VA 'significant and chronic system failures'

This was the headline

Scathing VA review finds 'significant and chronic system failures'
By Richard Simon
Los Angeles Times
Published: June 28, 2014

WASHINGTON—The VA suffers from “significant and chronic systemic failures” that must be addressed by department leadership, according to a White House report delivered to President Barack Obama on Friday, giving urgency to congressional legislation aimed at reducing veterans’ wait times for health care and holding officials more accountable.

Among the problems cited are a “corrosive culture” that has led to personnel problems within the Department of Veterans Affairs, exacerbated by poor management and a history of retaliation toward employees raising issues.

The report is the latest stinging assessment of the VA, which operates 1,700 hospitals and clinics.
read more here

But to us, we know none of this happened overnight. It began with the failure of politicians to prepare for the wounded two wars would create and manage to care for the veterans from past wars still unable to get the care they needed.

Medically unfit forced to fight
43,000 unfit troops sent to war

More than 43,000 U.S. troops listed as medically unfit for combat in the weeks before their scheduled deployment to Iraq or Afghanistan since 2003 were sent anyway, Pentagon records show.

Most of the nondeployable service members are in the Army, which is doing most of the fighting in Iraq and Afghanistan. Between 5 percent and 7 percent of all active-duty, National Guard and Reserve soldiers slated for combat were found medically unfit due to health problems each year since 2003, according to statistics provided to USA Today.

That was from USA Today in May of 2008. The following month the UK reported they had 10,000 medically unfit forced to fight.

Nearly 40% of Army suicide victims in 2006 and 2007 took psychotropic drugs like Prozac and Zoloft.
That was what was going on in the DOD but in the VA, it was worse as more needed care.
Why might troops be medicating themselves? Well, consider that repeated deployments to the war zones also contribute to the onset of mental-health problems. Nearly 30% of troops on their third deployment suffer from serious mental-health problems, a top Army psychiatrist told Congress in March. The doctor, said that recent research has shown the current 12 months between combat tours “is insufficient time” for soldiers “to reset” and recover from the stress of a combat tour before heading back to war.

The DOD failed the troops first and then the VA failed them as veterans because members of Congress did not pay attention and failed to do their own jobs.

Snapshot of How VA Budget Shortfall is Hurting Veterans’
Prepared by the Democratic staff of the House Veterans’ Affairs Committee
Access to Safe and Timely Care across the Nation

The VA claims that by shifting funds dedicated to replace old equipment and conduct maintenance the department can address its budget shortfall and meet veterans’ demand for timely, high–quality health care. The following snapshots from across the nation reflect the stark reality of the budget shortfall on veterans’ access to safe, high quality care.

The 3 surgical operating rooms at the White River Junction VAMC in Vermont had to be closed on June 27 because the heating, ventilation, and air conditioning system was broken and had not been repaired due to the siphoning of maintenance funds to cover the budget shortfall.

The VAMC in San Antonio could not provide a paraplegic veteran with a special machine to help clean a chronic wound because the facility did not have the equipment dollars.

The VAMC in Lebanon, Pennsylvania, closed its Geriatric Evaluation and Management Unit which does extensive case management to help elderly veterans increase their functioning and remain at home.

The Community Based Outpatient Clinics (CBOCs) needed to meet veterans’ increased demand for care in the North Florida/South Georgia VA Healthcare System have been delayed due to fiscal constraints. The Gainesville facility has made progress in reducing its wait lists, but as of April there were nearly 700 service-connected veterans waiting for more than 30 days for an appointment.

VA Medical Centers in VISN 16, which includes Arkansas, Oklahoma, Mississippi and Louisiana and part of Texas, have stopped scheduling appointments for many veterans who are eligible for care, pending available resources.

Even though the VA Palo Alto, California, Health Care System has used $3 million in capital funds for operating needs, as of March 1 more than 1,000 new patients had to wait more than 30 days for a primary care appointment. A third of these new patients had to wait more than 3 months. More than 5,000 patients had to wait more than 30 days for a specialty care appointment. Roughly 1,400 had to wait more than 3 months.

The replacement of the fire alarm system at the Loma Linda VAMC in California won’t be done this year because the facility is using most of its capital funds to cover operating expenses.

The White River Junction VAMC in Vermont struggling with a $525,000 shortfall in its prosthetics budget.

Because the FY 2005 budget is inadequate, the facility has not been allowed to hire 3 additional mental health care staff and 3 additional Registered Nurses for the ICU. Nurses in the ICU have been forced to work double shifts, which this Committee has found to be an unsafe patient practice.

