Two years ago, Congress created a new program, the Veteran’s Choice Program, to fix the well-publicized problems facing health services at the Veterans Affairs Administration, known as the VA. These problems ranged from poor care to wait times to see a doctor that were so long a person was likely to end up dead before they could be told why they were dying. Two years later, the program meant to put an end to these issues is experiencing the same problems and may be even worse than it originally was.

How did the VA healthcare system get to this point? Read more to find out how the VA system was originally crafted, and the issues it faced and continues to face as those in charge search for answers.

The VA System

Since the beginning of war, disease–not actual conflict itself–has been the number one killer of soldiers. With that consideration in place, the United States has offered benefits of some kind to veterans going all the way back to the Revolutionary War. While the system is still serving veterans of wars long over, it became more codified in 1930 when President Hoover created the Veterans Administration. At the time of its inception, the system had 54 hospitals, served 4.7 million veterans, and employed 31,600 people. Over the following years, a number of other agencies were created, including the Board of Veterans Appeals in 1933, the Department of Medicine and Surgery in 1946, and the Department of Veterans Benefits in 1953. All of these departments were eventually organized under the singular umbrella of the VA, which was also made a cabinet level department in 1989.

Over the years, the system has grown in size to become a massive department today. Now, the Veterans Health Administration operates with an annual budget of $59 billion. This budget covers a lot; according to the VA, it funds “150 medical centers, nearly 1,400 community-based outpatient clinics, community living centers, Vet Centers and Domiciliaries.” The system also employs over 305,000 health care professionals. On top of this, the VA is the largest Medical training system in the United States, serving the most graduate-level students and contributing greatly to continued medical research and discovery. This includes 76,000 volunteers, 118,000 trainees, and 25,000 faculty.

Overall, this massive system serves over 9 million veterans in the United States. Based on VA guidelines, once enrollment is initiated veterans undergo a means test to see if they are a priority and if they are able to afford the co-pays. Once these steps are completed, veterans then go to see a doctor within 14 days if they are new patients and between 14 and 30 if they are existing members.

Problems with the VA

The issues plaguing the VA primarily center on wait times. This concerns one of the three branches covered by VA system, namely the Veterans Health Administration. The other two primary branches deal with benefits and burials for veterans. The VA scandal involved a variety of issues, but wait times and the difficulty that many veterans have merely accessing medical care garnered most of the public’s attention.

Some veterans have had to wait for longer than 125 days to see a doctor, a stark contrast to the 30 days required by the system. In facilities across the country, there have been allegations that administrators falsified records to make it appear as though patient wait times were not longer than required. It had gotten so bad that some may have even died while waiting; however, due to record keeping issues, we don’t know exactly how many veterans with pending records were actually waiting for care when they died.

These complaints were not isolated to just one or a few places either, locations in Phoenix; Fort Collins, Colorado; Miami; Columbia, South Carolina; and Pittsburgh, to name a few, all reported problems. There were also issues with claims, especially as more Vietnam veterans were included in disability coverage. Claims have no time limit and can be filed at any point. The primary backlog that most are concerned with is not for decisions on claim appeals, but for the initial claim decisions themselves. These issues were severe enough that the head of the VA resigned in 2014 after the extent of the scandal became known.

Two years after the initial reports broke, results are still not much better for the VA system. This year there have again been reports from states about inaccurate wait times, cost overruns, poor care, and refusal to discipline employees despite poor care.

The following video looks at the scandal with the VA system:

The New System and Lingering Issues

In an attempt to solve the problem Congress created the Veteran’s Choice program. At a cost of $10 billion, this program was supposed to put an end to the problems facing the VA system, particularly long wait times to see a doctor. Under the program, eligible veterans are able to get healthcare from nearby medical centers rather than traveling to VA facilities if wait times or distance are an issue. However, instead of helping, the effort has by many measures made things worse. Wait times have actually increased under the new program, though, according to the VA that is in part because so many veterans are trying to use it. In some places, veterans were never referred to the program or the doctor they were designated to see was too far away.

Based on the system’s structure, the patient had to be the one to initiate appointments, not the provider. However, that wasn’t entirely clear for everyone involved and many veterans were left waiting for calls to schedule appointments. And even in cases where veterans are able to schedule an appointment and see a doctor, the Choice Program has a long backlog of payments that prevents doctors from being paid on time. Doctors have reportedly waited for 90 to 180 days after a long claims process to simply get paid for their services. The situation got so bad that thousands of veterans referred to the new program actually ended up going back to the traditional VA system because it was more efficient.

