It's Time To Put Up Or Step Down At The Veterans Administration
By Rick Weidman, Director, Government Relations
This fall, VVA's Government Relations Department has spearheaded a multifaceted
effort to inform members of Congress and the Clinton administration about
several serious problems in the Department of Veterans Affairs' managed-care
delivery system. VVA has concentrated its efforts on raising awareness about
destructive and inferior medical services that have resulted in the delivery of
second-rate medicine to veterans. The situation is especially alarming for those
veterans with severe mental disabilities, including those with combat-related
Post-traumatic Stress Disorder, with related substance-abuse disorders, and the
mentally ill homeless.
After an extensive series of meetings with VVA's
national officers, and with enormous input from VVA members, National President
C. George Duggins detailed the organization's concerns in a Sept. 8 letter to
"I would like to express our grave concern over quality-of-care issues within
the medical-delivery system of the Department of Veterans Affairs," Duggins
wrote. "While we have called for reform of this system on numerous occasions,
the delivery of health-care treatment—particularly for those veterans with
chronic health-care problems and special-disability programs—has worsened in
every area of the country."
Duggins called on Dr. Kenneth Kizer, DVA's medical system manager, to
reexamine the department's policies and to take corrective action in the areas
in which the system is failing its veteran clients. "In his attempt to
decentralize DVA's health-care administration, Dr. Kizer has created a
health-care delivery system that is far too concerned with costs, while ignoring
the provision of quality health care for those veterans who rely on DVA,"
Duggins said. "As DVA moves closer and closer to a dollar-driven HMO model, we
at VVA have become increasingly concerned that Dr. Kizer's policies have
resulted in superficial treatment of the least ill, while reducing service to
those veterans with the greatest need."
The Duggins letter pointed out that there have been "dramatic drops in
traditional in-patient treatment" for veterans suffering from PTSD, substance
abuse, and chronic mental illness without any accompanying increased capacity to
provide such treatment in the DVA's outpatient facilities. "We firmly believe,"
Duggins said, "that these decreasing services, and the department's reliance on
inadequate outpatient care, are contributing factors in the serious problem of
increasing homelessness among veterans."
Duggins then reaffirmed VVA Resolution V-l-97, which was adopted at the 1997
National Convention in Kansas City. That resolution states, in part: "the
quality of health care in DVA remains suspect as revelations of questionable
practices and adverse outcomes continue to emerge." DVA, the resolution
continues, "has lost sight of its obligation to provide quality health care as
defined by veterans and their families, opting instead for quality as defined by
health administrators and medical school affiliations." Duggins reminded the
President that VVA believes that the DVA is a "health-care system in crisis," as
far as meeting its obligations to seriously affected veterans.
"It is clear to us," Duggins concluded, "that the responsibility for many of
the current problems lands squarely on the shoulders of DVA's current
leadership." Reminding the President that "health care for our members is a
matter about which [VVA] will not compromise," Duggins asked that the President
"take appropriate action to insure that the delivery of VA health care is second
THE SPECIAL COMMITTEE
In 1996 the VA was directed to set up the Special Committee for Care of Severely
Chronically Mentally Ill Veterans, an advisory group designed to provide
oversight and policy making for severely mentally ill veterans. The committee is
made up of mental-health experts, mostly from within the VA.
An affiliated Consumer Liaison Council advises the special committee,
providing input and evaluations from representatives of veterans service
organizations, other federal health-care-related agencies, and the National
Mental Health Association.
Jacqueline Rector, a VVA national Board member and the co-chair of VVA's
Committee on PTSD and Substance Abuse, is a member of the Consumer Liaison
Council, together with former board member Linda Schwartz. The committee and
council meet several times a year to review and evaluate VA's overall quality of
care and performance in the delivery of mental-health services, and present an
annual report to the VA's under secretary of health.
Several alarming situations came to light during the committee's Sept. 9-11
meeting. Committee members discussed a VA study, which found that only 4 percent
of the severely and chronically mentally ill patients now being treated at VA
facilities are receiving aftercare or are even having their cases managed. Even
more distressing, VA does not know what happens to most of these patients
following their appointments because VA's record-keeping data is either
nonexistent or incorrect.
The study also found a disturbing lack of mental-health treatment at many of
the VA's community-based outpatient clinics, especially in rural areas.
Moreover, there are no alternatives in the private-sector managed care for the
delivery of these special-needs programs.
Also at the September meeting, Dr. Tom Horvath, the VA's chief of Mental
Health, Strategic Planning Group, announced that he will be leaving that job. As
the top mental-health doctor at the VA, Horvath has been and remains a strong
and steady advocate within the administration for protecting programs that deal
with mental illness, PTSD, substance abuse, and homelessness. He has proven to
be—along with Dr. Al Batres—a good friend of VVA.
In giving his reasons for leaving the position, Horvath spoke of the lack of
commitment and support for VA's core mental-health programs and the "ongoing
management and domestic policy disarray" in the agency. Not coincidentally,
those two factors were pointed out by VVA President George C. Duggins in his
Sept. 8 letter to President Clinton on the subject of the decline in VA health
care for severely mentally ill veterans.
With the resignation of Dr. Horvath, it is now more important than ever that
VVA monitor VA budget cutting. Our primary goal will be to see that Horvath's
successor does not take steps that would further erode the already poorly
functioning special disability programs. VVA will be working assiduously to
assure that Dr. Horvath's replacement is a strong leader who will continue to
carry out policies that are in the best interests of veterans—as opposed to
those primarily committed to managed care for the VA. Whoever takes over that
position must improve drastically the efficacy and efficiency of mental-health
treatment services offered by the VA's community-based outreach clinics.
ENROLLMENT FOR EVERYONE
On a positive note, the VA has announced that it has greatly simplified the
process for veterans to enroll and apply for VA health-care benefits. The new
program, which is part of the 1996 Veterans Health Care Eligibility Act,
required that veterans be enrolled as of Oct. 1 in order to receive health care
at VA medical facilities nationwide. However, although most veterans must be
enrolled to gain access to care and participate in the plan, there is no
deadline for doing so. The new simplified process requires only the completion
of a one-page application; which can be completed either in person or by mail.
One goal of the new program is to eliminate confusing eligibility criteria to
insure that enrolled veterans receive all needed health care in the proper
setting. The program offers enrolled veterans an array of health-care services.
"VA's goal is to provide the right care, at the right time, in the right
place," says Dr. Thomas L. Garthwaite, VA's acting under secretary for health.
"For the first time, we can offer a complete health-care package to veterans, a
full range of services that includes preventive care to promote, preserve, and
restore good health. Anywhere there is a VA medical presence, in more than 1,100
locations, enrolled veterans will be able to access these services."
All veterans should enroll, the VA says. However, veterans in the following
categories are not required to do so:
To receive an application form, or to get
more information about VA's new comprehensive health-care benefits plan,
veterans should call their nearest VA health-care facility or benefits office.
You also can visit VA's web site, www.va.gov
or call their toll-free number:
- Veterans with a service-connected disability of 50 percent or more
- Veterans seeking care for a service-connected disability only
- Veterans who were discharged from military service within the year who are
seeking care for a disability incurred or aggravated in the line of duty, but
one that VA has not yet evaluated
Once your eligibility is verified, VA will notify you of your enrollment and
you can begin receiving VA health care.
E-mail us at TheVeteran@vva.org