War Wounds Are Not The Stuff Of Mickey And Minnie

Posted on Thu 05/26/2016 by

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20090506_mcfee_2009By Dr. Robin McFee ~

20160525_disneyVAveteransmcdonald2016Comparing the disastrous, dysfunctional and damaged Veterans Administration (VA) to Disneyland only makes sense in Fantasyland.  Such was a key component of the message conveyed by, and that apparently was important to the latest Secretary of the VA – Bob McDonald. He was speaking at a Christian Science Monitor breakfast in Washington, DC just days ago when he tried to downplay wait times veterans must endure to obtain medical care from the VA, using a comparison with Disney. To everyone’s horror, except apparently the Secretary or his speechwriters and supporters (Daffy, Daisy, Pluto, Dopey and Grumpy), the blow back has been swift and loud, as it should be. Let me allow you to decide. Here is his full statement:

“When you go to Disney, do they measure the number of hours you wait in line? Or what’s important?” “What’s important is what’s your satisfaction with the experience.” “And that’s really the kind of measure I want to move to”, he said.”The days to an appointment is really not what we should be measuring”. “What really counts is how does the veteran feel about their encounter with the VA”, he said. McDonald continued to say that the “create date” metric, which measures how long a veteran has to wait from the moment they first ask for care, is not a “valid measure” of wait time. In March, the Government Accounting Office released a report citing delays in treatment for newly enrolled veterans.

Days to an appointment DO matter if you have a time critical illness. Call me crazy, but that’s kind of a basic thing we learn in med school. Just sayin!

One has to wonder what on earth the Secretary been doing these last 2 years in terms of revamping the VA. One has to hope he is not resting all the hopes and fears of wounded and damaged veterans on how a veteran “feels” about his or her encounter, on the off chance they can obtain medical care before the coroner is called. OK that was maybe a tad harsh. But seriously – 2 years on the job, with tons of cash at his disposal, and still the VA fails too many veterans on a daily basis. And these are people who NEED help.  Secretary McDonald – this isn’t rocket science. Come on…three guys with slide rules and prehistoric computers brought back Apollo 13 from over 100,000 miles in space in less than a week. You had 2 years to institute change that would matter. Yet you are still relying on more studies? Give me a 100 billion dollar budget, and I would wager 10 of my best med students could come up with serious, effective solutions quicker.

Although not a newsflash to readers at FSM, the VA has been fraught with problems for years, with cover ups galore, and a government only too happy to toss more money at the issues instead of insisting upon real change. In recent times the dysfunction has become all too deadly for far too many veterans. Yet we continue to toss money at the VA without better outcomes. Consider for a moment that the annual budget for the VA is over $160,000,000,000. That’s the equivalent of 16 Donald Trumps, or several US states combined. But what has this largesse purchased for our vets? According to the NY Times and other sources, estimates as high as 100,000 veterans are denied critical services in a timely manner. And when anyone has the temerity to put restrictions or expectations for better outcomes as conditions for funding, the usual suspects cry injustice (government unions, politicians).

One would have expected even in Washington that many misdeeds and scandals that plagued the VA in 2014 were remedied. Dare to dream. Arizona VA is still corrupt, the perpetrators received a slap on the wrist or were mostly shuffled to other positions instead of shown the door, or sentenced to time in ‘the house of many doors,’ where they belong.

In a National Review article http://www.nationalreview.com/article/433760/va-still-unreformed by Pete Hegseth (April 2016), the VA’s own inspector general recently found that over half of VA medical facilities investigated still use “improper scheduling.” On the benefits side, while the number of backlogged disability claims has come down, the wait for first-time applicants remains, on average, 389 days; it’s over 770 days in Baltimore and 630 days in Boston. Meanwhile, the backlog for appealed claims has skyrocketed to over 255,000 – and most of the veterans on that list have been waiting upwards of three years.

That is just a tiny snapshot of the many problems in the VA. To cover all the major problems foisted upon our veterans by the VA would require a Manhattan phone book sized article.

Veterans are still dying waiting for medical care. So much for the outcry and Congressional inquiries of 2014 and 2015. Just another game of government three card monte.

Those in the military recognize the risks associated with life in the service, on the battlefield, and that the enemy wants to do them harm; what our veterans don’t expect is being vulnerable at the hands of those entrusted to treat them upon returning home. Perhaps the Secretary of the VA was a tad confused in his analogy. Let’s be clear…wearing the uniform while deployed in dodgy places across the planet is not the same as wearing a costume, sauntering down the Disney streets of Tomorrow-land, Main Street USA, or Fort Wilderness. While not saying the current (tick tock tick tock?) VA leader suggested warfare was the same as waiting in line to ride Splash Mountain, nevertheless his analogy was flippant, self-serving (a not uncommon activity in VA Land or Obama Land), and serves more as a distraction than as segue to the issue of quality medical care. On that topic, the VA can’t do much bragging either.

