Health care through VA Facilities

[Bram]

With the latest scandal about the care & conditions in the Walter Reed Medical Center, I am reminded of my longstanding overall impression that VA Hospitals & Clinics, as well as the medical care itself, are often substandard to the medical care & facilities used by the general public.

I listened the other day to an interview of Bob Woodruff the ABC News journalist who was injured in Iraq. He suffered a traumatic brain injury & was immediately treated by the military medical staff at a field hospital, I believe. He credits them with saving his life. He was in a comatose state for over 30 days. IIRC, he went to Walter Reed upon returning to the USA for about 3 weeks, then because he had the option (read private insurance) he transferred to a top-notch rehabilitation facility in NYC. He has made great strides in his recovery and listening to him it sounds miraculous. He stated that most of those injured in Iraq do not have the option of choosing where they will receive their treatment, which could be far from friends & family, and that the VA System is overwhelmed by the sheer numbers of returning injured soldiers/marines needing care & treatment.

I have long thought that the VA System should be abandoned in terms of having separate physicians, clinics, hospitals, rehab centers, nursing homes and the like. The active or retired members of the military & their families could be treated within the communities where thery are stationed or live in the US. It seems to me that public & private hospitals, for example, undergo a lot more scrutiny & oversight (JCAHO, licensing, department of health reviews, etc) than does the VA facilities.

Perhaps I am naive, or just ignorant, but I just can't imagine that such deplorable conditions as were reported at WR would exist in a civilian medical facility. Our military deserves the very best of care in an efficient manner.

 

[Robert the Red]

VA healthcare was once bad, like you say, but is not necessarily lower quality any more:
http://www.washingtonmonthly.com/features/2005/0501.longman.html
The problem at Walter Reed is not acute care, but the care of those injured who are not yet discharged (not yet in the VA), but not in the bleeding-right-now stage, either. The Army is deciding whether to keep them in the military or discharge them, and they ended up shunted aside and more-or-less forgotten. Shameful, but not the VA's fault. And not a reflection on the acute care facilities of the active duty military (which have many top-flight former civilian physicians and nurses who have entered the military medical service since 9/11). Rather, it is a reflection on the leadership (right from the top, and by that I mean George Bush and Donald Rumsfeld) that allowed a bad-but-not-urgent situation to fester and fester.

 

[rs0460a]

I'll just post my own "reflection" based upon my involvement with the local VA clinic when I was going through my own screening (Agent Orange exposure and subsequent "condition").

While I found the facility good (e.g. equal to local facilities), I found the staff a bit streached in their ability to handle the workload. Long waiting times, difficulity in scheduling procedures (schedule/xcled/rescheduled - due to their workload) pales in comparison to the "civilian system".

I'm lucky that I use the "outside medical facilites" due to the fact that I'm covered by my employer (and May-1, as a retiree). However, I'll give the folks at the VA a "kudo". They have a lot of patients (mostly old, like me ) and have to put up with us "grouches"...

Yes, it could be better (of course, I'm measuring against our civilian health care system, which contains a top notch teaching hospital/facility), but I would say, for handling the direct service connected disabilites of their "patients", they could do better. However, I do realize that a lot of that is due to not funding and the limitations of congressional budget approval.

Could they do better (if all things were "equal") - Yes.

Will they do better (under the current "system" of funding) - No.

However, I do commend them for the job they do, under the circumstances..

- Ron

 

[Fireup2020]

Ditto & Amen to Robert the Red's response.

I prefer the VA to my "civilian" health care. I have changed PCP's three times trying to achieve the level of care/concern that I have become used to in the military and the VA. I have discussed this with others - and have come to the conclusion that non-Mil or VA doctors' hands are tied by the health care system - and this is why so little care is provided unless it is an emergency. If the VA thinks I need a cardio workup or lab work...they send me to whatever floor that department is on. Rather nice - instead of having to take another day off to go to a different place to get these things accomplished.

My VA care thus far ('93-96 routine care in Hampton, VA - culminating with an ER visit and an inpatient stay (3 days) - two sep incidents. '96-99' Detroit, MI - Gorgeous new state of the art hospital - great staff - routine care and one outpatient procedure....05-pres East Orange/Trenton, NJ - two ER visits, and routine care and all my service connection assessments & follow ups....so far so good.

I know many who are more than pleased with the VA system - and others at the other end of the spectrum....