Why Isn’t it Working?

So how has the new system that was meant to address these problems only exacerbated them in many cases? The answer starts with how the program was set up in the first place. The program’s basic tenet was to give veterans care faster and closer to home, specifically, this meant that if patients had to wait more than a month to make an appointment or drive over 40 miles to the nearest VA facility, they would be eligible. But the system has largely failed to live up to those promises largely because of how quickly the program was created and implemented.

Namely, once Congress approved funding and the president signed the Choice Program into law, the VA was only given 90 days to implement it. This was a program that would affect millions of veterans, hundreds of thousands of medical care professionals, and the families of both. The deadline was so short, in fact, that the VA quickly excluded itself from the process because it knew it would be unable to meet the requirements. This forced the agency to look to the private industry. However, most companies in the private industry were also turned off by the 90-day timeline.  While the VA was ultimately able to settle on two organizations, they have been scrambling to build the requisite network of health care professionals and still rely on the VA for referrals leading to the delays. The system proved to be too complicated and difficult to use for everyone involved, from veterans to doctors and VA administrators.

The accompanying video looks at the problems with the Choice Program:

Conclusion

When the true reality of the VA scandal broke two years ago, everybody agreed that the system was broken and needed to be fixed, fast. However, this is not the type of system that can be repaired and streamlined in just a few months. Unsurprisingly, the quick fix has turned into a disaster in need of a fix of its own. So what is the appropriate action moving forward?

Some have called for a total dismantling of the VA healthcare system as it is known today. Instead of providing care directly to veterans, the new system would simply pay for their care. However, critics are quick to denounce a system that would leave veterans to their own devices. It does seem unlikely an organization as sprawling as the VA will be torn down completely. Consequently, more internal reforms are likely. While the situation is in dire need of a solution, new fixes should not be rushed. Lawmakers will need to create a system that works well and gives veterans the care they need when they need it.

Resources

NPR: How Congress and The VA Left Many Veterans Without A ‘Choice’

NPR: For The VA’s Broken Health System, The Fix Needs A Fix

U.S. Department of Veterans Affairs: 10 Things to Know About the Choice Program

House Committee on Veterans’ Affairs: History and Jurisdiction

U.S. Department of Veterans Affairs: Veterans Health Administration

The Washington Post: Everything You Need to Know About the VA–and the Scandals Engulfing it

The Washington Times: VA Still Plagued by Problems Two Years After Scandal

The Military Advantage Blog: Care Commission Shocker: The Push to End VA Healthcare

Michael Sliwinski

Michael Sliwinski (@MoneyMike4289) is a 2011 graduate of Ohio University in Athens with a Bachelor’s in History, as well as a 2014 graduate of the University of Georgia with a Master’s in International Policy. In his free time he enjoys writing, reading, and outdoor activites, particularly basketball. Contact Michael at staff@LawStreetMedia.com.

The post Did the Program Meant to Rescue the VA Healthcare System Make it Worse? appeared first on Law Street.

Picture this: you wake up in the middle of the night with insane abdominal pain and call 911 to be rushed to the hospital immediately. Once you get there, the doctors decide you are suffering from acute appendicitis and you have to quickly be prepared for an emergency surgery to remove your appendix. Before you’re put under anesthesia, you notice the nurse prepping you is stumbling around, tripping over chords, and is seemingly having a hard time doing average tasks. Worried yet?

This exact scenario unfolded earlier this month at the Wilkes-Barre VA Medical Center, for which a nurse has been charged with reckless endangerment of a patient’s safety, driving under the influence, and public intoxication for showing up to work and then proceeding to work on an appendectomy while drunk.

The story, according to the drunk nurse, Richard Pieri, was that he had forgotten that he was on call at the hospital on February 4 until he received a call around midnight telling him to come into work on an emergency surgery. At that point, Pieri was already four or five beers deep at a local casino, but still decided it would be better to drive while intoxicated to the hospital and work on this surgery than it would be to acknowledge his mistake. In court documents, Pieri acknowledged that he just didn’t want someone else to have to come in while he was supposed to be on call. That is why he decided drunk surgery was a good plan–a great reminder to us all that alcohol can seriously inhibit good decision-making skills. Authorities later visited Piere and asked him if he knew why they were there to chat with him, Pieri nonchalantly responded, “I guess it has something to do with me being drunk on call.”

