Scandalous conditions at VA hospitals are nothing new

WASHINGTON — The scandal that has exploded in the government’s veterans hospitals runs a lot deeper than the issue of long waits for those seeking medical care.

And it’s been going on for a great deal longer, too, as a mountain of Government Accountability Office (GAO) audits can attest over many decades: countless reports of medical mistreatment; dangerously lengthy delays for ill veterans seeking care; shocking mortality rates when compared with private-sector hospitals for similar surgeries; old, rundown facilities; and aged, broken medical equipment.

These and other problems in the Department of Veterans Affairs’ vast bureaucracy have been exposed in a sea of reports now gathering dust in congressional oversight committees that have failed to effectively address their findings.

Lawmakers at Senate hearings last week were beating their breasts over reports of veterans facing long treatment delays that have resulted in numerous deaths. We still do not know how many, because of recent stories that the real numbers have been covered up.

Still, the fact remains that Congress has not done its job to see that VA programs, staffing, facilities and equipment are adequately funded and reforms enacted across the entire VA landscape. It’s been asleep at the switch.

Nor has the Obama administration done anywhere near the due diligence needed to see that VA has the resources to adequately care for the thousands of soldiers returning home from the Iraq and Afghanistan wars.

But the tragedy of this latest VA scandal is that we keep making the same mistakes over and over again, and never learn from them.

Let’s go back seven years ago when Washington Post reporters — after exposing shockingly shabby, unhealthy conditions at Walter Reed Hospital — found many of the same problems existed throughout the VA’s organization.

On March 5, 2007, reporters Anne Hull and Dana Priest told the story of 70-year-old Ray Oliva, whose “own VA hospital … was a mess. The (hospital) gown he wore was torn. The wheelchairs were old and broken.”

“It is not just Walter Reed,” Oliva told them. “The VA hospitals are not good either except for the staff who work so hard.”

The veterans in his VA facility, he said, “had to ask for beds that had good mattresses instead of broken and old.”

“I sat with guys who’d served in ‘Nam,” Oliva said. “We had terrible problems with the VA. But we were all so powerless to do anything about them.”

“Across the country, some military quarters for wounded outpatients are in bad shape, according to interviews, GAO reports and transcripts of congressional testimony,” Hull and Priest reported at the time.

“Among the most aggrieved are veterans who have lived with the open secret of substandard, underfunded care in the 154 VA hospitals and hundreds of community health centers around the country,” they said.

Now, veterans are coming forth yet again, telling horror stories of lengthy delays for time-sensitive treatment, and reports that for too many, that treatment has come too late.

I recall a more shocking situation when I was writing about GAO investigations in the 1970s and 1980s that told of higher than normal fatality rates in VA hospitals.

Anyone who thinks this problem has been fixed should read a study published in the American Journal of Public Health in December 2007. The grim title of this report, by a team of medical specialists, says it all:

“Reducing Avoidable Deaths Among American Veterans: Directing Private-Sector Surgical Care to High-Performance Hospitals.”

What this study recommended was simply letting our veterans have their surgery done at top private hospitals, which would not only give them better, more timely medical care, but in many cases save lives, too.

The study focused on 14 high-risk surgical procedures such as coronary bypass or carotid artery operations, and its findings were striking.

If these patients “had been directed to historically high-volume centers for their procedures, expected mortality would have decreased by 6.7 percent … potentially saving 376 lives” over the two-year period of the study.

“Directing private-sector care to medical centers with a history of low risk-adjusted mortality would have decreased expected mortality by 10.1 percent,” potentially saving 584 lives.

In either case, the study concluded that the VA “should consider focusing quality improvement efforts” on the care that veterans receive in the private sector, “particularly for the high mortality procedures” that veterans often undergo as they age.

The study added that VA hospitals have “a commitment to provide safe, high-quality care to its enrolled population. One effective mechanism to meet this obligation is to help ensure the quality of care provided to veterans outside of (VA hospital) walls.”

But there could be far more sweeping solutions to the VA’s continuing failures within the confines of this study. Let our veterans choose which hospitals they want to entrust with their care, perhaps under a voucher system financed by the government.

I once put this idea to Colin Powell during an interview for American Legion Magazine not too long after he had retired as chairman of the Joint Chiefs of Staff.

Powell told me that our veterans, who may have no other option but to go to VA hospitals, should be given the freedom to choose other medical institutions for needed surgery or other treatment.

The implicit proposal in the 2007 study in the American Journal of Public Health to let veterans have this choice deserves to be taken up in Congress. But it probably won’t happen without a fight.


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