VA Care Systems Remain Broken

Commission on Veterans’ Care Recommends Measures to Improve Treatment at Home
By JACQUELINE PALANK

WASHINGTON, June 29 — The presidential commission investigating problems in health care for military personnel wounded in Iraq and Afghanistan held its final hearing Friday, and focused on problems with moving patients through various stages of aid, from Defense Department hospitals to those run by the Veterans Administration or private health care, to home care and to jobs. Today’s veterans are more likely than those of previous conflicts to suffer from “polytrauma,” including burns, brain injury and shrapnel from explosives, members of the commission said, making their treatment more complicated.

The idea that it took a commission of outsiders to identify that veterans of this day and age are more likely to suffer from "polytrauma" (multiple injuries to multiple body areas) illustrates the idiocy of the VA system. The VA medical and nursing staff are obviously under-trained and quite disinterested on a large scale. In my view, this is because the VA has resorted to staffing its medical billets with doctors that are trained overseas and have little-to-no commitment to American ideals or appreciation of the sacrifice our soldiers, sailors, airmen and marines have made just to serve in the Armed Forces, never mind serving in a combat area.

Making matters worse, the VA relies primarily on residents from a multitude of medical schools that are rotated out after a very short period of time. These residents learn a wide variety of skills in a short period of time working with veterans, but they also learn that there is no future working for or with the VA system because of the low pay, poor administration, the lack of proper systemic management, and the inability to follow patients in a systematic and effective manner within the VA system.

We have relegated the care of our veterans to the lowest rung of the health care ladder, even to the point that illegal aliens are more likely to get better care and more interest than those who served faithfully in an honorable manner. Anyone that has received care from the VA, or has worked with the VA over the years, could have told the nation and our military and political leaders that the VA was not up to the task of providing for the needs of our current batch of severely wounded veterans coming out of Iraq and Afghanistan.

In the recent issue of the American Legion Magazine there is an article (available in PDF format at http://www.legion.org/) that outlines the fight that veterans have had to make in the courts to get the VA to honor its commitment to provide care for heroes of past eras, never mind those of this era. In one case the fight went on for sixteen (16) years and several layers of our federal courts... all because the VA has been designed to avoid taking responsibility for the proper care of our veterans and dismissive of the promise of health care made to everyone that served honorably.

The health care system should also take into account the strain that puts on family members, commissioners said, and should make more use of contractors who can help in out-patient care. The commission, led by Donna E. Shalala, a Democrat and former secretary of health and human services, and Bob Dole, the Republican presidential nominee in 1996, was established in March after articles in The Washington Post described poor conditions at the Walter Reed Army Medical Center here.

Then, too, the military hospital and medical care system has been significantly cut over the decades since I served. The Naval Regional Medical Centers in Oakland (California), Great Lakes (Illinois), New Orleans (Louisiana), Memphis (Tennessee) and elsewhere have all been reduced in status and staffing to the "Naval Hospital" designation and have suffered staffing shortages since the early 1980s. Some naval hospital facilities have been operating at less than 70% staffing capacity since 1981 and the military solution has been to change the numbers allocated on paper rather than meet the needs of the military communities.

The Army, too, has done much the same thing. Brooks Army Medical Center (BAMC) at Fort Sam Houston--home of the Academy of Health Sciences and the training grounds for almost everything medical in the Army--has been reduced in force several times since I was at Ft. Sam in the late 1970s. BAMC was considered the second flagship hospital for the Army and had a reputation for being excellent at treating burns and shrapnel injuries, but has come under fire in recent years for care that was not up to snuff. The hospital and dispensaries at Fort Leonard Wood in Missouri has a notorious reputation among folks in military medical circles.

It should have never required an external commission to take notice that both the military and VA health care systems were in need and providing less than acceptable levels of care, housing or coordination of family needs.

“We’re very solution-driven,” Ms. Shalala said of the panel. “We will not be issuing a report that points fingers.”

Shalala couldn't get out of her own way when she was the head honcho at HHS. Why she was chosen for this commission is a mystery. The commission is not representative of our veteran population. Almost none of its members have ever received care (especially extensive or intensive care) from the military or VA systems.

Besides, it is time we did start pointing some fingers at the politicians and military leaders that have consistently and deliberately put the health care needs of our military and our vets on the back burner while wasting billions of dollars on less important things... like the hundreds of thousands spent on "junket flights" taking high ranking officers and congress critters to Chicago and Indianapolis just in time for the Indy 500 every year. These trips--ostensibly scheduled and arranged for inspection tours--have been going on since I was stationed at Great Lakes and Fort Sheridan was still operating in the northern suburbs of Chicago... and word has it that they are still ongoing.

But we can ignore those issues and expenditures because they pale in comparison to the huge sums of money we spend on corporate welfare, tax breaks for big business and subsidies that are misdirected into the coffers of businesses (i.e. big agro-businesses) that were meant to go to family operations and farms. Or we could take a look at the billions sent overseas without any accountability in the form of foreign aid to regimes that do not distribute funds as intended, but pocket the funds in corrupt ways. In fact, in my research for grant money for a school safety project, I found almost three times as many grants for overseas projects as I have for domestic projects.

