The latest health care “scandal” involves the Veteran’s Administration, and what most physicians have known for years. The VA is the place where our military veterans go for health care when they have to, not when they want to. I trained at the Bexar County Hospital in San Antonio, Texas, and the Audie Murphy VA, which was right across the street. That was thirty-five, plus, years ago. The same residents and the same faculty were on staff at both facilities, but the rules were hardly the same, even back then.
The VA seemed to exist for those government employees who worked there, or typically only acted as though they were working. The clinics were horribly inefficient and were only surpassed in their lack of discipline by the nursing units. Getting anything done required forms to be filled out in triplicate and submitted through the appropriate channels, very military style. This included even getting an emergent blood test.
I recall vividly an example of how things “worked” in the VA. One evening I had a patient who was an alcoholic with a severe upper GI bleed. His blood pressure was dropping, so I ordered a STAT hemoglobin and hematocrit, a blood count to check on his level of anemia, but his nurse was on her lunch break. So, I drew the blood sample myself and hand carried it to the lab.
The massive laboratory was located in the basement, and required me to negotiate two locked doors, accessible only with the proper VA issued name badge. Once I made it through the security system the lab looked deserted. It was 9PM and none of the lab stations were occupied by the usual technicians. Finally, I found a guy, about thirty years old, sitting at a table in the corner, eating a sandwich. When I ask where everybody was, he said, “I’m it.” I told him I had a STAT H&H, and he said, “Just sit it over there on that table with the paperwork. I’m on my lunch break right now.” He didn’t seem the least concerned that there was a patient in the ICU who was actively bleeding. When I asked him how long it would be, he casually turned and looked at the clock on the wall, then said, “I’ve got another twenty minutes, and then I’ve three other STAT orders ahead of yours. So, it will be at least forty-five minutes.” I was furious! Didn’t this guy realize a patient’s life was in danger? When I threatened to report him, he simply shrugged and said, “I’ll get to it as quickly as I can,” then returned to his sandwich and soft drink.
Employees in the VA appeared to be immune from discipline. I was told that to get rid of someone who has achieved a G-12 or higher status was virtually impossible without an act of Congress. I’m not sure that was true, but clearly the employees didn’t seem terribly concerned about prospect of being reported to their superiors. I encountered a number of similar situations during the five years I rotated on various surgical services at the VA, and each time, my outrage was met with the same complacent attitudes. The philosophy was so infectious that virtually all the residents seemed to adopt a similar attitude when assigned to the VA. The only saving grace was they fact that the receiving department rarely took in true surgical emergencies. If they had, the results would have been disastrous.
The facts surrounding this current VA scandal comes as no surprise to anyone who ever worked in one of their facilities. I’m not certain there is a solution, but I suspect we’ll see some highly publicized reaction from this administration, after which the media will lose interest and things will quickly settle back into the status quo. The shame of it is that most patients in the VA system would prefer not to have to travel hours from their homes to obtain care that is far less efficient than they were promised. Our brave men and women who served us admirably deserve better.
Our government knows very well how to wage war using a heavily bureaucratic management system, which relies on soldiers, sailors, marines and airmen to offer themselves with unquestioned devotion to duty. The individual commitment was taken for granted during their tours of duty. Unfortunately, that commitment has not been reciprocated. A massive federal bureaucracy, the only management style known to our government, obviously does not lend itself to providing quality individual health care. Instead it promotes an impersonal, irresponsible and highly contagious virus that is obviously rampant in the VA, or at least it was when I was there. Rest assured that same virus will rapidly infect all of American health care, as it falls under growing government controls.
Photo by Julie70