I wonder if the VA just treats female patients better? Half the time the staff thinks I am here to visit "grandpa"

 

[samclem]

There's a very good article in this month's Discover magazine on health care for traumatic brain injuries (TBIs), which are far more common in Iraq than in previous wars. The bottom line: Care in the frontline hospitals is excellent--if you have a traumatic brain injury, there's probably no better place to go in the world than the military hospital at Balad, Iraq. The care in the follow-on hospitals/facilities gradually declines, but is still good. The problem appears to be in the long-term care situation. There are just not enough facilities (civilian or military) in local commnities to care for these patients. Something needs to be done.

 

[lets-retire]

I will give the VA hospital this: When they took my blood they hit the vein on the first try. No where else I've been has it happened that way. The question that I often pondered was why are they taking my blood when I am here for a hearing test?

 

[martyb]

I had an uncle who had been a prisoner of war during WWII. He had a severe case of psoriasis for much of his adult life. It tormented him terribly sometimes. I remember my dad telling me that although my uncle had been seen by numerous civilian doctors/specialists, the only place he had ever gotten any kind of relief had been at the VA hospital in Durham, NC. It was a pretty good drive from our home town to the VA, but one my uncle was glad to make when he needed to. With that being said, even though I qualify for treatment at the VA, I'll be sticking to my civilian doctors and hospitals. 30 years in the military have left me feeling that the overall higher quality of care is going to be with doctors and hospitals who practice their craft in a world of competition where they must stay on top of the latest knowledge and procedures. The military has been relatively good to me, but when it comes to my health, I'm choosing the civilian world.

 

[jazz4cash]

Although I am not a Vet and have no direct experience, I am convinced there are some real problems. The Washington Post expose continued today with the theme of "the problem is NOT isolated to Walter Reed". I live in the area and all I heard until recently was that the emergency care and rehab therapy at Walter Reed was 1st rate. The problem as Bram suggested seems to be when they are "done" with treatment, but a patient is caught between systems. The videos of the decrepit (sp) facility that you've seen a thousand times is an old MOTEL 6 across the street from the main hospital that was purchased by the Army many years ago........not to make any excuses, but it is not indicative of the facility in general and its no wonder that hundreds of VIPs have come and gone over the years without being inside "building 18".

 

[JohnEyles]

I am convinced there are some real problems.

Yeah, me too. Sad and shameful.

Does "support the troops" mean idiotic slogans, mindless "patriotism",
and not questioning the policies of our sh*t-heel of a president ?

Or does it mean pony'ing up the money to give the troops what they really
need: things like full armor on their Humvess, and the very best care if they're
wounded ?

 

[Brat]

There are problems with every system. That said my brother, a Vietnam Vet, uses the Portland facility and has received quality care. He has no major health problems and they intend him to stay that way.

 

[lets-retire]

Or does it mean pony'ing up the money to give the troops what they really
need: things like full armor on their Humvess, and the very best care if they're
wounded ?

I think even you will agree that having the Humvee in the first place is better than walking into combat. There is a weight limit on how much the logistics can carry. IIRC, an armored Humvee weighs either three or four times as much as a non-armored one, so the transport can only carry 1/3 or 1/4 the number of Humvees. The troops also still need a lot of other supplies, but if the transport is hung up carrying all of the armored Humvees then they will run short of those supplies. The short of it is, The Humvees arrive in country after a very long wait, leaving the troops to walk into combat. The re-supply chain is slowed way down, due to the armored Humvees clogging the system resulting in everything being in short supply, except the enemy. Those who are walking will lack one of the three required items for survival, the ability to move location very quickly, resulting in even more deaths, all so everyone can have an armored Humvee and be safer. :

 

[JohnEyles]

I think even you will agree that having the Humvee in the first place is better than walking into combat. There is a weight limit on how much the logistics can carry. IIRC, an armored Humvee weighs either three or four times as much as a non-armored one, so the transport can only carry 1/3 or 1/4 the number of Humvees. The troops also still need a lot of other supplies, but if the transport is hung up carrying all of the armored Humvees then they will run short of those supplies. The short of it is, The Humvees arrive in country after a very long wait, leaving the troops to walk into combat. The re-supply chain is slowed way down, due to the armored Humvees clogging the system resulting in everything being in short supply, except the enemy. Those who are walking will lack one of the three required items for survival, the ability to move location very quickly, resulting in even more deaths, all so everyone can have an armored Humvee and be safer. :

I'm not even going to try responding to this. I don't think it's necessary.

 

[eridanus]

I'm not even going to try responding to this. I don't think it's necessary.