The Secretary tries to sell the point that wait times are not critically important. The Secretary was using his own hand magic with the audience. If wait times were not important, one wonders why virtually every major provider of medical care includes that as part of their endpoints to measure. Though not a surrogate for quality per se, it is an indicator how well the enterprise is functioning. The Secretary has invoked the IOM on wait times. Their report likely relied upon VA supplied data, which makes it appear the wait times are not significantly different from private health care. One has to wonder did the VA give to the IOM data from the cooked books or real ones. You be the judge! But if investigative reporting from CNN, USA Today and other high profile news sources are to be believed, multiple VA hospitals continue to doctor their data. Too bad the VA doesn’t spend as much time doctoring their patients.

On a personal note, I’ve done some time at the VA in various roles, from a rotation in my early training to WMD and preparedness collaborations. So my comments are not to indict all members of the VA system. The directors I met and worked with truly cared about the veterans; some wore the uniform themselves, and understood what it was like to serve. I also interacted with people who, in the private sector would, and should have received the proverbial pink slip. So let me share a few other things that became immediately apparent during my times at various VA facilities.

First – our veterans deserve much better than what we provide for them. We as a nation made a promise to care for our veterans, and look after their families through a variety of health care programs. And in no small measure we have failed. These men and women who sacrifice so much for our country – you and me – are damaged, yet remain appreciative, and from stethoscope level, they are the salt of the earth. They rightly expected some protections beyond a pretty sound bite from politicians, and a government brochure bragging about the extensiveness of the VA health system. We treat our welfare recipients, even illegal aliens better, providing greater access, options and quality. A welfare recipient can saunter into any tertiary care health care facility and get top notch care at the ER or other specialty care. And usually at no cost (well you and I pick up the tab).

Second – beautiful buildings are not guarantees of good medical care, especially if those buildings are off the beaten path, difficult to access, are under-staffed, and full of overburdened health care professionals. The culture of corruption in the VA spent billions of the extra funds Congress voted since 2014 and over the years before then – on things that don’t really enhance quality, access or cost – like interior decorating, and nice offices!

Third – Leadership and the bureaucracy. As witnessed by the various administrators, undersecretaries, and pooh bahs at various VA centers (who should have their given names replaced with “Alleged” and indicted or fired) they have cooked the books, while our veterans suffer in the aftermath. There is much too much of the practice of shifting around crappy employees because they can’t be fired (government employees), placing them in roles they are ill equipped for, and ultimately become arrogant, obstructionist barriers to things being done in a timely manner. This is as true for the top brass (Politics and the Peter Principle) as the lower echelon employee. It is a lousy way to run an organization.

Fourth – politics and cronyism.

Fifth – it is a government enterprise. Red tape is everywhere. Were the tape yellow, the entire enterprise would look like a crime scene. Oh wait – Arizona VA qualifies for that, as they run double books on their activities, while needed medical care is delayed (until the patient dies?) or not rendered at all.

Sixth – purchasing is antiquated. Consider the electronic medical records the VA touts as top flight – yeh if you are in Zaire or another third world country. Think the online equivalent of a dot matrix printout that threw up. The records are virtually unintelligible, with repetition that would make the Kit Kat candy bar commercial seem like a vacation to the senses compared to the painfulness of reading a VA patient’s medical file. Plus it takes years in the procurement process to obtain technology that once set up, is already outdated. Welcome to government – it is not unique to the VA.

Seventh – most of the physicians, nurses, PT/OT – rehab specialists, and other health care professionals do care about the veterans, their patients. But given the hassle of working in a government medical facility (Think Obama fairy tale “if you like your doctor you can keep him”), where everything is layers upon layers of burdensome barriers that only a government run enterprise could conjure…not exactly the best environment, or great recruiting tool to attract the best and brightest. Plus patchwork care – outsourcing specialists and other important assets occurs.

If you want to know what government run healthcare looks like (unless you are in Congress) check out the VA. It is the prototype for what Obama and the ultra left plan to do with the rest of US healthcare – Obamacare being just the beginning. So if the idea of bureaucrats stacked to the ceiling and in control of your health turns you on, you will love the VA. Personally I prefer private healthcare, imperfect, and in need of repair though it is.  