Even though the San Diego VAMC expects to exceed its goal in medical care cost collections, it will divert $3.5 million of non-recurring maintenance funds to partially cover operating expenses, and has delayed filling 131 vacant positions for 3 months. The facility has a waiting list for patients of 750 veterans.

Because the Iowa City VAMC had to shift maintenance funds and equipment funds to cover a FY 2004 million shortfall of $3.2 million in medical care expenses in FY 2004, the facility is facing severe infrastructure problems and a larger shortfall of $6.8 million in FY 2005 that puts patient care and safety at risk. The facility wanted to spend $950,000 in non-recurring maintenance funds last year to prevent a mechanical failure of the electrical switcher, which would close the facility, but was required to use those funds to cover a budget shortfall in medical care last year. As a result in FY 2005, the VA must divert $1.5 million of medical care funds to maintain the key electrical switchgear for the hospital.

Recently, a motor failed on a hospital bed, which the VA planned to replace but couldn’t because of the shortfall, causing a fire with the patient on the bed. Fortunately the patient was able to get out of the bed safely, but the facility was forced to expend $700,000 of medical care dollars to replace all the beds, which thanks to the diligence of VA staff lasted 7 years beyond their life expectancy. The facility could not use capital funds to replace the very old beds because the money had already been siphoned off to cover medical care.

To bring the shortfall down to $6.2 million the facility has delayed hiring staff for 4 months. The deliberate short staffing of nurses on the psychiatric ward – as a means to correct the budget shortfall -- has forced the VA to cut the beds available for treatment in half.

As a result of cost cutting measures to make up for the shortfall in FY 2005, the Portland, Oregon, VAMC is delaying all non-emergent surgery by at least six months. For example, veterans in need of knee replacement surgery won’t be treated because of the budget shortfall.

Since FY 2002, the Portland VAMC has had to use its equipment and non-recurring maintenance funds to cover medical care expenses. For FY 2005 the facility needed $13 million for medical and clinical equipment but only received $2 million.

The facility is reducing staff as a cost-cutting measure and is now short at least 150 hospital staff, including nurses, physicians, and social workers. As a result of budget cuts for staffing, the VA has cut the number of medical beds available to care for veterans.

Veterans in need of outpatient psychiatric treatment at the Portland facility are on a waiting list because of the budget shortfall.

The Biloxi, Mississippi, VAMC has diverted maintenance dollars to meet operating expenses for the past two years but the facility will not be able to balance its budget without reducing staffing levels at a time when the Gulf Coast Veterans Health Care System has approximately 100 new veterans seeking enrollment each week.

Fifty percent of all the veterans receiving home health care through the San Antonio VAMC will now have to fend for themselves. This cost-cutting measure means that some 250 veterans, including those with spinal cord injuries, will no longer be provided this care.

The VA Connecticut Healthcare System is facing a major budgetary challenge of sending veterans to non-VA facilities for hospitalizations because the VA has a shortage of beds to care for veterans and staff.

Due to the budget shortfall, the VA facility in Bay Pines, Florida, has been forced to put veterans who have a service-connected illness or disability rating of less than 50% on a waiting list for primary care appointments. As of late April, some 7,000 veterans will be waiting longer than 30 days for a primary care appointment.

Can we stop pretending this is new? Unless we do, nothing will ever be fixed for real. They talk about being able to send veterans to outside doctors. That practice was going on in the 90's. When the VA didn't have enough doctors available, they outsourced.

Can All Veterans Enroll in VA Health Care?
Not every veteran is automatically eligible to enroll in VA health care, contrary to numerous claims made concerning “promises” to military personnel and veterans with regard to “free health care for life.”

Eligibility for enrollment in VA health care has evolved over time. Prior to eligibility reform in 1996, all veterans were technically eligible for some care; however, the actual provision of care was based on available resources.

The Veterans’ Health Care Eligibility Reform Act of 1996 (P.L. 104-262) established two eligibility categories and required VHA to manage the provision of hospital care and medical services through an enrollment system based on a system of priorities.6 (See the Appendix for the criteria for the Priority Groups.) P.L. 104-262 authorized the VA to provide all needed hospital care and medical services to veterans with service-connected disabilities; former prisoners of war; veterans exposed to toxic substances and environmental hazards such as Agent Orange; veterans whose attributable income and net worth are not greater than an established “means test”; and veterans of World War I. These veterans are generally known as “higher priority” or “core” veterans. The other category of veterans are those with no service-connected disabilities and with attributable incomes above an established “means test.”

You can read more about this from the link above. I knew about it because in the 90's my husband's claim was tied up for 6 years. He had to have a private doctor evaluate his condition as part of the claims process. They didn't have enough psychiatrists back then either.

Not much has changed and that is the most revolting thing of all.