“There’s a comfort in being scared, when you’re the only one who dares to make the gun smoke black in a white washed town”
We’ve sat back and watched the whole VA debacle unfold in the last few months. I’ve kept my commentary to myself until the story developed and I could break it down. Now, I still don’t think we have the full story, we probably never will. But, those of us that have been interacting with the VA on a regular basis know what’s going on. Those of us that have had to sit in waiting rooms and jump through flaming hoops just to receive simple care or counsel know better than the narrative being forged on high in DC and the media.
I’m going to state something right off the bat: the only interaction I’ve had with the VA has been through the education channels and as a paramedic on an ambulance, treating veterans and transporting them to and from VA hospitals, clinics, and retirement homes. These are my observations based on what I’ve SEEN and experienced, from the outside. So, in that aspect, I’m hoping that my perception could possibly be closer to that of the typical, apple pie, ma and pa, American civilian. I have had to deal with the bullshit as being a patient advocate but, I’ve never had to go to the VA for healthcare reasons, for which I’m seemingly fortunate.
Having said that, my observations have led me to a pretty dim conclusion. The VA should be absolutely ashamed of their standards of care and conduct. It’s become an ridiculously abysmal cesspool of bureaucracy. When I hear people mention the VA, it’s most often in the tone one would expect someone to speak of a free clinic in the inner city. The VA has become synonymous with an overtaxed and apathetic welfare system, being utilized and brutalized by the very people it’s been put in place to help. No one hears “VA hospital” and thinks of John Hopkins or the Mayo Clinic. VA hospitals, at least the ones I’ve spent time in, are dark, outdated, and labyrinthian. Nothing is easy in a VA hospital. Even when I’ve had to bring a critically ill or injured patient, there’s layers of red tape that I’d had to go through just to get them to a nurse and a bed, which brings me to my next point.
I can’t help but acknowledge the FACT that the VA healthcare system is understaffed and overtaxed. It’s a free service provided to veterans, a population, and with any free service, someone is inevitably going to not only take advantage of it, but abuse it. I’ve listened as fellow vets sat and explained to me how to scam 100% disability by just saying certain things. I have overheard two former Airmen, most likely from the 80’s or 90’s, brag about how they’re collecting disability AND working a government job, and not a damn thing is wrong with them. I’ve watched in shame as my brothers and sisters of the GWOT claim PTSD just to get the benefits, while guys who have ACTUAL problems sit quietly, keeping their nightmares and problems to themselves. I hate to say it, but I think this is one of the main progenitors to the current state the VA finds themselves in.
The abuse of the system has caused the VA to create more and more layers of bureacracy, cut corners, and misallocate their resources. I’m by no means making excuses or rationalizing the current state of the VA. My intent is to educate those that think this problem is localized to a few VA facilities and appeared out of thin air. This problem has been brewing for years, I suspect moreso recently due to the influx of GWOT veterans on the current system. This overflow of a need of care has caused a burnout on staff and procedure.
I dreaded taking a patient to the VA hospital. The nurse was always a saggy-eyed, bitter, exhausted creature. Usually the first question was “how drunk are they?” Were they so flooded with drunk vets that the first question in patient turnover was HOW drunk they are? I usually left the hospital pissed and with an incident report in hand.
Critical aspects of care and sanitation took a back seat in July of 2010 when my local VA hospital, John Cochran, was investigated for reportedly exposing over 1,800 veterans to HIV and HEP B and C due to dirty dental tools. This infraction made national headlines, but eventually the focus left the hospital.
Prescriptions for some heavy drugs were being written at the cyclic rate after a 3 minute visit with a doctor. My girlfriend at the time had gone in, said her back was sore. and a few days later, she had Oxycontin in the mail. We were pretty shocked considering it was just muscle strain and she was hoping more for an x-ray or diagnostic exam. The same goes for behavioral health services. Instead of counseling veterans, prescriptions are written by overbooked shrinks, just to clear the office traffic. This dangerous practice leaves the troubled vet with not only a psychological issue, but a chemical dependency.
My point is: the poor standard of care, misallocation of resources, and shit leadership is nothing new. It didn’t just pop up this year. However, the deaths of veterans while they waited for care has sparked a semi-serious debate in DC. Congressional panels point fingers at each other ridiculously. It’s turned into a high school blame-game for political gain versus a search for the root of the problem. The one thing that is hard to prove is that the VA doesn’t have enough money. Since 9/11, the budget has increased 237% from $45 BILLION in FY2001 to $150.7 BILLION in FY2014. The ONLY entities that got a bigger bump were the State Dept and Dept of Homeland Security. The DoD only received a 104% increase in the same time period…. and that was with a war in TWO theaters going on.
I don’t think it’s a budget issue as much as a leadership issue. I think we can all agree that as far as federal agencies go, the proverbial shit rolls downhill. Everything, including attitudes, start at the top. I think, in general, the VA was apathetic at best. There isn’t really a financial incentive to provide the best care we can for vets. There’s the moral and ethical obligation, absolutely, but as far as making money, there’s none when it comes to veterans. Actually, after I wrote “When the Music Stops”, a buddy of mine, whom I hold in very high esteem, brought a sobering thought to my attention-
Let’s say the typical GWOT veteran receiving benefits due to an injury or PTSD costs the taxpayers $1 Million a year. As of right now, the suicide rate among GWOT vets is 22-23 per day. That saves the American taxpayer $22-23 MILLION a day. Multiply that times 365….that’s $8.3 BILLION a year. There’s more financial incentive to ignore the problem, which is an absolutely nauseating notion.