Because today’s wounds are different and the families of the veterans are different — many are older, with homes and spouses to return to — more veterans should be allowed to return home for treatment, commissioners said.

Bovine excrement! This is the same type of thinking that brought about the managed care systems that have ruined our health care and insurance coverage systems, and the same type of thinking that has turned the Medicare system into a "denial factory" that lives and breathes by the number of claims it rejects so that a lesser standard and sub-standard level of care can be provided. While it is important to include home care in the regimen of available treatment options, we must be sure not to do so prematurely or as a matter of routine. It has already been demonstrated that the level of follow-up care for veterans is dysfunctional when vets are treated in VA hospitals and clinics... How much more dysfunction and neglect will creep in if vets are not seen except by visiting nurses, aides and home care?

Returning patients to their homes can relieve the strain on some families, said commissioners, who reported that some relatives must now leave their homes and jobs to assist with their service members’ treatment in distant hospitals run by the Departments of Defense or Veterans Affairs. But caring for injuries at home requires support from the V.A., they said, and support offered now is often insufficient.

Yes, the emotional support of families is an important element of care. But as many family members of vets will tell you, their biggest strain and drain comes from fighting for proper and adequate care for their loved ones. Like Medicare, the VA has come to live and breathe for its denial of care and benefits. It has long waiting times for appointments. The level of accuracy of medical records is poor at best, bordering on medical malpractice almost daily (my own VA medical records are inaccurate to a large part due to the constant turnover of residents and the lack of proper history methods). There are families that are still fighting for ordinary care, and many that require extensive care have been forced to fight the system tooth and nail to get care that would have been routinely provided in a civilian setting (i.e. follow-up care for TBI (traumatic brain injury) survivors).

I would suggest that anyone who doubts how screwed up the VA system is should talk to some of the Service Officers of the various veteran groups that work in the hospitals and clinics. Again, I call for the re-training of military medics and corpsman by the VA. I call for legislation in every state and at the federal level that recognizes the excellent training and experience of these medical personnel so that their training and experience can be turned into civilian credentials. I call for social workers and ombudsmen that have military experience. I call for medical and nursing staff that are trained in the United States rather than foreign medical schools. I call for hospital staffing that does not rely solely upon residents rotating through as a part of their training in medical school.

Another consideration is that the patients’ physical wounds are also accompanied by post-traumatic stress disorder, commissioners said.

PTSD was first denied by the VA. Subsequently, it was recognized, but then marginalized by the VA. We have seen reports from reliable news sources that illustrate the denial of PTSD by military commanders, and the stigma that accompanies any request for pre-emptive treatment of PTSD symptoms in the field. If the VA and military medical systems are dysfunctional to the "Nth degree," the psychiatric care system of both institutions is dysfunction to the "Zth degree." Some research is pointing to PTSD developing in veterans that served honorably and never saw any combat... because the level of day-to-day stress, danger and denial of needs in the military is cumulative in effect. Additionally, those vets coming out of the service often have stress relating to the adjustment to civilian life. After living a military life for 6-30 years, coming to a civilian life that limits what work can be done, often suffers from a lack of motivation to get things done efficiently and in a timely manner, and does not recognize the skills and experience level veterans actually possess, there can be overwhelming stress... and a demonstrated record of adjustment difficulties.
The hearing on Friday was the commission’s seventh, and several members of Congress who have introduced legislation on veterans care came to testify. Mr. Dole and Ms. Shalala asked if they would include the commission’s recommendations in pending legislation.

“We would welcome suggestions, absolutely,” said Senator Carl Levin, Democrat of Michigan and chairman of the Senate Armed Services committee.

Mr. Levin said the Senate’s veterans bill, which is scheduled for the floor, seeks to improve medical record sharing between the military and the Department of Veterans Affairs as well as address discrepancies in the disability ratings each department uses to determine how much in benefits a service member is paid each month.

Representative Steve Buyer, Republican of Indiana and the ranking member of the House Veterans’ Affairs Committee, said he was concerned that the departments did not adequately use private contractors to provide outpatient treatment, which could allow patients to receive care at home rather than have to travel to a veterans hospital.

“If we’re patient-centric, we should allow the transition of that patient to occur,” Mr. Buyer said.

Ms. Shalala said, “This is a different war in which we have people who have families and they want to go home.”

Buyer, like the Republican governor of Indiana, is fixated on privatization. Gov. Mitch Daniels of Indiana has been so enthralled with privatization that he has leased the Indiana Toll Road (against the wishes of Indiana citizens), is seeking to sell the Indiana Lottery, and has been privatizing correctional facilities, social work functions and Medicaid services... all with short-sighted short-term gains and ignored long-term losses. The idea of privatizing the VA via contracted outpatient services is just another way of avoiding the promises made to our vets and avoiding the direct responsibility for providing proper care. Like most pro-business proposals offer by the Republican side of the political process, it is designed to undermine the system and will eventually lead to even more failures in providing care for our heroes. The idea of using private contractors will not fix the system, will not assure proper car and will not solve the problems at the VA... but it will raise costs, benefit profit-making (gouging) enterprises and promote fraud in the system.