The Department of Veterans Affairs sent a statement to the Washington Post noting that it will not tolerate behavior like this, especially since it can put veterans who are coming in for care at serious risk. The VA is currently working on reinforcing its guidelines for staff and ensuring that an incident like this never happens again. Pieri’s affidavit notes that he was tasked with prep work that was legitimately important:

[He] was responsible for preparing the patient, retrieving the patient, preparing the materials inside the room, documenting the surgery, and monitoring the vitals of the patient throughout recovery.

In addition, the affidavit pointed out that the operating room, in general, can be dangerous if someone is intoxicated:

[The operating room] is filled with complicated equipment that Pieri needs to operate and has several loose wires and cords that can be tripped on or disconnected by somebody with an inability to properly ambulate themselves.

While details about the patient have not yet been released, reports indicate that he or she was readmitted to the hospital after the surgery for complaints of stomach pains. There is no evidence to suggest that this readmission has anything to do with Pieri’s drunkenness–thank goodness–but he was promptly removed from patient care responsibilities after this incident.

While this story turned out alright (for the most part), it’s a sobering reminder to us all that alcohol can have serious consequences in certain situations. Just because you think you’re alright to drive home, make a large purchase, or even perform a serious medical procedure, doesn’t mean you are. So, think carefully about when and where you drink and make responsible decisions everyone, because no one wants to be that guy who was jokingly asked, “Rick, are you drunk?” after he stumbled into work.

Alexandra Simone

Alex Simone is an Editorial Senior Fellow at Law Street and a student at The George Washington University, studying Political Science. She is passionate about law and government, but also enjoys the finer things in life like watching crime dramas and enjoying a nice DC brunch. Contact Alex at ASimone@LawStreetmedia.com

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For the majority of my life, war has been the norm in the United States. We entered Afghanistan in 2001 and Iraq in 2003. War is the new normal–and between 2004-2011 war was, as expected, mostly the leading cause of death for troops in the U.S. military. But for the last two years, that trend did not hold true. Suicide has surpassed war as the number one killer of American troops.

Suicide is also incredibly prevalent among veterans. According to a report released by the Department of Veterans Affairs, 22 veterans take their own lives every day. Given the way the VA collects that information it’s speculated that that number could be even higher. To put this in context, roughly 20 percent of suicides in the United States are committed by veterans, even though they make up just 10 percent of the population. That’s a startling and terrifying figure; as News21 put it:

Suicide rates within the veteran population often were double and sometimes triple the civilian suicide rate in several states. Arizona’s 2011 veteran suicide rate was 43.9 per 100,000 people, nearly tripling the civilian suicide rate of 14.4, according to the latest numbers from the state health department.

Now, the civilian suicide rate has also been rising. According to the New Yorker:

In the United States, suicide rates have risen, particularly among middle-aged people: between 1999 and 2010, the number of Americans between the ages of thirty-five and sixty-four who took their own lives rose by almost thirty percent.

Suicide is a gigantic issue among both our troops and our veterans. The ways in which we understand Post Traumatic Stress Disorder and the effects of war continue to evolve, but clearly we haven’t done enough. See the infographic below for just some of the ways in which veterans’ and active service peoples’ duties can affect them.

Courtesy of Blackwater Law.

PTSD is tricky because it can show up suddenly or gradually, sometimes a long time after the traumatic event. In addition, medical care for veterans hasn’t always been as top notch as it could be–we all remember the VA hospital scandals earlier this year. PTSD can fuel depression, alcoholism, and various other problems. There are other reasons that veterans and service members are at particular risk. For some, reacclimating to civilian life can be very difficult. While there’s no dispositive list of risk factors, it’s clear from statistics alone that this is a significant problem.

The argument that the suicide rate will go down once we’re fully out of Afghanistan and Iraq seems like it should make sense, but it’s not that simple. Even while those wars have been slowly de-escalated, suicide rates have remained pretty constant. That ties back to the fact that PTSD can develop over time along with those struggles that veterans face when they return. A troubling portion of our nation’s veterans become homeless, which makes getting them access to health care and help even more difficult. After all, since 2010, there has been a thirty-three percent increase in homeless veterans.

The fact is that anyone who is a member of our military forces–or former member–deserves the utmost respect, help, and care. But that simply isn’t happening–and until I started looking up these statistics today I didn’t quite realize how much we are failing them. Something has to change–and it starts with awareness.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

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