A scathing 158-page Inspector General’s report released last week detailed serious problems and “failed leadership” among the VA’s enormous health care system in general and at the Washington D.C. VA Medical Center specifically. This comes on the heels of another investigation that found that the VA director violated ethics policies, and eventually forced the retirement of David Shulkin’s chief of staff, Viveca Wright Simpson.

The report, a follow up to an interim report from last April detailed a laundry list of offenses that “put patients at risk” and were the result of “failed leadership.”

According to the report, some of the issues found included “prolonged or unnecessary anesthesia” because staff couldn’t find needed equipment, delays or cancelations of procedures, more than $92 million in waste on medical supplies, and a serious potential data breach due to patient records sitting in more than 1,300 unsecured boxes.

No patients died as a result of this mismanagement, but IG Michael Missal cautioned against the “culture of complacency,” and more potential problems if a tighter rein isn’t kept on the 1,700 VA medical centers across the country. The problems had apparently been going on, and known to those in authority for years, and nothing was done.

“In interviews, leaders frequently abrogated individual responsibility and deflected blame to others,” the IG’s report says. “Despite the many warnings and ongoing indicators of serious problems, leaders failed to engage in meaningful interventions of effective remediation.”

Shulkin, the only holdover from the Obama administration, came out swinging, saying that a number of improvements are underway. Chief among them was the firing of the director of the D.C. medical center, Brian Adkins, and naming retired Army Colonel Lawrence Connell to replace him.

Three regional directors were also replaced, and the 23 hospitals they oversaw will now report to a new executive in Washington.

But for all of the director’s plans, few have been effectively implemented, leading to more of the same.

According to another report released last month, Shulkin inappropriately accepted tickets to the world famous Wimbledon tennis match, and racked up airfare costs for his wife’s travel on that same trip totaling more than $122,000. Shulkin’s Chief of Staff Viveca Wright Simpson took steps to falsify the information reported to a VA ethics lawyer.

The investigation also found that nearly half the 10-day trip was spent on leisure activities and that an aide was directed to work with Shulkin’s wife to plan activities, making “extensive use of official time” for making those leisure arrangements.

The IG’s memo said that Shulkin needs to reimburse the government for the costs, discipline his chief of staff, and retrain the rest of his staff as to the appropriate use of their time when it comes to travel planning, as well as the ethics of accepting gifts. Shulkin bristled, but said he would comply with the IG’s office. His chief of staff opted to retire.

In the wake of this latest scandal within the agency, Shulkin was summoned to the office of White House Chief of Staff John Kelly and was told to get his house in order, and stop talking to the media and creating drama within the agency and for the administration.

Kelly offered the assistance of the White House in dealing with some of the staffers at the VA, but was later furious when Shulkin went to the press afterward and mischaracterized the meeting. This is reportedly not the first time this has happened.

“After visiting the White House, Shulkin spoke to The New York Times. He declared victory, announced he had the power to can insubordinate political appointees, and said he had the White House’s full support,” according to Axios.

“[Shulkin] said in an interview that President Trump and Mr. Kelly supported his making changes at the department, including the removal of any staff members who did not support him.”

Shulkin has previously gone so far as to suggest that political subversives were trying to oust him from his job. Shulkin has even posted armed guards outside his office, fearing a mutiny, according to some reports.

While political subversives may be a stretch, in light of the latest scandal, President Trump has been considering replacing Shulkin with Energy Secretary Rick Perry, or someone of his own choosing who will be less quarrelsome with not only other members of his own agency but the Trump administration as well.