While those who worship at the altar of government will bristle at the notion of privatizing or dramatically redesigning the VA, the fact remains if you don’t change it from the bottom up and the top down, veterans will continue to be caught in a deadly crossfire of politics and incompetence. While most of the physicians and nurses I know who work for or consult at the VA are competent and care about the mission, not to mention deliver good care (once the veteran/patient can get seen) as anyone who has ever dealt with leviathan sized organizations recognizes it takes a committee and act of God to get anything done. And usually the most useless of team members are the most protected – by union or patronage.

Government is not the solution for all of society’s ills. Unfortunately there is a growing percent of our fellow countrymen who believe government is the answer. I’m not sure government even understands the question.

Discussion

Some might suggest the VA is too big to fail. I would argue it is too big to succeed.

How do we improve the healthcare we promised our Veterans? For the scope of this article we will focus on the broad strokes. An enterprise as large and monolithic as the VA with the umpteen moving parts will require lots of strategies. There is no quick fix. Money alone won’t do the trick. But in the shadow of Memorial Day, this is the season to remind our elected officials, especially before their summer vacation, and while we are in a presidential campaign season, to loudly support our veterans.

Political leadership – from POTUS and Congress across both parties is essential. But lobbying efforts and political ideology remain powerful barriers to VA reform.  Special interests benefit from the status quo. That’s where you and I come in. We bury our elected officials with our advocacy.

Clearly major reforms are needed. This includes giving our veterans choice. Real choice, not the paper one from last year that was full of restrictions, could be costly, and mired in VA obstructive policies. Veterans ought to be able to avail themselves of the same quality care, in their own communities, that the rest of us can. Instead we force them into geographically spaced centers, some isolated, some not, but clearly distinct from the healthcare nonmilitary citizens can access. Let me repeat myself – we afford welfare recipients more options than veterans in real world terms.

Although “private” is anathema to the ultra left in terms of the VA, it is worth considering. Could things truly get worse by lessening the influence of government – including breaking up the bureaucracy, as well as both political and union strangleholds on the VA?

It might be nice to let physicians take a greater role in directing the bigger picture of the VA; that would be a novel thought….letting health care professional run health care.

Hegseth suggests holding officials more accountable would be an important step towards improving VA performance. No doubt, but good luck with that, if past performance informs future expectations.

Some might argue – incorporate the local VA into a successful private health care system, and restructure so that outcomes, not politics dictate change. I would argue we give the Vets the military equivalent of a private insurance card like what you and I have, or just let them go to any health care system that is convenient, instead of dealing with a middle man.

Regardless of the revamping, we must stop the culture of corruption that is institutionally protected at the VA. Imposing real consequences to bad leadership is a no brainer. Even Dopey and Sleepy would recognize that!

Or maybe Secretary McDonald was offering a solution – let Disney take over the VA. They could do no worse than Uncle Sam has done.

Conclusion 

To be sure there are many successful VA programs and thousands of health care professionals working at VA facilities that tirelessly, admirably and effectively deliver quality services to veterans. But there is a chasm between the best and the worst performers.  

War wounds are not the stuff of Mickey and Minnie. While the VA may not be Disneyland, it is increasingly appearing to act like a “mickey mouse” enterprise. Secretary McDonald invoked the ire of those who rightly are growing impatient with the state of healthcare we provide to our veterans. There are elements of the VA that remain corrupt dysfunctional enterprises that perennially reveal new scandals, and seem to worsen with age, failing to fundamentally address the ills endemic in the organization, and relie upon an annual redo to try again to get it right. At what point do we as a society tell the VA ‘enough is enough…get your house in order or we will?’ And when we finally decide to do so, we won’t be singing “it’s a small world” or whistling a happy tune!  Maybe it is time for us to put Secretary McDonald on Mr. Toads Wild Ride.

UPDATE

Before this was posted, Secretary McDonald apologized for his Disney comparison, and comments at the CSM meeting.

FamilySecurityMatters.org Contributing Editor Dr. Robin McFee, MPH, FACPM, FAACT, is medical director of Threat Science – and nationally recognized expert in WMD preparedness, who consults with government agencies, corporations and the media. Dr. McFee is the former director and cofounder of the Center for Bioterrorism Preparedness (CB PREP) and bioweapons – WMD adviser to the Domestic Security Task Force, numerous law enforcement and corporate entities after 911, as well as pandemic advisor to federal, state and local agencies, and corporations during the anthrax events, SARS, Avian and swine flu epidemics. Dr. McFee is the former chair of the Global Terrorism Council of ASIS International, and is a member of the US Counterterrorism Advisory Team. She has delivered over 500 invited lectures since 9-11, created graduate level courses on WMD preparedness for several universities, authored more than 100 articles on terrorism, health care and preparedness, and coauthored two books: Toxico-Terrorism by McGraw Hill and The Handbook of Nuclear, Chemical and Biological Agents, published by Informa/CRC Press.

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