita Tucker, a business professor at Boston University, system breakdowns, or what she calls “operational failures,” and the workarounds they stimulate, can “consume up to 10 percent of a nurse’s day.” Most hospital nurses are stretched to their limits during their 12-hour shifts. No nurse has 90 minutes to lose to a slow pharmacy or an inefficient hospital bureaucracy.
I saw the common sense that can underlie workarounds when my hospital floor instituted bar code scanning for medication administration. Using a hand-held scanner to register bar codes on medications and patients’ hospital bracelets sounds smart. But then some medications routinely came without bar codes, or had the wrong bar codes, and we nurses weren’t given an easy way to report those errors. Patients’ wrist bands could be difficult to scan and the process disturbed them, especially if they were asleep. The lists of medications on the computer screen were also surprisingly hard to read, which slowed everything down.
But the biggest problem was that the scanning software did not work with our electronic medical records — so all drugs had to be checked off in both systems. This is a huge problem when dealing with patients like those receiving bone-marrow transplants, who might get 20 drugs every morning — some of which are delivered through IVs and come with nonstandard doses. What was already a lengthy process suddenly took twice as long.
Some nurses responded to the arrival of the bar code system with workarounds, including refusing to use the scanner, or taping copies of patient bar codes to their med carts. I tried to adhere to the rules, but if I was especially busy or couldn’t get a medication to scan, I would chuck the whole process.
However, because bar code scanning has been shown to reduce errors in medication administration, the hospital officials wanted it to be done consistently. They produced a public list of all the nurses on the floor. Each nurse was labeled green, yellow or red, depending on the percentage of medications he or she administered using bar codes. Family members, doctors — anyone could see how a nurse was graded.
Over time the list worked, but the sting of it also endured. We were being punished for taking time for patients, even if it meant bending the rules. No one among the managerial class seemed to understand that nurses care a lot about patient safety. The unheard concern was that a green light for bar code scanning meant a patient could fall into the red zone for something else.
Workarounds in health care always involve trade-offs like this, and often they are trade-offs of values. Increasingly, the entire health care system is built on workarounds — many of which we don’t always recognize as such.
Consider the use of medical scribes, who complete doctors’ electronic paperwork in real time during patient visits. The American College of Medical Scribe Specialists reported that 20,000 scribes were working in 2014, and expects that number to climb to 100,000 in 2020.
I have heard doctors say they need a scribe to keep up with electronic medical records, the mounting demand of which is driving a burnout epidemic among physicians. Scribes allow doctors to talk with and examine patients without having a computer come between them, but at base they are a workaround for the well-known design flaws of electronic medical records.
As a nurse, when I first learned about scribes, I was outraged. On the job, nurses hear repeatedly how health care companies can’t afford to have more nurses or aides to work with patients on hospital floors — and yet, money is available to pay people to manage medical records. Doctors who use scribes tend to see their productivity and work satisfaction increase, but the trade-off is still there: Scribes demonstrate the extent to which paperwork has become more important than patients in American health care.
The Affordable Care Act, which I support because it has made health care available to millions of previously uninsured Americans, is also an enormous workaround. The act expanded Medicaid, protected patients with pre-existing conditions and offered subsidies to make private insurance more affordable. Obamacare, though, was never intended to make sure that all Americans had affordable care; it works around our failure to provide health care to all our citizens. In its own way, the Affordable Care Act is as jury-rigged as using ceiling tiles to stash medications.
The United States spends more per person on health care than any other industrialized country, yet our health outcomes, including overall life expectancy, are worse. And interventions like bar code scanning are a drop in the bucket when it comes to preventable medical mistakes, which are now the third-leading cause of death in the country. Our health care nonsystem is literally killing us.
As the workarounds accumulate, they reveal how fully dysfunctional American health care is. Scribes are workarounds for electronic medical records, and bar code scanning is a workaround for our failure to put patient safety anywhere near the top of the health care priority list. It’s a values trade-off that the nurses on my floor instinctively understood.
As the U.S. battles the largest measles outbreak in decades, big tech companies like Facebook, YouTube and WhatsApp are trying to tamp down the spread of misinformation about vaccines. WSJ’s Spencer Macnaughton explains. Photo Composite: Adele Morgan/The Wall Street Journal