By Lance Wang, Editor
I had the opportunity to interact with the Veterans’ Administration while in uniform, much more so since retiring from the Army. As with any large organization I’ve encountered good and bad. Certainly the good is the dedicated functionaries who I encounter, many of whom are themselves veterans. I also have been particularly pleased with the service of a nearby VA Community-Based Outreach Clinic which provides responsiveness that I’ve never encountered from a big city VA facility. They have provided more continuity of care than I encountered in military or the civilian world. However the “bad” side has certainly made itself known. I live in a border region of New York, and the ability of Veterans Administration facilities to talk across state lines is still bureaucratically challenged to a very frustrating degree. For instance, rather than referring 50 miles to the nearest VA Hospital in New York, they have to refer me to three times that distance to a facility in Vermont. The employees of the VA who I encounter know this limitation of their system, and share my frustration. I don’t blame them.
Why is it so difficult to bring the problems in the VA to solution stages? For years the VA has been neither fish nor fowl – it did not have the accountability nor true profit motive that civilian medical agencies have, nor did it have the discipline to which a military agency was subjected. It was designed to replace a 19th century system which largely put the onus on charitable organizations and local communities to care for veterans. It was never fully resourced to perform its mission, resulting in fraud and scandals like we saw in Arizona’s VA system several years ago. Or it resulted in terribly substandard care like revealed in a 1970 Life magazine expose called “Our Forgotten Wounded” regarding what Vietnam Veterans were encountering in VA hospitals, what Life called a “medical slum.” The complaint of the VA hospital administration in the article – “We’re just not being funded so as to give our services.”
The workload for the VA has only increased since the editorial was written. Battlefield mortality has again decreased – some wounds that would have been certain to kill someone during the Vietnam War are now survivable. However, they are survivable in some cases with considerable follow-up care required, often for life. In addition, as our Vietnam veterans require geriatric medicine, demands will again rise. So, as in 1970, are we prepared to pay the costs for the VA to do their job? Or are we to treat our veterans as out of sight and out of mind, with the VA only commanding attention when its problems come to a head as in Arizona?
Recently, the lack of accountability and discipline was highlighted in a USA Today report. The report indicated that “In 2014 and 2015, the VA spent nearly $6.7M to secretly settle cases with hundreds of employees who were either fired or forced into retirement due to inadequate performance.” This included doctors who made mistakes that caused harm to patients. One VA podiatrist was allowed to resign after harming 88 patients at a hospital in Maine. Another VA radiologist in Washington was allowed to resign after finding that he misread “dozens of CT scans.” Because of the nature of their departure from the VA, these individuals’ poor performance does not make it into national registries and databases.
Until the VA is treated as a civilian entity, with the same accountability (and liability) as a civilian hospital, this will continue to happen. I understand the challenges of hiring medical professionals for government employment – the military branches often face the same challenges. However, compensating for lower wages with lower accountability is not the answer – it will not provide the health care that our veterans need, nor of the caliber that they deserve. Further, I’m also well aware of how challenging and cumbersome the civilian personnel system is for the Federal Government. Supervisors need to be trained to document and evaluate poor performance. It has been my experience that the reason that the government (and other large organizations) often need to “settle with” as opposed to “firing” an employee is that supervisors often do not do their job when it comes to documenting employee performance.
It seems amazing that we can create a world class military, unmatched in technological advantage, yet still are having a hard time creating a system of medical care that is equally unmatched for our veterans. Our veterans, and the thousands of outstanding employees of the VA who do go over and above to take
Volume 71. Number 4. Winter 2017