I don't intent to appear to be picking on the VA's medical care but I really can't help myself at this point from writing about (against) a medical system that is in need of a complete rebuilding...not just some improvements at the margins. I have seen good and bad at the VA during the last 5 years but recently I have witnessed or been told about such egregious occurrences that I feel the need to dedicate another post to the VA. See last week's article here.
For the past month or so, my friend's father, who just turned 90, has been declining precipitously. His father used to go the health club at least 3 times a week and the last month he was completely lethargic and only wanted to stay home. My friend told me last Saturday that his father was entering a new and difficult health stage and I told him although it is possible to quickly decline, I tended to doubt that there wasn't an underlying cause to his decline. I told my friend to have his father checked out for a urinary tract infection (UTI) (or other possible infections) because I remembered that his father had become lethargic a few previous times and it ended up he had UTI's. He told me that he doesn't need to have his father checked out because he had brought his father to the VA to see his physician on June 22, 2012. I told him that he better check it out anyways because the infection could have come right after the lab work was done or that the VA is incompetent and they forgot to let him know that there is a problem.
My friend contacted his dad's non-VA physician who took a urine specimen. Low and behold, it showed that his father has a UTI and he is now on an antibiotic and his energy level is beginning to rebound.
Then, this afternoon, his father's VA doctor called with results from the June 22 appointment (4 weeks ago) and the doctor tells him that his father had a UTI. My friend told the doctor that he already knows about it and his father is being treated. This specific healthcare provider at the VA is extraordinarily negligent. But is this incident an anomaly at the VA or a pattern...I am beginning to think it is a pattern. My friend's father suffered needlessly for an extra 3 and a 1/2 weeks.
People love throwing around buzzwords relating to healthcare like Accountable Care Organizations (ACO's) and continuity of care.
President Obama, you already control the VA Medical System. Is this system to be revered and glorified? Practice what you preach. Add real accountability into your healthcare organization, not just some joke government plan which makes it look like there is accountability while veterans are being treated with negligence and an overall lackadaisical attitude.
If not, maybe the government should look into closing VA medical centers and allowing veterans to go to the healthcare provider of their choosing by issuing them Medicare type cards which will allow healthcare providers to be reimbursed for treating veterans similar to the manner in which they are reimbursed for seeing senior citizens.
The VA health care system has been in turmoil since my first experience with the agency as a provider in 1970 at the Kansas City VA. Of course, that was at the time numerous veterans were returning from the Vietnam War. Oh, excuse me it was officially a 'POLICING ACTION'. My role as a psych contractor was to provide substance abuse, including alcohol abuse treatment.
ReplyDeleteThe first issue was that the VA administration in Washington and at hospitals throughout the country despised Vietnam vets who had substance abuse issues. Initially I thought the problems and snafus in getting each veteran processed through the basic intatke medical examination and laboratory completed came about due to the general dislike of the veteran group we were to serve.
Certainly, we had our problems in the system because of our clientel. However, the screening and admission issues were and continue to be epidemic throughout the system. The unconscionable delays in getting even the most routine processes completed were frustrating for us as clinicians but devastating to the veterans and their families.
There have been number overhauls, supposedly, of the system in the last 42 years. None have been effective. There is a culture of laziness within the system, a institutional lack of concern for veterans needing and seeking care. The system is too large and cumbersome. Improvement of access to care, quality of care, and consideration of the patients being served gets lipservice. Remember, "Lipstick on a pig"? this is it.
The VA must be regionalized into patient populations areas with similar veteran numbers. Authority must be de-centralized. Clinical decisions must be delegated to competent clinicians without waiting for authorization from the grid-locked management bureaucracy.
People are suffering and dying needlessly. And, by the way, mental health and substance abuse diagnoses are still very stigmatized within the VA.