Wow. No kidding.

 

[lets-retire]

I'm not even going to try responding to this. I don't think it's necessary.

I know, it's difficult to argue when you're disagreeing the correct answer.


MODS: I won't say anything else about this in this thread. Now back to your regularly scheduled thread.

 

[JohnEyles]

I won't say anything else about this in this thread.

Me neither - this sort of thing belongs in 'Other Topics'. Sorry.

 

[ellenjoan]

To be exact, Walter Reed is a Department of Defense hospital, not a VA hospital.

 

[Bram]

To be exact, Walter Reed is a Department of Defense hospital, not a VA hospital.

I didn't know that Ellen! As I have listened to more of the discussions I learned that I had the misconception that all military medical care was thru the VA, that military hospital doen't =VA hospital.

Now Pres Bush has appointed Bob Dole & Donna Shalala to head a probe into problems with military care. The pic I saw of him on the news, Dole was looking rather frail. I can just see this 84 yr old traipsing around inspecting hospitals. : Oh, that's right he's a wounded veteran, thus an expert!

Why do they have to reinvent the wheel? There are mechanisms in place to inspect, measure & certify quality care for private & community hospitals. Nothing is ever that simple tho', is it!

 

[RP]

An interesting discussion here. Some points:

1.> Interesting how so many people don't even know the difference between the VA and the DoD ... especially the media. Not meaning this as a dig, merely an observation on how our US school systems, media and life experiences in general have marginalized our military over the 40 plus years that I have been associated with it. We, as a nation, expect our military to not only be the best in the world at what the military is designed to do .. defend against an enemy attack, but also to do the nebulous, non-military things like impose our US model of democracy on others. And when they get hurt, we don't fund the hospitals they need for care.

2.> There will always be problems with any large organization trying to deliver health care. The difference between a leader who is on top of the situation and one who is asleep at the switch is how the leader monitors and reacts. I have a great deal of admiration for Bob Dole ... but to think he is the most effective investigator is a stunning act of either ignorance or a deliberate attempt at obfuscation. I would be much more impressed with a team leader who knew something substantial about medicine as well as health care administration. How much do you really think a person of Dole's visibility is going to "see" that senior leadership doesn't want him to "see"?

3.> The media has missed again the opportunity to point out one of the real root causes of problems in both the military health care system and the VA. Funding. The current administration, for reasons I can not comprehend still has both organizations running on a continuing resolution status. This means in practicality that a hospital administrator can't even by toilet paper if s/he has already used the same number of rolls used up by this time last year. The existing federal budgetary system is already a joke since the fiscal year effectively is only about 9 months or so ... but it's now into the 5th month of FY 2007 and the VA, for example, still doesn't have a budget. VA Clinics can't even issue many routine maintenance prescription to vets because of this sheer lack of caring for either the patients or the asministrators, military and civilian who have to labor under this artificial burden.

Sad.

 

[dumpster56]

I have great respect for what bob dole did for our country, however he is another white old fossil that is out of touch with the mess that we now have. An overwhelmed defense department medical system. Wounded men and women with lost arms and legs, damaged skulls from the mess in Iraq and so we send more young american boys into the mess .

Makes alot of sense. But then again americans have had the kool aid bush and company poured them. If we don't fight them in Iraq they will come here. Uh are we gonna stay in Iraq forever? These people are gonna want to blow up others for another 50 years.

Nice job gang.

 

[lets-retire]

I have to say the decline started along time before Bush II. I'm not saying he isn't to blame for at least some of the problems, but when the government decided to start cutting the military, medical was one of the major items cut. It is very expensive to keep doctors on the payroll to do little, so they are cut. Families can still use the medical facilities on a space available basis, but that is military speak for families go downtown, because we are swamped with the military members. This during a relatively low operations tempo period. With the high tempo now the military hospitals, that were cut under Bush I and Clintoon, are overwhelmed.

As far as the VA goes, I don't ever remember them not being overwhelmed.

 

[Fireup2020]

RP - Great post on your item #1....I too am amazed when people think the military hospitals are VA hospitals and vice versa.

Military members typically are not eligible for VA care (they are still servicemembers - not veterans yet) except in RARE cases (stationed in remote areas - with no base nearby - often the case with recruiters)

There is often a huge difference in the care provided - the military is looking to keep the troops healthy and reassembled - and the VA is busy keeping us running after the military mashes us up!

Like I said earlier, my military and VA healthcare has been pretty da#n good so far!