After the “waiting list death” scandal registered on the political radar, an investigation was initiated. That’s all well and good, except that the VA was put in charge of investigating themselves. I can only imagine that if the VA can’t be troubled to police their own in the first place, they wouldn’t be any more inclined to carry on with a lengthy, difficult, and costly investigation. POTUS even made a televised statement of confidence in Shinseki’s integrity, ethical devotion, and ability to head his own investigation, basically washing his own hands of the situation and putting the ball back in Shinseki’s court. So with that in mind, Shinseki stepped down. Let’s face it, he had over 5 years and all the resources to get a handle on the situation. However, DC claims they didn’t have a clue about the goings on in the VA until it broke in the media. This tells me two things: First, Shinseki didn’t do his job. He sat back with his feet kicked up on his desk and tried to let a government entity run itself. If a problem came up, it got swept back under the rug and not reported to higher. Secondly, and most infuriating, DC doesn’t care, period. They’re so aloof, playing the political power game, that the medical care of those charged with going to foreign lands and enacting THEIR policy, is of little concern to them. After all, it’s just numbers. It’s not their sons and daughters. It’s not them, they have access to the best medical care money and influence can buy. The VA is a taxpayer funded entity, what could possibly go wrong with all the money being thrown at it?
Now the media attention has shifted to other things, but it was brought to light last month that many of the whistleblowers at various VA facilities are being retaliated against, even so far as having their employment terminated. I see a big wig VA official, sitting back with his sweet benefits and pay, overseeing a monster that runs itself. As long as reports aren’t made about the shortcuts being taken, the documents being “lost”, and the waste being perpetrated, everyone can come to work, have an easy day, and go home with a paycheck. Then comes along that good samaritan, bringing the house down. Now he ACTUALLY has to do his job. There are suits overseeing his every move, every day, and he now has to walk the floors and make sure his subordinates are doing what they’re ACTUALLY supposed to be doing. Anyone that’s ever been in the military or worked a federal job has no doubt seen this kind of shit on a regular basis. It’s the best worst kept secret in government. You can drop the ball as much as you want and as long as no one is hurt or dies, no one cares. A patient’s record gets lost or destroyed, tough shit. Forgot to schedule a procedure? No problem, it can wait if you remember it later. There’s no REAL accountability in government jobs unless there’s a political reason.
As far as the investigation went, it resulted in Congress granting another $17 Billion this summer to fix the problem. It’s typical Washington rationale, throw money at the problem until it goes away. The more money you throw at a problem, the more it looks like you’re taking it seriously. The bill that was passed, did however, give the VA more freedom to hire and fire senior management. But ultimately, it’s rewarding the VA for bad behavior and failure. I understand how bad it would look, had congress denied the VA, standing there with a big, fat, black eye and a case of the clap, but why not nut up and address the ACTUAL problems? Incompetence, of course is a foundation, but sitting on top of that foundation are the seriously fucked up incentives related to government-run healthcare. These incentives are exactly what leads to abuse, shortcuts, and rationing of care #ThoseWaitingListsDoe
The VA provides substandard care because it can afford to. Now, it seems they’ve just got more money to do it with.
I think if the VA actually wanted to do better for our veterans, then they’d take steps to improve themselves. I think they should take an honest look at some of the cases they pay for and know beyond a doubt are bullshit. We all know there are those “welfare soldiers” abusing the system and I think following up on those claims with some honest criticism would open up doors for those who NEED care. Private hospitals do it every day. Private hospitals HAVE to be more critical or they lose money. I think there should be more oversight at ALL levels, not just the clerk sitting at the desk interacting with veterans, but the folks steering the ship too. I think if a facility isn’t equipped to deal with a critical case, they should receive a voucher to utilize a private facility of their choice. I think this should be awarded without the typical “fill out form 2756-B, mail it in to the address provided, a reply will be sent in 4-6 weeks, then a voucher will be awarded to a facility of our choosing. acceptance at a private facility does not guarantee an appointment” -crap the VA is known for. Finally, an oversight committee should set up secret shopper type stings. I know it sounds shifty, but what better way to determine the quality of care and service being provided than to send someone in under cover to receive said care or procedures and report back to the powers that be? It sounds a sight better than letting the dental unit know 3 weeks in advance of the exact date and time an inspection is taking place. Plenty of time to sterilize that equipment and burn some less than satisfactory paperwork.
In the end, my pipe dream, utopian vision for at least GWOT vets, is to see the mom and pop foundations, charities, grants, and organizations get the recognition and usage they deserve. It would be amazing to tell the the politicians in Washington, that USE veterans and our problems for political grand-standing and gain, to tell the VA, “No thanks, we got this.” I would love to see a generation of our nation’s finest, using their resources, connections, and innovations, to take care of EACH OTHER. The VA shouldn’t be an obligation, but a choice. We just need to band together, which I’ve started seeing of late thanks to social media. This allows us to demonstrate our value to each other and prove ourselves assets to society, rather than a perceived tax infliction.
In the absence of the above, the VA needs to pull their head out of their ass. However, as long as the voters and taxpayers stand idly by, the politicians will keep their heads in the clouds, and the VA will continue to do what they always have…with the same impunity they’ve always had.
After all, the only one paying any REAL price is the tired veteran sitting in the waiting room…